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Summary Governance & Strategy lectures
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Governance & StrategyLecture 1.
Part 1: Introducing G&S
Take-aways:
- Governance is multi-level
- Governance is about getting things done in networks
Governance is about making policy and achieving some kind of change to solve problems.
All previous courses have focused on the management of what happens within organizations and
running organizations:
Focusing on daily practice within an organization that matters. This is the micro level of daily life and
practices within an organizational level.
Also see: Riley & Manias (2006) “Governance in operating room nursing: Nurses’ knowledge of individual surgeons”
,In this course: a level is introduced to the understanding of healthcare management. Outside of the
organizations many factors have an impact on what happens, both within organization and in daily
practice. They form the context of what happens within the organization. Entails the macro scale.
Also see: Peters, B. G., & Pierre, J. (2001). Developments in intergovernmental relations: towards multilevel governance.
Policy and Politics, 29(2): 131- 136.
So: governance is multi-level. There’s a meso level of the organization, that can be managed by
strategies to run the organization. In this course we analyze the macro level: outside political context
which influences organizations on a meso-level. And see what this means on a micro level of daily
practices and routines within the organization. The levels are interdependent, there’s interaction
between them. These interaction is what we are interested in in G&S.
, Governance is about getting things done in networks.
We have somehow moved from hierarchies to networks. Hierarchies: top down control, for instance
in politics. Rhodes (2007), indicated the ‘’hollowing out of the state’’ over the past 30 years. This is an
empirical change, something in reality which changed the way how things are done. But also: it
changed the way of thinking. The state has hollowed out top-down, sideways and bottom-up. The
power or authority of the state has been hollowed out. They are much less capable of implementing
solutions to problems than they were before. Example: decision making is moved to higher level, e.g.
the EU. That impacts our daily reality and the organizations. At the same time, private companies
such as big pharma have a larger impact on the power of the state to implement policy, this is
hollowing out sideways. The states have been hollowed out from down below, e.g. by communities.
Citizens have become much more assertive. For instance skepticism about science of populism. Also:
much more power is invested in lower levels, also called decentralization, for instance towards
municipalities being responsible for policies.
Two examples
1: See: Scholten G, Muijsers-Creemers L, Moen J, Bal R. (2018).
Structuring ambiguity in hospital governance. Int J Health Plann Mgmt, 1–15
1: Duality of hospital governance: in hospitals managers have to deal/content with the expertise of
doctors. Decisions have to be made in cooperation, doctors are invested with a lot of power. All sorts
of network in decision making come in to play, not as clear as to what happens. A lot of ambiguity
that leaves a lot of space for policy to become implemented.
2: Some households have different problems at the same time. To solve those medical expertise is
needed but for instance also help for financial problems, even more stakeholders can be involved.
Therefore, networks are needed and coordination between different stakeholders such as: case
worker, police, physician, etc. The network mediates how the problem is addressed. Governance is
about solving problems and getting things done, and therefore these networks that mediate them
need to be considered.
Strategy: is about what can you do to address challenges from the outside and inside of
organizations. It’s about having a roadmap and targets.
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