Zoekresultaat: 5 artikelen

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Artikel

Rebellerende zorgprofessionals

Improviseren met regels, passie en verantwoording

Tijdschrift Beleid en Maatschappij, Aflevering 2 2021
Trefwoorden healthcare rebels, administrative burden, quality of care, etnography, accountability
Auteurs Iris Wallenburg, Hester van de Bovenkamp, Anne Marie Weggelaar-Jansen e.a.
SamenvattingAuteursinformatie

    Bureaucracy and ‘red tape’ are seen as a main annoyance in healthcare practice. ‘Rules’ like guidelines and performance indicators would withdraw professionals from their real work, that is, helping patients. However, rules may also improve quality of care if they foster high quality practices. In this research, we explore how healthcare rebels deal with rules in their everyday work: how rebels ignore, engender and bend rules to build new environments for doing good care. Drawing on ethnographic research in three hospitals in the Netherlands (2017-2018), we reveal how rebels build and care for clinical microsystems containing their own clinical unit and related contexts (e.g. pharmaceutical suppliers, ICT companies, primary care) to evoke alternative and situated practices of good care delivery – i.e. focusing on quality of life and person-centred care. Rebels enact mechanisms of decoupling and recoupling to disconnect rules that embark on good care in specific patient situations, and build new routines that foster good care. However, such caring practices are hard to generalize as they often occur ‘under the radar’ and hence remain hardly noticed to the outside world. We argue that through revising accounting processes, and paying more attention to narratives of good care, more convenient quality systems could be found.


Iris Wallenburg
Dr. Iris Wallenburg is universitair hoofddocent, sectie Health Care Governance, Erasmus School of Health Policy & Management aan de Erasmus Universiteit Rotterdam.

Hester van de Bovenkamp
Dr. Hester van de Bovenkamp is universitair hoofddocent, sectie Health Care Governance, Erasmus School of Health Policy & Management aan de Erasmus Universiteit Rotterdam.

Anne Marie Weggelaar-Jansen
Dr. Anne Marie Weggelaar-Jansen, MCM is universitair docent, sectie Health Services Management and Organization, Erasmus School of Health Policy & Management aan de Erasmus Universiteit Rotterdam.

Roland Bal
Prof.dr. Roland Bal is hoogleraar beleid en bestuur van de gezondheidszorg, sectie Health Care Governance, Erasmus School of Health Policy & Management aan de Erasmus Universiteit Rotterdam.
Artikel

Naar bestuursgericht toezicht in de zorg: een zoektocht naar passendheid

Tijdschrift Bestuurskunde, Aflevering 4 2018
Trefwoorden healthcare governance, management-oriented regulation, experimenting, recoupling, reflective regulation
Auteurs Dr. Annemiek Stoopendaal en Dr. Hester van de Bovenkamp
Samenvatting

    In this article, we discuss how regulation of governance in healthcare has been shaped over the past decade. We describe the presuppositions under this movement. Searching and balancing was needed to meet the complexity of care management. This has to do with the fact that the external pressure on the regulator after incidents is high. Due to this pressure, it is necessary to constantly ensure that management-oriented regulation does not narrow to the supervision on the actor with final responsibility. The regulation of good governance requires reflectivity of the inspectors and is aimed at stimulating recoupling between management and shop floors. This requires space for experimentation for both managers and inspectors. To provide this space, we do not only need a political and social debate about the quality of care and its management, but also attention and appreciation for the difficult considerations of organizing care.


Dr. Annemiek Stoopendaal

Dr. Hester van de Bovenkamp

    The often gloomy analyses of democratic representation at the local level are frequently directed at the problems with parties and elections. Direct participation is not a good alternative because only certain people who are already politically active use it. However, with the help of the concept ‘representative claim’ and based on two qualitative case studies of decentralizations in the social domain, the authors show that there are other representative people besides elected politicians. These self-appointed, non-elected representatives may advocate on behalf of vulnerable groups who themselves do not have a strong voice in politics. In addition this study shows that elected representatives, like political parties and local counselors, can strengthen their representative role by: (1) cooperating better with the non-elected representatives, (2) highlighting their representational claims and the basis of these claims, and (3) strengthening their responsiveness towards their support base through authorization and other accountability structures other than elections. In this way the democratic representation in municipalities is reinforced and may be stronger than the often gloomy analyses suggest.


Dr. Hester van de Bovenkamp
Dr. H.M. van de Bovenkamp is universitair hoofddocent aan het instituut Beleid & Management Gezondheidszorg (iBMG) aan de Erasmus Universiteit Rotterdam.

Dr. Hans Vollaard
Dr. J.P. Vollaard is universitair docent Nederlandse en Europese politiek binnen het Instituut Politieke Wetenschap van de Universiteit Leiden.
Artikel

De democratische vertegenwoordiging van cliënten en patiënten bij de decentralisaties

Tijdschrift Beleid en Maatschappij, Aflevering 2 2015
Trefwoorden representative claim, democratic decision making, Decentralization, social and health policies, Municipalities
Auteurs Dr. Hester Van de Bovenkamp en Dr. Hans Vollaard
SamenvattingAuteursinformatie

    Citizen participation is firmly on the agenda of many Western policy makers. Numerous opportunities for individuals to participate in public decision-making have been created. However, few citizens use these opportunities. Those who do are often the highly educated, white, middle and upper classes that also tend to dominate other democratic spaces. Opportunities to become active can increase inequalities in terms of whose voices are heard in public decision-making. This fundamentally challenges the central democratic value of equality. Nevertheless, others can represent the interests of those who remain silent. Using the concept of representative claim this paper explores a variety of forms of representation (electoral, formal non-electoral and informal self-appointed) in the domain of social policy which is currently decentralized in the Netherlands. We conclude that especially informal self-appointed representatives such as medical professionals, churches and patient organizations can potentially play an important role in representing groups who often remain unheard in the public debate. They can therefore play an important role in ensuring the democratic quality of the decentralization process.


Dr. Hester Van de Bovenkamp
Dr. Hester van de Bovenkamp is universitair docent bij het Instituut Beleid en Management Gezondheidszorg van de Erasmus Universiteit Rotterdam.

Dr. Hans Vollaard
Dr. Hans Vollaard is universitair docent Nederlandse en Europese politiek bij het Instituut Politieke Wetenschap van de Universiteit Leiden.
Artikel

Van optimale schaalgrootte naar legitieme schaalgrootte

Een analyse van het publieke debat over schaalgrootte in de zorg

Tijdschrift Bestuurskunde, Aflevering 4 2012
Trefwoorden scale, healthcare organization, legitimacy, values
Auteurs Jeroen Postma, Kim Putters en Hester van de Bovenkamp
SamenvattingAuteursinformatie

    Over the last decades an increasing number of mergers and acquisitions between Dutch healthcare organizations has taken place (up scaling). More recently there is a rise in the numbers of new small-scale healthcare organizations and small-scale care facilities (down scaling in the numbers). The wide variety of scales, each with its pros, cons and (historical) contexts, makes the existence of one optimal scale an illusion. Our research question is: when, and on the basis of which values, is scale of healthcare organizations legitimate? We answer this question by analyzing 650 newspaper articles from fourteen national newspapers. By using theory about legitimacy and values, we argue that five values underlie the public discussion on scale: governance, the human size, quality of care, market power and efficiency. We conclude that achieving legitimate scale involves dealing with those five values, which are not always commensurable and sometimes conflicting. With this article we contribute to the scientific debate about scale and values. We also give recommendations to policy makers and executives that can be used to improve the legitimacy of scale decisions.


Jeroen Postma
J.P. Postma MScBA is adviseur bij BMC AdviesManagement en promovendus aan het instituut Beleid en Management Gezondheidszorg (iBMG) van de Erasmus Universiteit Rotterdam (EUR).

Kim Putters
Prof. dr K. Putters is bijzonder hoogleraar Management van instellingen in de gezondheidszorg aan het iBMG.

Hester van de Bovenkamp
Dr H. van de Bovenkamp is universitair docent aan het iBMG.
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