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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.
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.

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.
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
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