Zoekresultaat: 21 artikelen

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Thema-artikel

From National Lockdowns to Herd Immunity: Understanding the Spectrum of Government Responses to COVID-19 (2019-2021)

Tijdschrift Bestuurskunde, Aflevering 3 2021
Trefwoorden COVID-19, Health Policy, Policy Strategies, Policy Capacity, Leadership
Auteurs Michael Howlett
SamenvattingAuteursinformatie

    Governments around the world responded at roughly the same time but in several different ways to the emerging threat of COVID-19 in early 2020. This article sets out the nature of the different strategies that emerged over the course of the pandemic, focussing on the policy tools deployed. Some of these efforts were successful in containing the coronavirus while others were not, in some cases due to poor initial choices and in others due to poor implementation of the chosen strategy. Although the initial understanding each government had of the nature of the disease was the same, different state capacities and different levels of preparedness and effective leadership can be seen to have resulted over time in the emergence of six distinct approaches to the pandemic which, once deployed, proved difficult, although not impossible, to change as the pandemic unfolded.


Michael Howlett
Dr. M. Howlett is professor at the Simon Fraser University in Vancouver, Canada.
Thema-artikel

Tweebenig besturen binnen zorgnetwerken

Besturen tijdens de ‘hamer’ en de ‘dans’ in zorgregio west

Tijdschrift Bestuurskunde, Aflevering 3 2021
Trefwoorden network management, health care managers, innovation, consolidation, health care networks, COVID-19, crisis management
Auteurs Jelmer Schalk, Eduard Schmidt, Suzan van der Pas e.a.
SamenvattingAuteursinformatie

    Crisis management requires health care managers to simultaneously innovate, i.e. to adjust – and to consolidate, i.e. to provide stability. COVID-19 was no exception in this respect. In this study, we ask to what extent multi-actor and multi-level health care networks stimulate or hinder balancing innovation and consolidation. We present the results of a qualitative case study, drawing upon 29 interviews with health care managers in one region in the Netherlands. Our analysis chronologically follows the crisis management response and differentiates between ‘the hammer’ phase (the ‘lockdown’) and the ‘dance’ phase (learning to live with the virus). We show that, especially in the hammer phase, formal networks can contribute to consolidation, yet innovation comes mostly from informal and personal networks. While the hammer phase should help organizations prepare to live and dance with the virus, we show that multi-actor and multi-level networks focus more on idiosyncratic organizational interests, although some of these are in fact productive. We conclude with recommendations for practice.


Jelmer Schalk
Dr. J. Schalk is universitair hoofddocent bij het LUMC.

Eduard Schmidt
Dr. J.E.T. Schmidt is universitair docent bij de Universiteit Leiden.

Suzan van der Pas
Dr. S. van der Pas is universitair hoofddocent bij het LUMC.

Sietse Wieringa
Dr. S. Wieringa is huisarts bij het LUMC.

Sandra Groeneveld
Prof. dr. S.M. Groeneveld is hoogleraar Publiek Management bij de Universiteit Leiden.

Jet Bussemaker
Prof. dr. M. Bussemaker is hoogleraar Wetenschap, beleid en maatschappelijke impact bij het LUMC.
Article

Performing the COVID-19 Crisis in Flemish Populist Radical-Right Discourse

A Case Study of Vlaams Belang’s Coronablunderboek

Tijdschrift Politics of the Low Countries, Aflevering 2 2021
Trefwoorden populism, COVID-19, crisis, discourse
Auteurs Jens Meijen
SamenvattingAuteursinformatie

    In June 2020, the Flemish populist radical right party Vlaams Belang (VB) published the Corona Blunder Book (CBB; Coronablunderboek in Dutch), detailing the government’s mistakes in handling the COVID-19 crisis. Populist parties can ‘perform’ crisis by emphasising the mistakes made by opponents (Moffitt, 2015) and may use a specifically populist discursive style, consisting largely of aggressive and sarcastic language (Brubaker, 2017). This paper takes the CBB as a case study in the populist performance of crisis and the populist style, finding that the book is, first, a clear example of populist ‘everyman’ stylistics and the performance of crisis, and, second, that VB uses the book to shift the COVID-19 crisis from a public health crisis to a crisis of governance, seeking to blame Belgium’s federal structure for the government’s alleged mismanagement of the COVID-19 pandemic and hence arguing for Flemish independence, one of the party’s main agenda points.


Jens Meijen
Jens Meijen is a PhD candidate at Leuven International and European Studies (LINES) at KU Leuven. His research focuses on nationalism, populism, and diplomacy.

Luana Russo
Luana Russo is an assistant professor in quantitative methods at the Faculty of Arts and Social Sciences (FASoS) of Maastricht University. Her research focuses on two main connected branches: political and electoral behaviours and quantitative methods. Her substantive research interests are in comparative politics, electoral and political behaviour, polarization, political participation, electoral geography and quantitative methods. She holds a PhD from Scuola Superiore Sant’Anna (2011).

Min Reuchamps
Min Reuchamps is professor of political science at the Université catholique de Louvain (UCLouvain). His teaching and research interests are federalism and multilevel governance, democracy and its different dimensions, relations between language(s) and politics and, in particular, the role of metaphors, as well as participatory and deliberative methods.
Artikel

Rebel-leren: hoe een rebelse sector tot lerend verantwoorden komt

Tijdschrift Beleid en Maatschappij, Aflevering 2 2021
Trefwoorden quality of care, rebels, accountability, organization/sector learning
Auteurs Annemiek Stoopendaal en Wilma van der Scheer
SamenvattingAuteursinformatie

    Healthcare is often dominated by the curative domain. Yet, for a new way of improving of and accounting for quality of care, we have to shift our focus to the care for people with disabilities. Since long, quality of care is translated into performance indicators and standards. This reductive way of measuring quality was pursued for the entire healthcare sector. Where this might fit in with hospital care, it was experienced as constraining in care for the disabled. In this sector it was seen as a poor representation of the plurality of healthcare provision. A number of ‘quality rebels’ aimed to create a more suitable and rich Quality Framework for the sector, with attention for objective, subjective and intersubjective dimensions of care. In this article, we analyze the way in which the sector has realized this aim, and we show how this rebellious sector succeeded in transforming the idea of accountability for quality of care, by emphasizing on the reflection and learning processes that take place at all levels of the sector, and beyond. A new approach which requires a continuous cycle of disrupting, creating, and maintaining institutionalized patterns of thinking and doing. It requires ‘rebel learning’.


Annemiek Stoopendaal
Dr. Annemiek Stoopendaal is organisatieantropoloog en universitair docent/senior onderzoeker, Erasmus School of Health Policy & Management, sectie Health Care Governance aan de Erasmus Universiteit Rotterdam.

Wilma van der Scheer
Dr. Wilma van der Scheer is gezondheidswetenschapper, directeur van het Erasmus Centrum voor Zorgbestuur en leider van de academische werkplaats zorgbestuur, Erasmus Centrum voor Zorgbestuur aan de Erasmus Universiteit Rotterdam.

Marianne van Bochove
Dr. Marianne van Bochove is universitair docent, sectie Health Care Governance, Erasmus School of Health Policy & Management aan de Erasmus Universiteit Rotterdam en senior onderzoeker aan De Haagse Hogeschool.

Katja Rusinovic
Dr. Katja Rusinovic is lector grootstedelijke ontwikkeling, faculteit Bestuurskunde, Recht & Veiligheid aan De Haagse Hogeschool.

Suzanna Koops-Boelaars
Suzanna Koops-Boelaars, MSc, is promovendus, sectie Health Care Governance, Erasmus School of Health Policy & Management aan de Erasmus Universiteit Rotterdam.
Artikel

Access_open ‘We gaan het gewoon doen!’

Rebelse initiatieven in onderwijs en ouderenhuisvesting

Tijdschrift Beleid en Maatschappij, Aflevering 2 2021
Trefwoorden rebellion, housing for older people, education, rules and regulations, room to manoeuvre
Auteurs Marianne van Bochove, Katja Rusinovic, Suzanna Koops-Boelaars e.a.
SamenvattingAuteursinformatie

    Both education and housing are highly regulated sectors in the Netherlands. According to various stakeholders, regulations and formal and informal rules hinder the development of new initiatives aimed at providing attention to personal needs and wishes of children (in education) and older people (in housing). This article focuses on founders of initiatives in both sectors that, despite institutional obstacles, dare to do things differently. We adopt a rebellion perspective, which focuses on how individual and collective actors aim to create favorable circumstances for providing better services, even if this means they have to disrupt existing institutions. In-depth interviews were conducted with 22 founders of rebellious initiatives in education and housing for older people. According to the founders, what makes them different from others is having a dream, learning by doing, and critically assessing rules and regulations. Founders in both sectors not only interpret rules differently, but also try to change them. In order to do so, they need supportive internal and external contexts, which they create through personal contacts and social media. Although rebellion in both sectors has many similarities, sector-specific institutional settings and past events do shape its appearance.


Marianne van Bochove
Dr. Marianne van Bochove is universitair docent, sectie Health Care Governance, Erasmus School of Health Policy & Management aan de Erasmus Universiteit Rotterdam en senior onderzoeker aan De Haagse Hogeschool.

Katja Rusinovic
Dr. Katja Rusinovic is lector grootstedelijke ontwikkeling, faculteit Bestuurskunde, Recht & Veiligheid aan De Haagse Hogeschool.

Suzanna Koops-Boelaars
Suzanna Koops-Boelaars, MSc, is promovendus, sectie Health Care Governance, Erasmus School of Health Policy & Management aan de Erasmus Universiteit Rotterdam.

Joost van Hoof
Dr. ir. Joost van Hoof is lector urban ageing, faculteit Sociaal Werk & Educatie, aan De Haagse Hogeschool.
Article

Consensus Democracy and Bureaucracy in the Low Countries

Tijdschrift Politics of the Low Countries, Aflevering 1 2019
Trefwoorden consensus democracy, bureaucracy, governance system, Lijphart, policymaking
Auteurs Frits van der Meer, Caspar van den Berg, Charlotte van Dijck e.a.
SamenvattingAuteursinformatie

    Taking Lijphart’s work on consensus democracies as our point of departure, we signal a major shortcoming in Lijphart’s focus being almost exclusively on the political hardware of the state structure, leaving little attention for the administrative and bureaucratic characteristics of governance systems. We propose to expand the Lijphart’s model which overviews structural aspects of the executive and the state with seven additional features of the bureaucratic system. We argue that these features are critical for understanding the processes of policymaking and service delivery. Next, in order to better understand the functioning of the Netherlands and Belgium as consensus democracies, we provide a short analysis of the historical context and current characteristics of the political-administrative systems in both countries.


Frits van der Meer
Frits van der Meer, Professor Institute Public Administration, Leiden University.

Caspar van den Berg
Caspar van den Berg, Campus Fryslân, University of Groningen.

Charlotte van Dijck
Charlotte van Dijck, PhD Fellow Research Foundation Flanders (FWO), KU Leuven Public Governance Institute.

Gerrit Dijkstra
Gerrit Dijkstra, Senior Lecturer, Leiden University.

Trui Steen
Trui Steen, Professor, KU Leuven Public Governance Institute.
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
Artikel

Access_open Van toezicht op kwaliteit naar toezicht op bestuur

Ontwikkeling van bestuursgericht toezicht in semipublieke sectoren

Tijdschrift Bestuurskunde, Aflevering 4 2018
Trefwoorden Inspection, Governance, Semipublic sector, Quality improvement, Opportunities and risks
Auteurs Dr. Meike Bokhorst, Dr. Marieke van Genugten, Dr. Mirjan Oude Vrielink e.a.
Samenvatting

    In Dutch semi-public sectors of education, healthcare, and housing there is a tendency towards governance based inspection. The attention of inspectorates shifts from inspection on minimum quality standards to inspection on governance based quality improvement. The aim of this special issue is to learn more about the opportunities and risks of governance based inspection. The survey and sector articles show that governance based inspection (1) puts the responsibility of governors to stimulate quality on the agenda, (2) makes governors more aware of the quality targets they want to achieve within their organisations, and (3) has a deregulating effect. However, the risks are (1) reregulation via sector norms, (2) a lack of reality checks, and (3) a narrow focus on governors instead of the quality of public services. Consequently, inspectors have to learn new skills and competences. All in all, governance based inspection can complement but not replace other ways of inspection.


Dr. Meike Bokhorst

Dr. Marieke van Genugten

Dr. Mirjan Oude Vrielink

Prof. dr. Thomas Schillemans

    Since 2018, the Department of Public Administration of the Faculty of Behavioural, Management and Social Sciences (BMS) of the University of Twente, in close cooperation with the municipality Zwolle, the Province of Overijssel and BMC advice, have been organizing the yearly Van Poelje lecture (named after administrative scientist and founder of Dutch Public Administration Gerrit van Poelje). The first lecture took place on 29 January 2018 in the ‘Grote Kerk’ in Zwolle. The subject of the lecture was the secret of successful regions: which policy works? Otto Raspe of the Dutch Planning Agency for the Environment delivered the keynote speech. Presentations from the administrative field were given by Henk Jan Meijer (mayor of the municipality Zwolle) and Staf Depla (alderman of the municipality Eindhoven) who respectively addressed the cooperation in the regions Zwolle and South-East Brabant. Bert van Delden responded from the point of view of the Home Office (he deputized for his minister, Kajsa Ollongren). After a short debate, the afternoon was closed by Marcel Boogers (senior advisor at BMC and professor at the University of Twente) with a scientific reflection on the subject of the lecture. The main message of the keynote speaker Otto Raspe was that an urban region is successful if it is able to use its agglomeration advantages. This is possible by seeking connections between clusters and the knowledge infrastructure, and between human capital and a pleasant living and social climate.


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.
Artikel

Herstel en vertrouwen: professionals, ervaringswerkers en de herstelvisie in de Nederlandse geestelijke gezondheidszorg

Tijdschrift Beleid en Maatschappij, Aflevering 3 2018
Trefwoorden Trust, Recovery, Professionals, Peer specialists, Habermas
Auteurs Marijn Kester MSc en Mr. dr. Olivier Lingbeek
SamenvattingAuteursinformatie

    This text wants to draw attention to the question: How do peer specialists build a bridge between the modus operandi of health care professionals and the lifeworld problems of clients receiving mental health care? The Dutch mental healthcare system has recently been host to a range of new developments. Two new trends can be distinguished, going by the name of ‘Recovery-oriented healthcare’ and the introduction of ‘Peer Specialists’. These coincide with changes in budget and organization of treatment. There is an increased awareness of the need for efficiency and cost reduction in the organization of care. The meaning and use of recovery-centered approaches and working with peer specialists remain fairly marginal enterprises due to ever increasing pressure emanating from execution of regulations and administrative procedures, and an accompanying decrease of professional autonomy. In the light of Habermas’ theoretical framework, it is an emphasis on a system-oriented organization of care that cause new approaches to barely be able to find a considerable place in the contemporary practice of mental healthcare in the Netherlands. Trust is identified as an essential foundation on the basis of which future principles of organization should be developed.


Marijn Kester MSc
Marijn Kester MSc is medisch socioloog.

Mr. dr. Olivier Lingbeek
Mr. dr. Olivier Lingbeek heeft een eigen adviesbureau op het gebied van bestuurlijke vraagstukken met betrekking tot planologie en sociologie.
Artikel

Lokale netwerken als instrument voor centraal beleid?

De relativiteit van metagovernance

Tijdschrift Bestuurskunde, Aflevering 2 2018
Trefwoorden metagovernance, Local networks
Auteurs Filip De Rynck, Caroline Temmerman en Joris Voets
Samenvatting

    Collaboration between public actors and social partners is becoming increasingly important as an administrative solution for complex societal challenges in health care, spatial development, mobility management or water management. In this article we focus on the relationship between the central Flemish government and local networks that are set up by this government. In the scientific literature much attention is paid to the concept of metagovernance as analytical perspective to analyze the relationship between the government and networks. The concept offers the government a toolbox with roles and instruments from which it can choose to support and stimulate networks in order to achieve the desired network results. However, our research shows that such an approach is not sufficient to capture the relationship between the central government and local mandated networks in Flanders. We argue for a broader interpretation of the concept of metagovernance, in which the dynamics of local networks are viewed as the outcome of power relations between actors that are represented at both local and central level and that are intertwined with each other. Only in this way will we we understand why certain choices are made about local mandated networks, why local networks show a lack of dynamism and why local actors in local networks also do not want local networks to become more dynamic and effective. We do notice that the pressure on these arrangements is increasing, partly due to new actors who are not involved in these arrangements.


Filip De Rynck

Caroline Temmerman

Joris Voets
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

    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

Gezocht: Burgerparticipatie (voor vaste relatie)

Een vergelijkende gevalsstudie naar 26 lokale netwerken in het sociale domein in de regio Arnhem

Tijdschrift Bestuurskunde, Aflevering 1 2016
Trefwoorden citizen participation, co-production, local networks, decentralization, collaboration
Auteurs Rigtje Passchier MSc en Dr. Jelmer Schalk
SamenvattingAuteursinformatie

    In 2015, Dutch local governments have become responsible for youth care, social welfare, employment and income assistance programs, as a result of decentralization. Many municipalities have set up service delivery networks and community teams, in which they collaborate with healthcare providers and civic organizations to build integrated care services. It is assumed that these networks will improve outcomes in terms of enhanced people’s self-reliance and healthcare cost control; by operating close to citizens they are in a position to know the client, activate a client’s social network and mobilize specialized professional expertise if necessary. However, a comparative case study of 26 emerging local networks in the Arnhem area indicates that healthcare providers use the networks mainly for presentation purposes in an effort to secure business continuity, that the role of local governments is fuzzy, and that citizen participation only thrives when actively encouraged in a climate of trust.


Rigtje Passchier MSc
R. Passchier MSc is interim manager voor de publieke zaak en promovenda aan de Universiteit Leiden.

Dr. Jelmer Schalk
Dr. J. Schalk is universitair docent aan de Universiteit Leiden.
Artikel

Vertrouwen in toezichtbeleid

Tijdschrift Beleid en Maatschappij, Aflevering 3 2014
Trefwoorden Trust, regulatory policy, accountability, control, supervision regime
Auteurs Lydia Paauw-Fikkert MSc, Dr. ir. Frédérique Six en Prof. dr. Paul Robben
SamenvattingAuteursinformatie

    Regulatory supervision and inspection have become key features of public governance, some authors even talk about the ‘audit society’ or the age of ‘regulatory capitalism’. Despite international research showing the importance of trust in supervisory relations, there is still a fierce debate about the role of trust in Dutch supervisory relations. Several inspectorates have incorporated trust as a central theme in their supervisory policy. This article describes the role of trust within the policy of the Dutch Healthcare Inspectorate (IGZ). This research addresses four themes in dealing with the concept of trust in supervisory relations: from transparency to accountability, from output performance to performance and risk management, from trust or control to trust and control, and, finally, a special regime for reliable inspectees. The empirical analysis in this paper contributes to the knowledge about the role of trust in supervision (policy) and to the debate about the role of trust in regulatory supervision policy.


Lydia Paauw-Fikkert MSc
Lydia Paauw-Fikkert MSc is senior adviseur bij de Inspectie voor de Gezondheidszorg.

Dr. ir. Frédérique Six
Dr. ir. Frédérique Six MBA is universitair docent aan de VU Amsterdam.

Prof. dr. Paul Robben
Prof. dr. Paul Robben is adviseur bij de Inspectie voor de Gezondheidszorg en bij iBMG-Erasmus Universiteit Rotterdam
Artikel

Verandermanagement en beleid: waarom vertonen professionals weerstand tegen nieuw beleid?

Tijdschrift Bestuurskunde, Aflevering 2 2014
Trefwoorden public policy,, change management, policy implementation, public management, resistance to change
Auteurs Lars Tummers
SamenvattingAuteursinformatie

    Professionals often have problems with governmental policies they have to implement. This can lead to diminished legitimacy and lower policy performance. The goal of this article is to identify the main reasons why professionals resist implementing new policies. An interdisciplinary approach is taken. From public administration literature, I use the policy alienation model, which consists of five dimensions: strategic, tactical and operational powerlessness, societal meaninglessness and client meaninglessness. These are possible reasons why professionals resist public policies (‘resistance to change’, a concept drawn from change management literature). I test these assumptions using a survey among 1,317 healthcare professionals. The results show that when professionals experience that a policy is meaningless for society or for their own clients, they show strong resistance. A lack of perceived influence is much less important in explaining resistance, although this is partly dependent on the particular profession someone belong to. The policy alienation model can help policy makers and managers to develop policies which are accepted by professionals. The article ends with practical recommendations for policy makers, managers and professionals.


Lars Tummers
Dr. L.G. Tummers is verbonden aan de opleiding bestuurskunde van de Erasmus Universiteit Rotterdam en het Center for the Study of Law & Society van de University of California, Berkeley.

    Values like quality of life, efficiency of services, solidarity in finances and privacy of clients are being compromised continuously in daily practices, inspired by opinions and ideology of (groups of) individuals. Yet, systems like healthcare are dominated by technocratic procedures to enforce transparency and efficiency. This functional rationality pushes away the more fundamental debates on values. This doesn’t mean they are not being compromised, but it’s done in a hidden way. It’s the nurse taking decisions on the amount of time available for a patient. Although restricted by procedures nurses compromise differently. The same counts for healthcare executives in their boardrooms. Restricted by system requirements they take decisions differently, inspired by their convictions. It is all ‘hidden ideology’ in institutions, interactions and intuitions. Even the political arena is imprisoned by the self made technocratic way of debating and deciding on important societal issues. Political debates should be about the values behind procedures instead of technocratic in its essence. Critical checks and balances have to be reinstalled (or reanimated) in political decision making in order to do this and meet patients’ or citizens’ needs, instead of maintaining a procedural attitude that drives politics and ideology away from society.


Kim Putters
Prof. dr. K. Putters is hoogleraar Management van Instellingen in de Gezondheidszorg (Professor of Health Management) bij het Instituut Beleid Management Gezondheidszorg, Erasmus Universiteit Rotterdam, tot 15 juni 2013 lid van de PvdA-fractie in de Eerste Kamer en eerste ondervoorzitter van de Eerste Kamer. Per 15 juni 2013 is hij directeur van het Sociaal en Cultureel Planbureau.
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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