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Duwtjes of druk?

De percepties van zorgprofessionals aangaande ‘nudging’ in ziekenhuizen

Tijdschrift Bestuurskunde, Aflevering 4 2020
Trefwoorden nudging, ethics, autonomy, healthcare, professionals
Auteurs Nienke Maria Huis in ’t Veld MSc, Rosanna Nagtegaal MSc en Prof. dr. Mirko Noordegraaf
SamenvattingAuteursinformatie

    ‘Nudging’ has been introduced as a policy and management tool as a way to influence behaviour without limiting choice. Nudging is mainly used to influence citizens’ behaviour but can also be used to influence the behavior of healthcare professionals. Examples include posters used to improve hand-hygiene compliance, or ‘default’ options in systems to reduce excessive prescriptions of specific medication. However, using nudges raises major worries and ethical issues, also in relation to the independence of healthcare professionals. While the scientific discussion about the desirability of nudges is extensive, the voices of healthcare professionals, who are the subjects of nudges, remain unheard. In this qualitative research we explore the perceptions of nudging held by various healthcare professionals. The interviews reveal that healthcare professionals are generally unfamiliar with the concept of nudging, but they do recognize nudges in their own field of practice. Furthermore, while they are predominantly positive about nudging, they also express concerns about the pressure on their autonomy. These concerns are related to changing professionalism and regulatory pressures in healthcare.


Nienke Maria Huis in ’t Veld MSc
N.M. Huis in ’t Veld, MSc is alumna aan de Universiteit Utrecht, departement Bestuurs- en Organisatiewetenschap.

Rosanna Nagtegaal MSc
R. Nagtegaal, MSc is promovenda aan de Universiteit Utrecht, departement Bestuurs- en Organisatiewetenschap.

Prof. dr. Mirko Noordegraaf
Prof. dr. M. Noordegraaf is hoogleraar Publiek Management aan de Universiteit Utrecht, departement Bestuurs- en Organisatiewetenschap.
Artikel

Access_open Nudging in perspectief

De verbreding van gedragsinzichten in beleid

Tijdschrift Beleidsonderzoek Online, juni 2020
Auteurs Pieter Raymaekers en Marleen Brans
SamenvattingAuteursinformatie

    Theorieën en methoden uit de gedragswetenschappen betreden steeds nadrukkelijker de beleidsscene. Gedragsinzichten en nudging beloven beleid te verrijken en te versterken. Het begin van deze gedragswetenschappelijke omslag of behavioural turn laat men doorgaans samenvallen met de publicatie van het boek Nudge van Richard Thaler en Cass Sunstein in 2008. In dit artikel plaatsen we nudging in perspectief en argumenteren we dat het concept zowel een zegen als een vloek betekent, en zowel een katalysator als een rem is voor de bredere toepassing en verankering van gedragsinzichten in beleid. Ondanks het aantrekkelijke narratief botst nudging op functionele limieten en ethische bezwaren. Om de gedragswetenschappelijke, experimentele en evidence-based beleidsbeloften alsnog in te lossen, zien we een strategie van steeds verdere verbreding. Het programma van de Behavioural Insights-beweging op basis van vijf pijlers leek in eerste instantie een oplossing te bieden, maar kampt door een eendimensionale interpretatie met interne spanningen. De nog bredere en ambitieuzere Behavioural Public Policy-agenda biedt nieuwe perspectieven, maar moet op functioneel en ethisch vlak nog verder onderbouwd worden.


Pieter Raymaekers
Pieter Raymaekers is onderzoeker en vormingscoördinator bij het KU Leuven Instituut voor de Overheid. Zijn onderzoek focust op de toepassing van gedragsinzichten en nudging in beleid.

Marleen Brans
Marleen Brans is gewoon hoogleraar aan het KU Leuven Instituut voor de Overheid en schatbewaarder van de International Public Policy Association. Ze verricht voornamelijk onderzoek over de productie en consumptie van beleidsadvies.
Article

Deliberation Out of the Laboratory into Democracy

Quasi-Experimental Research on Deliberative Opinions in Antwerp’s Participatory Budgeting

Tijdschrift Politics of the Low Countries, Aflevering 1 2020
Trefwoorden Deliberative democracy, mini-publics, participatory budget, social learning, deliberative opinions
Auteurs Thibaut Renson
SamenvattingAuteursinformatie

    The theoretical assumptions of deliberative democracy are increasingly embraced by policymakers investing in local practices, while the empirical verifications are often not on an equal footing. One such assertion concerns the stimulus of social learning among participants of civic democratic deliberation. Through the use of pre-test/post-test panel data, it is tested whether participation in mini-publics stimulates the cognitive and attitudinal indicators of social learning. The main contribution of this work lies in the choice of matching this quasi-experimental set-up with a natural design. This study explores social learning across deliberation through which local policymakers invite their citizens to participate in actual policymaking. This analysis on the District of Antwerp’s participatory budgeting demonstrates stronger social learning in real-world policymaking. These results inform a richer theory on the impacts of deliberation, as well as better use of limited resources for local (participatory) policymaking.


Thibaut Renson
Thibaut Renson is, inspired by the 2008 Obama campaign, educated as a Political Scientist (Ma EU Studies, Ghent University) and Political Philosopher (Ma Global Ethics and Human Values, King’s College London). Landed back at the Ghentian Centre for Local Politics to do empirical research. Driven by the moral importance of social learning (vs. political consumerism) in democracy, exploring the empirical instrumentality of deliberation.

    Information platforms can facilitate data sharing and make new applications possible. It is essential to connect a wide range of both public and private parties to a platform if real data-based transformation is to get off the ground. However, organizations are reluctant to share data if they do not know exactly what it can be used for or if they have no direct interest in it. Achieving a good solution requires a lot from the innovation process itself and the way it is managed. This article uses three innovation perspectives for the analysis of a logistics information platform. This analysis shows that different stages in the development of an information platform can be distinguished, each with its own dynamic. For local government the involvement of and connection to local parties is important, while innovation as a whole benefits from the link with an overarching agenda that transcends the local level.


Prof. dr. Bram Klievink
Prof. dr. ing. A.J. Klievink is hoogleraar Bestuurskunde aan de Universiteit Leiden, met een speciale focus op digitalisering en publiek beleid.
Artikel

Over zelfredzame burgers gesproken

Hoe ambtenaren een buigzaam burgerschapsideaal vormgeven

Tijdschrift Beleid en Maatschappij, Aflevering 4 2019
Trefwoorden Interactional framing, Self reliance, Silent ideologies, Micro frames, Self referentiality
Auteurs Drs. Harrie van Rooij, Dr. Margit van Wessel en Prof. dr. Noelle Aarts
SamenvattingAuteursinformatie

    The concept of self-reliant citizens reflects an ideology of citizenship that is multiple and flexible. It could be regarded as a ‘plastic’ word, malleable and adjustable according to convictions, needs and purposes. This study shows the importance of considering the way in which ideological views on citizenship are transferred, adjusted and enacted in an organizational context. On the basis of a case study at the Dutch Tax and Customs Administration (DTCA), we contribute to knowledge on the way processes of framing interrelate on micro, meso and macro levels. We found that frames on self-reliance are enacted in a way that tensions and dilemmas are neutralized or reduced. In a dynamic context of conflicting goals and limited resources, DTCA-employees create meanings of self-reliance which legitimate practices and policies. By doing this they reproduce both organizational and social perspectives. Accounts of citizenship play an important role in this process. Self-reliant citizens are presented as active and responsible. The need of help is imagined as a normal and yet an atypical situation. This study promotes attention to the possibility that organizational systems reproduce perspectives in a way that alternative views remain unnoticed, whereas organizational choices are silently accepted as natural facts.


Drs. Harrie van Rooij
Drs. Harrie van Rooij is PhD-kandidaat (buitenpromovendus) bij het Institute for Science in Society (ISiS), Radboud University, en coördinerend adviseur corporate communicatie bij het ministerie van Financiën.

Dr. Margit van Wessel
Dr. Margit van Wessel is universitair docent, leerstoel Strategische Communicatie aan de Wageningen University & Research.

Prof. dr. Noelle Aarts
Prof. dr. Aarts is professor Socio-Ecological Interactions aan het Institute for Science in Society (ISiS), Radboud University.
Kroniek

Makkelijker kunnen we het wel maken, beter voorlopig niet

Wat de Belastingdienst kan leren van institutionele crisistheorie

Tijdschrift Bestuurskunde, Aflevering 3 2019
Auteurs Prof. mr. dr. Stavros Zouridis en Vera Leijtens LLB MSc

Prof. mr. dr. Stavros Zouridis

Vera Leijtens LLB MSc
Article

Fiscal Consolidation in Federal Belgium

Collective Action Problem and Solutions

Tijdschrift Politics of the Low Countries, Aflevering 2 2019
Trefwoorden fiscal consolidation, fiscal policy, federalism, intergovernmental relations, High Council of Finance
Auteurs Johanna Schnabel
SamenvattingAuteursinformatie

    Fiscal consolidation confronts federal states with a collective action problem, especially in federations with a tightly coupled fiscal regime such as Belgium. However, the Belgian federation has successfully solved this collective action problem even though it lacks the political institutions that the literature on dynamic federalism has identified as the main mechanisms through which federal states achieve cooperation across levels of government. This article argues that the regionalization of the party system, on the one hand, and the rationalization of the deficit problem by the High Council of Finance, on the other, are crucial to understand how Belgium was able to solve the collective action problem despite its tightly coupled fiscal regime and particularly high levels of deficits and debts. The article thus emphasizes the importance of compromise and consensus in reducing deficits and debts in federal states.


Johanna Schnabel
School of Politics and International Relations, University of Kent, Rutherford College, Canterbury CT2 7NX, United Kingdom.
Thema-artikel ‘Uitgesproken Bestuurskunde’

Europese regelgeving: meer dan de som der delen?

Tijdschrift Bestuurskunde, Aflevering 2 2019
Trefwoorden European Union, EU legislation, evaluation, implementation, European administrative networks
Auteurs Prof. dr. Ellen Mastenbroek
Samenvatting

    Evaluations of EU legislation can fulfill a key role in the European policy process. They can provide the knowledge base required for political accountability towards the electorate, and form a basis for the improvement of existing legislation. This article introduces a research agenda in the realm of the ex-post evaluation of EU legislation, which comprises two research lines. The first strand comprises research into ex post legislative evaluations conducted by the European Commission. This research is innovative, because EU policy researchers so far have barely touched upon evaluation, as a final and important stage in the EU policy cycle. By assessing evaluation critically, we can ascertain to what extent the EU’s ex-post evaluation system is more than an instrument, aimed at increasing the EU’s legitimacy. The second research strand is own evaluation research, focusing on the role of European administrative networks- intergovernmental structures that have been established to improve the implementation of EU legislation by the member states. By critically evaluating the functioning and effectiveness of these networks, I hope to be able to find out whether and under what conditions these network structures are more, than the sum of their national parts.


Prof. dr. Ellen Mastenbroek
Thema-artikel ‘Uitgesproken Bestuurskunde’

Gedragen gedragsverandering

Tijdschrift Bestuurskunde, Aflevering 2 2019
Trefwoorden public administration, public management, psychology, behavioral public administration, behavior change, design science
Auteurs Prof. dr. Lars Tummers
Samenvatting

    Changing behavior is often necessary to tackle societal problems. Governments can change behavior via economic incentives (such as subsidies for electric cars), bans/mandates (such as prison sentences for drug smuggling), communication (for example information campaigns) and nudges (for example, being a donor by default). However, the government should not be a manipulator that applies the latest behavioral tricks without societal support. Public administration research shows that support cannot be taken for granted. If there is no support for behavioral change, well-intended interventions can even be counterproductive. I therefore develop a model for supported behavioral change. I provide five criteria that indicate when there is supported behavioral change: if the behavioral change is both effective (1) and efficient (2), and when there is support for behavioral change among politicians (3), among implementing organizations (4), and among citizens (5).


Prof. dr. Lars Tummers
Thema-artikel

Voortvarend in verbouwen

Hoe Denemarken efficiënt drastische beleidswijzigingen realiseert (maar niet per se heel effectief blijkt)

Tijdschrift Bestuurskunde, Aflevering 1 2019
Trefwoorden Comparative public administration, Public reform, Reform implementation, Decentralisation, Civil service
Auteurs Eline van Schaik MSc
Samenvatting

    In international comparative research, a dominant image often emerges of Denmark as a frontrunner in innovative governance, gaining top results in international rankings.
    Based on four recent examples of national public reforms, this article studies the dynamics of reform implementation in Denmark, which can be characterised as expeditious and efficient. Three explanatory factors are discussed: a political, systemic and managerial factor. What is Denmark, a country in many ways similar to the Netherlands, doing differently? The article concludes that, for the Netherlands, the guiding element of Danish public reforms can be found not in the results of these reforms, but in the efficiency with which they are implemented.


Eline van Schaik MSc
Artikel

Slimme handhaving in de sociale zekerheid

Lessen uit een landelijke enquête onder uitkeringsgerechtigden

Tijdschrift Beleid en Maatschappij, Aflevering 4 2018
Trefwoorden Regulatory enforcement, Social security, Compliance, Motivational postures, Procedural justice
Auteurs Dr. Marc Hertogh en Dr. Willem Bantema
SamenvattingAuteursinformatie

    Using survey data from 1,300 welfare recipients in the Netherlands, this paper explores the effects of different enforcement styles in the field of social security law. Although most policy debates focus on punitive and persuasive enforcement, our findings suggest that both styles only play a limited role in explaining regulatory compliance. Our study also shows that the level of compliance among welfare recipients is related to their ‘motivational postures’ (Braithwaite 2003; 2009; 2011). While some of these ‘postures’ are shaped by elements of procedural justice, others are related to the perceived legitimacy of laws or to instrumental motives. Given these findings, we suggest that compliance with social security laws may not only depend on punitive or persuasive enforcement, but also on the degree in which regulatory enforcement is attuned to the individual characteristics of welfare recipients. Finally, these ideas are translated into several practical suggestions for the ‘smart enforcement’ of social security law.


Dr. Marc Hertogh
Prof. dr. M.L.M. Hertogh is Hoogleraar rechtssociologie aan de Rijksuniversiteit Groningen.

Dr. Willem Bantema
Dr. W. Bantema is Senior onderzoeker bij de Onderzoeksgroep Cybersafety aan de NHL Stenden Hogeschool Leeuwarden

Dr. Rik Reussing
Dr. G.H. Reussing is onderwijscoördinator van de joint degree Public Governance across Borders aan de Universiteit Twente en redactiesecretaris van Bestuurswetenschappen.

Sedef Turper
Artikel

De digitale kooi: administratieve uitsluiting door informatiearchitectuur in de Basisregistratie Personen

Tijdschrift Beleid en Maatschappij, Aflevering 1 2018
Trefwoorden Bureaucracy, Iron cage, Civil registry, ICT, Public services
Auteurs Dr. Rik Peeters en Dr. Arjan Widlak
SamenvattingAuteursinformatie

    The Dutch Municipal Personal Records Database is an IT-innovation that enables the use of the civil registry by hundreds of (semi-)public organisations. Literature review and a case study show how this ‘basis registration’ creates a deep tension between system and lifeworld: citizens who do not fit the system’s criteria lose their access to the major part of public services. The instrumental rationality of the system simplifies the use of addresses for service delivery to one single definition, turns the consequences of address mutations into a black box, and reduces the discretionary space of street-level bureaucrats to handle with social complexities and unintended consequences of the system. This type of IT-innovations can, therefore, come to resemble a ‘digital cage’: a highly disciplining system that hinges on hardware and software design instead of Weberian rules and procedures.


Dr. Rik Peeters
Dr. Rik Peeters is professor en onderzoeker bij de afdeling bestuurskunde van CIDE in Mexico-Stad en directeur van de Brigada Kafka Foundation in Mexico.

Dr. Arjan Widlak
Arjan Widlak is directeur van de Stichting Kafkabrigade in Nederland.
Artikel

Verkeer als stelsel met stelselverantwoordelijkheid voor veiligheid?

Naar een moderne governance opvatting van ‘co-responsibility’ bij stelsels

Tijdschrift Bestuurskunde, Aflevering 1 2018
Trefwoorden traffic safety, systems approach, governance, co-responsibility
Auteurs Dr. mr. Dick Ruimschotel
Samenvatting

    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.


Dr. mr. Dick Ruimschotel
Essay

Access_open Beleidsevaluaties: meer dan een ritueel!

Tijdschrift Beleidsonderzoek Online, september 2017
Auteurs Frans de Haan en Jan-Maarten van Sonsbeek
SamenvattingAuteursinformatie

    Dit essay is een reactie vanuit het ministerie van Sociale Zaken en Werkgelegenheid op de column ‘Beleidsevaluatie als ritueel’ van Peter van Hoesel (BO januari 2017).


Frans de Haan
Frans de Haan is als onderzoekscoördinator werkzaam bij het ministerie van Sociale Zaken en Werkgelegenheid.

Jan-Maarten van Sonsbeek
Jan-Maarten van Sonsbeek is als Chief Science Officer werkzaam bij het ministerie van Sociale Zaken en Werkgelegenheid.

    Nationaal en internationaal staat onderzoek dat maatschappelijk relevant is, wetenschappelijk gezien hoge kwaliteit heeft, en zowel integer als efficiënt wordt uitgevoerd in de schijnwerpers. Het achterliggende idee is dat alleen zo de gewenste maatschappelijke impact kan worden bereikt. Door het bevorderen van verantwoorde onderzoekspraktijken, waarbij er onder andere expliciet aandacht is voor aspecten als stakeholderparticipatie, interdisciplinaire samenwerking, replicatie en systematische reviews, kunnen financiers of programmeurs van onderzoek hieraan bijdragen. In dit artikel wordt een overzicht gegeven van de wijze waarop ZonMw dat doet als kennisprogrammeur op het gebied van het gezondheidsonderzoek. Hiertoe is een toetsingskader ontwikkeld en toegepast op zestien lopende onderzoeksprogramma’s, dat ook voor andere domeinen en actoren betekenis heeft. Een belangrijke aanbeveling is dat ‘verantwoord programmeren’ een eigen kennisbasis behoeft om de toegevoegde waarde ervan te kunnen bepalen. Naast investeringen in metaonderzoek vraagt dat om een goede monitoring en informatievoorziening bij de kennisprogrammeur.


Wendy Reijmerink
Wendy Reijmerink is stafmedewerker Strategie en Innovatie bij ZonMw. Zij werkt aan een promotie over de maatschappelijke impact van publieke kennisprogrammering.

Wija Oortwijn
Wija Oortwijn is sectorleider Zorg bij Ecorys. Zij heeft jarenlange ervaring met evaluaties van beleid en onderzoeksprogramma’s alsmede impactanalyses op het terrein van de zorg.
Artikel

Welvaart gemeten, verdeeld en verduurzaamd

Tijdschrift Beleid en Maatschappij, Aflevering 4 2016
Trefwoorden Welfare economics, Asymmetrical information, Situational contracting, Political theory, Behaviourism
Auteurs Prof. dr. Dik Wolfson
SamenvattingAuteursinformatie

    This paper shows how interactive governance can be helpful in dealing with information asymmetries in the design and administration of public policy. It describes the checks and balances of a properly incentivized mechanism design of contextual or situational contracting that reveals information on diversity in demand for public intervention, deals with complexity, creates commitment to the public cause and disciplines uncooperative behavior. The contractual mode, moreover, discloses the actual trade-offs between rivalling criteria of good governance such as individual freedom, efficiency, distributional concerns and sustainability, deepening our insight in who gets – or pays for – what, when, where, how and why, as the key issues of policy analysis. Evidence from early applications is combined with suggestions for rolling out this new mode of relinking public policy, implementation and external control.


Prof. dr. Dik Wolfson
Prof. dr. Dik Wolfson is emeritus hoogleraar economie, en geniet gastvrijheid bij de afdeling Bestuurskunde en sociologie van de Erasmus Universiteit Rotterdam.
Artikel

Beleid voor de irrationele mens

Hoe gedragswetenschap de bestuurskunde zou kunnen versterken

Tijdschrift Bestuurskunde, Aflevering 3 2016
Trefwoorden public administration, psychology, decisions, (ir)rationality
Auteurs Dr. Marijke van Putten, Prof. dr. Wilco van Dijk en Prof. dr. Eric van Dijk
Samenvatting

    Policy is often based on the assumption that people are rational decision makers. Rational decision makers search all relevant information before they make a decision. They list the pros and cons of relevant options and make a well thought choice that best fits their fixed preferences. However, research from amongst others psychology and behavioral economics shows that people decide differently and that they are irrational, emotional decision makers instead. Policy therefore fits people’s decision making strategies worse than expected. It is important for policy makers to gain insight into situational influences on decisions and the influence of the so-called choice architecture on decisions. In this article we discuss research that tested when policy was more efficient, based on behavioral insights and the view of man as an irrational, emotional being.


Dr. Marijke van Putten

Prof. dr. Wilco van Dijk

Prof. dr. Eric van Dijk
Artikel

Waarom zorgorganisaties in Nederland fuseren

Tijdschrift Bestuurskunde, Aflevering 3 2016
Trefwoorden merger motives, healthcare executives, health policy, healthcare reform, healthcare mergers
Auteurs Dr. Jeroen Postma en Anne-Fleur Roos MSc.
Samenvatting

    In many OECD countries, healthcare sectors have become increasingly concentrated as a result of mergers. However, detailed empirical insight into why healthcare providers merge is lacking. Also, we know little about the influence of national healthcare policies on mergers. We fill this gap in our knowledge by analyzing the results of a survey study among Dutch executives about mergers between healthcare organizations in the period from 2005 to 2012. During this period, Dutch healthcare providers faced a number of policy changes, including increased competition, more pressure from purchasers (health insurers), growing financial risks, de-institutionalization of long-term care and decentralization of healthcare services to municipalities. Our study shows that Dutch healthcare providers predominantly merge to improve the provision of healthcare services and to strengthen their market position. Efficiency and financial reasons are also important drivers of merger activity in healthcare. Motives for mergers seem to be related to changes in health policy, in particular to the increasing pressure from competitors, insurers and municipalities.


Dr. Jeroen Postma

Anne-Fleur Roos MSc.
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