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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

Professioneel vermogen

Proactieve ‘coping’ door publieke professionals

Tijdschrift Beleid en Maatschappij, Aflevering 4 2015
Trefwoorden Public professionals, Teachers, performance pressures, proactive coping, professional capability
Auteurs Prof. dr. Mirko Noordegraaf, Nina van Loon MSc, Madelon Heerema MSc e.a.
SamenvattingAuteursinformatie

    Professional services such as educational services, are increasingly managed and optimized in order to improve performances. Performances of students, teachers and school (boards) are measured and evaluated. Increasingly, rules and systems focus on outputs and control. Consequently, the ‘freedom’ of professionals such as teachers is reduced, or is perceived and felt to be reduced. There have been growing debates on the problematic effects of performance pressures. Often, public professionals are seen as ‘defenseless victims’ of systems and pressures – they are ‘professionals under pressure’. In this paper, we introduce a more positive way of understanding professionals and professional action in changing contexts. We see professionals such as teachers as ‘active agents’ who can develop and regain control over their own situation. Professionals can deliver quality, in spite of bureaucratic burdens and managerial intrusions. We call this ability professional capability: ‘the ability to proactively deal with work-related expectations, tasks and burdens in dynamic stakeholder environments’. This paper combines research on public administration, organizational sociology and occupational psychology, to generate a more productive understanding of proactive coping of professionals in public domains. We define and operationalize professional capacity, we explore sources and effects, and we develop hypotheses for further research.


Prof. dr. Mirko Noordegraaf
Prof. dr. Mirko Noordegraaf is als hoogleraar publiek management verbonden aan het departement Bestuurs- en Organisatiewetenschap (USBO) van de Universiteit Utrecht.

Nina van Loon MSc
Nina van Loon MSc was als promovenda verbonden aan het departement Bestuurs- en Organisatiewetenschap (USBO) van de Universiteit Utrecht en is thans werkzaam bij Aarhus University, Denemarken.

Madelon Heerema MSc
Madelon Heerema MSc is als researcher verbonden aan het departement Bestuurs- en Organisatiewetenschap (USBO) van de Universiteit Utrecht.

Marit Weggemans MSc
Marit Weggemans MSc was als student-assistent verbonden aan het departement Bestuurs- en Organisatiewetenschap (USBO) van de Universiteit Utrecht.
Artikel

Professionals onder druk of professionele tegendruk? Gebalanceerde motivatie voor de publieke zaak in professionele publieke dienstverlening

Tijdschrift Beleid en Maatschappij, Aflevering 3 2014
Trefwoorden Professionals, public services, motivation, public values
Auteurs Nina Mari van Loon MSc en Prof. dr. Mirko Noordegraaf
SamenvattingAuteursinformatie

    There are many practical and academic concerns about public professionals and the pressures and burdens they experience. Professional autonomies and skills are reduced, it is argued, as a result of businesslike new public management, in order to control service results. The solution is clear: organizational logics must be weakened, professional autonomies must be enlarged and professional ways of working must be ‘rescued’. In this paper we re-interpret this presumed problem by analyzing: the interaction between organizational and professional logics, by relating these to a broader institutional logic and by tracing the contribution of individual professional motivations. Professionals, it is shown, can be motivated by broader ambitions to serve society. Such public service motivation consists of three types of motives: rational/instrumental, affective and normative. Our results show that employees in different public professional services show different patterns of motives, which we mainly explain by relating their motivations to the nature of the services they render – whether they render people-changing or people-processing services. These institutional dimensions imply that professional work can be managed, not so much by businesslike ‘market logic’ but by strengthening the meaning of the work professionals do. Professional pressures against organizations do not have to be suppressed – they can be productively used.


Nina Mari van Loon MSc
Nina van Loon MSc is als promovenda verbonden aan het departement Bestuurs- en Organisatiewetenschap (USBO) van de Universiteit Utrecht.

Prof. dr. Mirko Noordegraaf
Prof. dr. Mirko Noordegraaf is als hoogleraar publiek management verbonden aan het departement Bestuurs- en Organisatiewetenschap (USBO) van de Universiteit Utrecht.
Artikel

Vluchten in bureaucratie

Bureaucratische gehechtheid onder professionals in de jeugdhulpverlening

Tijdschrift Beleid en Maatschappij, Aflevering 1 2012
Trefwoorden professionalism, youth care, accountability, bureaucracy, marketization
Auteurs Drs. Daniel van Hassel, Prof. dr. Evelien Tonkens en Drs. Marc Hoijtink
SamenvattingAuteursinformatie

    In recent decades, professionals in the public sector have been faced with increasingly detailed demands concerning accountability and performance. It is often argued that this increased accountability and its bureaucratic pressures limit professionals’ discretionary space and autonomy. However, this critique is hardly based on empirical research on the experiences and perceptions of professionals themselves. In this article we present an investigation into these perceptions and experiences with accountability in one particular brand of the public sector, namely youth care.
    Our research indicates that professionals in youth care are hardly interested in greater autonomy or discretion. They rather want clarity, security and options for learning. Moreover, we found ‘bureaucratic attachment’: attachment to bureaucratic procedures particularly as a reaction to increased fears to be sued when something goes wrong with clients. In the recurrent arguments for reduction of bureaucracy, this other face of bureaucracy is often disregarded.
    Regarding working conditions however, the professionals we interviewed do want more discretion. Especially concerning occupation of beds, as the requirement for permanent occupation is viewed to augment risk. We therefore argue for better backing of professionals in youth, for a more precise battle against unnecessary bureaucracy, and for professionalization in order to handle more discretion.


Drs. Daniel van Hassel
Daniel van Hassel is socioloog en als onderzoeker verbonden aan het Nederlands instituut voor onderzoek van de gezondheidszorg (NIVEL), waar hij zich bezighoudt met het thema beroepen in de gezondheidszorg, d.hassel@nivel.nl.

Prof. dr. Evelien Tonkens
Evelien Tonkens is bijzonder hoogleraar actief burgerschap bij de afdeling Sociologie en Antropologie van de Universiteit van Amsterdam en toezichthouder van Meander Medisch Centrum te Amersfoort, e.h.tonkens@uva.nl.

Drs. Marc Hoijtink
Marc Hoijtink is socioloog en onderzoeker aan Kenniscentrum Maatschappij en Recht van de Hogeschool van Amsterdam, waar hij zich bezighoudt met de thema’s sociaal beleid en professionaliseringsvraagstukken, m.a.hoijtink@uva.nl.
Artikel

Sluipend kwaliteitsverlies in de geestelijke gezondheidszorg

Professionals over de gevolgen van marktwerking

Tijdschrift Beleid en Maatschappij, Aflevering 1 2011
Trefwoorden mental health care, marketization, Diagnosis Related Groups (DRG’s), policy implementation, professionalism
Auteurs Nienke van Sambeek, Evelien Tonkens en Christian Bröer
SamenvattingAuteursinformatie

    In order to facilitate the creation of a regulated market, Diagnostic Treatment Combinations (DBC’s in Dutch) have been introduced in Dutch mental health care in 2008. DBC’s are developed to distinguish and price the ‘products’ of health care, in order to make comparison and competition between health care providers possible. In this qualitative study we analyzed mental health care professionals experiences with the DBC-system. We focused on two questions: (1) what does the DBC-system and the related introduction of marketization of mental health care mean for professionals? and (2) how do professionals cope with the DBC-system in their daily practices? We found that the logics of the market and bureaucracy, both incorporated in the DBC-system, often conflicted with the values and ethics of mental health care professionals. Mental health professionals experience deterioration of professionalism and quality of care. They were coping with conflicting values by non-compliance with rules and pragmatic use of the DBC-system. It is argued that the efforts of professionals to protect the quality of their work might actually lead to invisibility of the problems they encounter, which reinforces the policy they criticize.


Nienke van Sambeek
Nienke van Sambeek is psycholoog bij de Psychologische Praktijk Putten.

Evelien Tonkens
Evelien Tonkens is bijzonder hoogleraar actief burgerschap, afdeling Sociologie en Antropologie aan de Universiteit van Amsterdam en toezichthouder GGZ centraal. Correspondentiegegevens: prof. dr. Evelien Tonkens, Universiteit van Amsterdam, afdeling Sociologie en Antropologie, St. Actief burgerschap, Oudezijds Achterburgwal 185, 1012 DK Amsterdam, E.H.Tonkens@uva.nl.

Christian Bröer
Christian Bröer is universitair docent sociologie aan de Universiteit van Amsterdam.
Boekbespreking

Boekbespreking

Tijdschrift Beleid en Maatschappij, Aflevering 3 2006
Auteurs Martijn van der Meulen

Martijn van der Meulen

    Demand-steering policies in healthcare are understandable but problematic answers to the desire for democratization that dates from the seventies of the former century. Prominent critics such as Achterhuis and Illich were very critical of the undemocratic character of health care. Yet their romantic idea of society excused them from the need to articulate democratic alternatives. The empty space that they left was filled by the concept of demand-steering. Demand-steering, however, rather than strengthening democratic practices, merely undermines them, by preferring exit above voice, by putting up new bureaucratic barriers between clients and professionals and by undermining the quality of the relationship between clients and professionals.

    Doing more justice to the democratic impulse is possible and desirable. A new step towards this aim is being taken by a fourth logic of steering, (next to the familiar logics of the market, bureaucracy and professionalism) that centers on improving the dialogue between clients and professionals. The one variant, democratic professionalism, starts from the position of the professional and aims at intensifying democratic control, while the other variant, collaboration, starts from the client and aims at providing him with more influence and responsibility for the health care process. This fourth logic however can only provide a new impulse to democratization when the vague notion of the dialogue is elaborated more thoroughly.


Evelien Tonkens
Evelien Tonkens is bijzonder hoogleraar actief burgerschap bij de afdeling sociologie en antropologie van de Universiteit van Amsterdam en opleidingsdirecteur/docent van de masteropleiding social policy and social work in urban areas van de Uva. Correspondentieadres: UvA – afdeling sociologie en antropologie, Oudezijds Achterburgwal 185, 1012 DK Amsterdam, e-mail: e.h.tonkens@uva.nl
Artikel

Vervreemd of gewoon verschillend?

De gevolgen van onderwijshervormingen voor loyaliteiten van schoolleiders in het voortgezet onderwijs

Tijdschrift Beleid en Maatschappij, Aflevering 4 2009
Auteurs Bas de Wit
SamenvattingAuteursinformatie

    Since the 1980s, there has been a rise of managers and executives in public domains. Especially in domains like education, this development was accompanied by sharp controversies and 'clashes' between managers and professionals, who would be 'alienated' from each other. The classic nature of professional and managerial loyalties would seem to strengthen this alienation. Professionals would primarily be loyal to their profession, whereas managerial loyalties would mainly focus on organisations. Although research has criticized the one-sidedness of professional loyalty, managerial loyalty has hardly been studied up till now. In this article, managerial loyalties are analyzed theoretically as well as empirically. The article rests upon a qualitative study among school leaders in Dutch secondary education. It shows that management reforms in education did not result in the adoption of a new, primary loyalty to organizations, management or performance by school leaders. Instead, long-standing relations, for example with teachers, remain meaningful, also because most school leaders have a professional background as teacher. Consequently, assumptions about managers who alienate from professionals, and managers who do not value their relationships with professionals must be criticized, at least in (secondary) education.


Bas de Wit
Bas de Wit is als promovendus verbonden aan het departement Bestuurs- en Organisatiewetenschap van de Universiteit Utrecht. Correspondentiegegevens: Drs. B.C. de Wit, MSc Universiteit Utrecht Departement Bestuurs- en Organisatiewetenschap Bijlhouwerstraat 6 3511 ZC Utrecht b.c.dewit@uu.nl
Artikel

Vraaggestuurd organiseren

Professioneel management van vraagsturing in publieke dienstverlening

Tijdschrift Beleid en Maatschappij, Aflevering 3 2006
Auteurs Mirko Noordegraaf
SamenvattingAuteursinformatie

    'Demand-based organising' has become popular throughout public domains, sometimes complementing, sometimes working against 'fact-based' and 'market-based' organising. This raises critical questions, about ways in which 'customer' and client demands are and can be known, and how multiple demands can be aggregated. In addition, it is difficult to link demand-based strategies to public service contexts, full of professional practices. How do public managers cope with such contradictory conditions? How can they organise in demand-based ways, amidst contradictory demands? This article, firstly, explores how demand-based rhetoric and instruments have been introduced. Secondly, it explores how public managers really (can) work in demand-based settings. Thirdly, it explores how demand-based practices can be organised, so that public service contexts can be managed 'professionally'. This leads to a paradoxical conclusion. Professional public managers organise in demand-based ways by not handing-over or 'outsourcing' content to customers and clients, but by substantiating demands themselves.


Mirko Noordegraaf
Dr Mirko Noordegraaf is verbonden aan de Utrechtse School voor Bestuurs- en Organisatiewetenschap (USBO) van de Universiteit Utrecht.

    The recent decline in professionalism has frequently been explained as a result of the rise of New Public Management (NPM). As will be shown in this article, however, NPM does not automatically result in a decline in professionalism; its effects differ in various professional contexts. In a case study of the work of social insurance doctors and labor specialists the authors demonstrate that NPM structures the technical aspects of professional tasks, that are the verifiable elements of the professional's judgment. NPM proofs to have strong influence on the techniques for quality insurance (performance of production, time and lawfulness). On the longer term this influence can undermine professional self-regulation. NPM has little impact on the indeterminate task aspects, the professional judgment itself, even though this part has become more 'technical' in years. The case study shows however that this is not due to NPM but to the impact of bureaucratization of the professional task. Furthermore it becomes clear that this impact is stronger in the case of the labor specialist than with respect to the social insurance doctor.


Duco Bannink
Duco Bannink is verbonden aan de Universiteit Twente. Correspondentieadres: Duco Bannink, Universiteit Twente, Faculteit Bedrijf, Bestuur en Technologie, Postbus 217, 7500 AE Enschede, 053-4893222, d.b.d.bannink@utwente.nl

Berber Lettinga
Berber Lettinga is verbonden aan de Universiteit Twente.

Liesbet Heyse
Liesbet Heyse is verbonden aan de Universiteit Twente.
Artikel

Hoeders van de hygiënische stad

Beveiligers, toezichthouders en handhavers in de openbare ruimte

Tijdschrift Beleid en Maatschappij, Aflevering 3 2009
Auteurs Ronald van Steden en Maddy Roelofs
SamenvattingAuteursinformatie

    Over recent years, we have seen a steady increase in the number of security officers and city supervisors in Dutch urban areas. However, despite the mounting presence and visibility of these auxiliary patrols, little is known about how citizens perceive and value them. A questionnaire held among a sample of 761 residents of Amsterdam shows that citizens have mixed opinions. Many people are accepting or neutral about the occurrence of security officers and city supervisors in urban space, but at the same time lack a clear idea of their quality and professionalism. This somewhat ignorant and laconic attitude raises the question whether people underestimate the potential consequences of omnipresent quasi-police. It is argued that more repressive approaches may generate substantial conflicts with the general public. Furthermore, safety and security may become 'consumer goods' in the sense that people are quite happy to leave their responsibilities to paid policing professionals – a position which promotes the rise of a 'culture of control'.


Ronald van Steden
Ronald van Steden is als universitair docent verbonden aan de Faculteit der Sociale Wetenschappen van de Vrije Universiteit te Amsterdam. Correspondentiegegevens: Dr. R. van Steden Vrije Universiteit Faculteit der Sociale Wetenschappen Afdeling Bestuurswetenschappen De Boelelaan 1081 1081 HV Amsterdam r.van.steden@fsw.vu.nl

Maddy Roelofs
Maddy Roelofs was werkzaam bij de Dienst Onderzoek en Statistiek van de gemeente Amsterdam.
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