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    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.
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