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Complete summary 'Governance & Strategy'
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Including all lectures, working groups and papers, as well as some corona-related detours
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Week 1: governance Students are able to provide a description of the concept of governance;
Students can explain the concept of networks in governance theory;
Students can explain that governance can be studied at different levels (micro, meso,
macro), using different theoretical lenses.
Lecture 1
Outer context influences inner context (in the health care organisation, characteristics):
social environment, cultural changes, expectations, law, technology, politics, budgets cuts,
international agreements, innovation, etc. Also vice versa, inner context influences outer
context. This G&S field is concerned with these interactions: how policy on a macro-level
impacts what is done in organisations on a meso-level and how people act and interact on a
micro-level, and vice versa. Governance means something different on macro/meso/micro
level. Central is an element of steering. Power of government: centralized, top-down. To
governance: shift responsibilities from government to other stakeholders, e.g. the market,
municipalities, communities. Lesser level of control by government.
Framework to study what is happening in healthcare, look at governance from 3
perspectives:
Macro = HC system. Role of patients/citizens, view on care, associations.
Meso = HC organizations. Shaping everyday reality, role of stakeholders.
Micro = day-to-day interactions between patients/carers, professionals/managers.
see how policy works out in practice.
Staff-problem:
Macro: task distribution, technology as solutions, role of informal care
Meso: but who bears clinical responsibility? Implementing technology is complex
Micro: how people act, trust? What do patients want? How do technologies work out in
individual practice?
Strategy: heading into a certain direction, aiming to a goal, meant to keep you afloat in a
changing outer context. Also how you present yourself to the world.
Corona
Communication to outside: media etc. Inside: make staff do work in less-protected
environments. Main issue: how to govern in uncertainty, with the need to update policies
every day. What is valid knowledge now?
On a policy level
The government makes the final decision, but it relies heavily on other stakeholders (zoals
veiligheidsregio’s, burgemeesters; decentralisatie; RIVM, nu een experteise center, paar
maanden geleden nog stikstof-boosdoener).
Power differences: FMS in media beïnvloedde schoolsluiting. Were they not at the table? Or
not listened to?
What happens in organizations? (2nd level)
1
, Layers, sharing of gear and push towards government (minister moet meer bestellen),
coordination patients form local hospitals to national coordination, self-produce IC
ventilators, limiting normal care as preparation.
How do people act? (3rd level)
Ensure staff keeps coming, intense decisions, mental and physical consequences postponed
patients, societal behaviour (not go to the beach, or go to the crowded beach).
In het begin weinig in het nieuws over ouderen, gehandicapten etc: loneliness, required
help/assistance, etc. When studying policy, it is important to reflect upon the patient/citizen
perspective!
Developments in intergovernmental relations: towards multi-level governance (Peters &
Pierre)
The article describes the steering of institutions and intergovernmental relationships on
different levels, i.e. local, regional, national, transnational institutions (e.g. EU). Oemar. Er
is horizontale en verticale governance. P132: “Institutional relationships do not have to
operate through intermediary levels but can take place directly between, say, the
transnational and regional levels, thus bypassing the state level.”
We are witnessing an (inter)-institutional change. We are moving from a liberal-democratic
state-perspective towards a model that is characterised by complex patterns of
contingencies and dependencies on external actors. There is a development from a ‘demand
and control’-state towards an ‘enabling’-state, where power is more derived from wielding
and coordinating resources from public and private actors, than from formal constitutional
powers.
Previously, the overall nature of the political project was mainly focused on expanding the
political sphere in society; currently, objectives are to increase efficiency in public service
delivery and delivering more customer-attuned. A common feature has been to make state-
centred societies less state-centred.
Policy changes trigger (or necessitate) institutional changes and vice versa, institutional
changes often entail some degree of policy change. Decentralisation and European
integration have reshuffled institutional relationships and created a system where the nature
of exchange is characterised more by dialogue and negotiation than command and
control/legalistic.
Intergovernmental relationships are becoming increasingly negotiated and contextual. Multi-
level governance can e.g. feature collaborative exchanges and joint decisions making
between institutions are different levels of the political system.
Multi-level governance: refers to negotiated, non-hierarchical exchanges between
institutions and (inter)national, regional and local levels. Expanded, it also denotes
relationships between governance processes at different levels, vertical layering. Important
note: these institutional relationships can bypass levels. This emergency has been propelled
by a weakened state because of the fiscal crisis; transnational institutions such as the EU
withdrawal of the state opens up new opportunities for cities.
New public management-style reform: aims at allowing each level of government to
separate the political-democratic element of government from the managerial-service
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