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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

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.
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