In this feature authors discuss recent research findings that are of interest to readers of Beleid en Maatschappij.
Systematic research on societal responses to profit in healthcare is scarce. It is a highly complex topic, with many tensions in the public and political debate. In a recent Dutch publication on profit, authors use a ‘lifeworld’ perspective to assess profit in their research, while their assessment could have been different using a ‘system’ perspective. Both perspectives have their merit, and debate on the role of profit in health care should separate the two perspectives. We describe both perspectives and use them to clarify whether making a profit is different from paying that profit to shareholders. We conclude that in healthcare, the general tension between the perspectives can be summarized as ‘profit for one actor may feel – but isn’t always – someone else’s loss’. Recognizing these tensions and searching for a strategy to align interests in which everyone gains may help the current stagnated debate on this issue in the Netherlands.

Alhoewel het gebruik van beleidsevaluaties (of het gebrek eraan) een van de meest besproken thema’s is in de evaluatieliteratuur, berust veel onderzoek over het thema enkel op anekdotisch bewijs, en zijn er nauwelijks studies beschikbaar die aandacht hebben voor de samenhang tussen verschillende factoren die impact kunnen hebben op het gebruik. In voorliggend artikel presenteren we de resultaten van een studie waarin we hebben getracht om op een systematische wijze inzicht te bieden in de combinaties van factoren die instrumenteel gebruik van beleidsevaluaties bevorderen of verhinderen. We onderzochten in dit verband alle evaluaties die in de periode 2013-2016 werden uitgevoerd bij de Inspectie Ontwikkelingssamenwerking en Beleidsevaluatie. Via Qualitative Comparative Analysis (QCA) bekeken we welke combinaties van de volgende factoren als noodzakelijk en/of voldoende bleken voor evaluatiegebruik: (1) politiek gehalte van het onderwerp, (2) interesse van de beleidsmakers, (3) aanwezigheid van nieuwe kennis in de evaluatie, en (4) de timing van de evaluatie.
Voor de praktijk van beleidsmakers en evaluatoren benadrukken we het belang van tijdigheid en interesse voor een evaluatie. Onze analyse laat zien dat professionals die op deze factoren inzetten, een gunstig klimaat creëren voor het gebruik van evaluaties. Wat betreft tijdigheid lijkt het van belang de evaluatie te laten sporen met het schrijfwerk van een beleidsafdeling aan nieuw beleid of grote beleidsveranderingen. Goede anticipatie en een sterke institutionalisering van het evaluatieproces zijn hiertoe cruciaal. Of het thema van de evaluatie een sterke politieke gevoeligheid kent, is minder belangrijk. Mits sprake is van de juiste omgevingscondities, kunnen ook dergelijke evaluaties sterk instrumenteel worden benut.

Incidents in organizations are inevitable. Sometimes these incidents get out of hand and reach the newspapers. But there are also incidents that are addressed in a timely and effective manner and do not escalate to become serious failures. Based on six concrete ‘near misses’ within the education sector, we have investigated how appropriate actions can prevent serious omissions and which mechanisms play a role in this.

Lack of safety leading to death or injury has many aspects: personal violence, traffic, accidents at home or the work place, not to mention other external sources as radiation and fine dust or internal sources like diseases. In this paper we restrict ourselves to the lack of safety in traffic as a system, and address the following questions: (1) Is traffic a system with one dominant responsible actor (Ministry of Traffic)? (2) What explanations are offered for the lack of safety? (3) Who is responsible for safety? (4) What sort of interventions are suitable for enhancing safety? and (5) What type of process/consultancy is most appropriate for answer the preceding questions?
The paper arrives at its conclusions via an indirect way, namely a short analysis of what a system comprises and what constitutes an explanation, responsibility and effectiveness. It appears that we are all causally involved in the lack of safety, and we are all responsible at all levels of society: micro-individual, meso-organizational and macro-societal. Therefore a promising route to maximize safety is a governance perspective comprising multiple stakeholder co-responsibility. It remains to be seen whether this perspective should replace the predominant command and control governance or complement it.

This article analyses a cause for the abundance of disproportional risk policies in the Netherlands. Many policymakers and academics believe that people in the Netherlands today are so risk averse that they are not willing to accept any risk that may result from reasonable risk policies. However, as some examples that we present show, there appears to be another kind of Dutch citizen: a citizen that understands and supports the decision of authorities that increase the risk to citizens but are necessary from the perspective of the common good. We argue that the belief in the unreasonable citizen is informed by one-sided research that only asks citizens how they perceive risks and what they want as risk consumers. Asking the same respondents face-to-face what they would do as policymakers themselves, however, results in diametric answers that show a rational and social side of those respondents. Respondents give higher priority to the education system or traffic safety than to preventing unusual risks such as asbestos or terrorism to themselves. Hence, the justification of reasonable risk policies is not as difficult as generally assumed.

This paper analyses various landmark criminal cases in the Netherlands that saw individual professionals being blamed for allegedly contributing to safety-critical events occurring in the past twenty years. These cases can be seen as symbolizing an increasingly risk-averse society whose expectations of human capacity for securing safety have reached unprecedented levels. In this view, punishing professionals who make dangerous mistakes serves to re-establish the illusion of being in control and to satisfy emotions. In practice, however, the prosecution of professional error appears to be somewhat out of touch with public sentiment, as responses to the cases discussed revealed little public support and a backlash among professionals. Moreover, safety science and practice claim that punishing individual error tends to undermine safety and overemphasizes the role of individual error compared to systemic failures. This begs the question of whether criminal liability should be imposed at the system level, as recently happened when local governments were sentenced following fatalities on dangerous road spots. Sentencing ‘system administrators’ may have advantages, but probably produces negative effects as well. Therefore, it would be ideal if administrators reduced the need for resorting to criminal law by proactively and generously taking responsibility for their organisation’s share in accidents.

Since the start of the 21^st century, most nations have followed the lead of the World Health Organization and developed specific policies to tackle the ‘global obesity epidemic’. The medical reasoning is that non-contagious diseases are the most important causes of mortality and morbidity, especially in prosperous nations. As these diseases are conceptualized as ‘caused’ by ‘unhealthy lifestyle choices’, there is dire need for preventive lifestyle policies that help people make ‘the healthy choice’. Seen from this perspective the distribution of responsibilities between governments and their citizens is made in accordance to the ‘intervention ladder’, which has been developed from a stewardship model.
Regarding the ‘obesity epidemic’, this contribution tests the basic medical claims behind this science policy complex. We find that the knowledge base for these claims is highly uncertain and that interventions lack efficacy. Furthermore, research points to increased levels of stigmatization of ‘fat people’, leading more discrimination. All this changes the status of the policies from preventive (i.e. proportionate) to precautionary (i.e. disproportionate). Further analysis of the preventive medical and policy paradigms shows both are by default biased towards precaution. Combined with the notion that citizens of democratic societies are entitled to trustworthy and transparent information, this contribution concludes that a reorientation of both paradigms is called for.

De digitalisering van de samenleving heeft verschillende gevolgen voor de overheid en overheidsbeleid. Eén daarvan heeft betrekking op de manier waarop beleidsanalyse kan worden gebruikt. In deze bijdrage worden de mogelijkheden van meer adaptieve vormen van beleidsanalyse verkend, waarbij beleidsvoerders stap voor stap en op basis van informatie uit het beleidsproces proberen meer over de beleidsuitvoering te leren. Die vorm van beleidsanalyse, die op een aantal punten afwijkt van eerdere vormen, heeft gevolgen voor de organisatie van de overheid maar ook voor de wijze waarop het toezicht moet worden ingericht. Dat levert interessante vragen en spanningen op voor de ‘digitale’ overheid.

This essay describes how municipal councillors can make the difference in the multiple democracy, in which forms of representative and participative democracy touch upon each other. The essay has three parts. The first part addresses the questions: what do you make politics of, and how do you fill in your role as municipal councillor in this multiple democracy? The second part is about the question: where to steer and control in the local interplay? The final part of the essay discusses what forms there are and at what moments they can be used. The key argument of the authors is that municipal councillors can make the difference by: (a) working on social assignments and connecting to these social assignments the administrative and organizational assignment by setting priorities; (b) being responsible for the whole system (for the community and for the municipality); (c) steering on a democratic process on the basis of clear criteria; (d) ensuring appropriate forms per assignment and per policy phase; and (e) thereby also supervising implementation and management.

The introduction of dualistic administration in the municipal government in the Netherlands in 2002 created the profession of the registrar. This article contains a description of the way Dutch municipal registrars fill in their office nowadays. The research shows that registrars deal with a wide range of tasks, that can be divided in four task fields: secretarial tasks, facilitating, representing and advising councillors. In the filling in of these task fields several profiles of registrars arise. So the basic registrar mainly organizes council meetings and reports on these meetings. The basic registrar plus performs the same tasks, but is also active in a few other task fields. The strategic advisor is the most active on all task fields. There are some significant differences between the three profiles when it comes to the importance of registrars to their activities, their value orientations and their competences. Contextual factors are hardly important, except the size of the municipality. It is also remarkable that the registrar has shown little activity with respect to two developments that are becoming increasingly important for municipal councils: regionalization and socialization of local government.

There is a lot of criticism on the profile descriptions in which Dutch municipalities express the requirements which they put on a new mayor to be appointed. They would look too much like each other and contain few real choices. This article describes the requirements Dutch municipalities put on candidate mayors and analyses the discriminatory power of profile descriptions. A content analysis of 231 profile descriptions and talks with five focus groups show that municipal councils especially ask for integer networkers and linkers, who are above all effective, empathic and communicative. The differences between municipalities in this respect are small and the municipal size hardly makes any difference. Municipal councils do not fully utilize the opportunities in profile descriptions for local customization and barely translate the local conditions into specific requirements. The explanation for this is partly located in isomorphic processes, that lead to uniformity: municipal councils follow the guide of the national government for the appointment process and copy texts from each other. At the same time the office of the mayor in the Netherlands asks for a specific content, that is translated into the profile descriptions. It is therefore the question if the criticism on profile descriptions is fully justified. They do have discriminatory power, although municipal councils could make much sharper choices in what they expect from a mayor, appropriate to the challenges the municipality faces.