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Complete summary of Governance & Strategy lectures
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In this document you will find a clear and complete summary of all lectures given for the course Governance & Strategy.
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Lectures of Governance & Strategy (2022)Erasmus university Rotterdam
Content
Lecture 1: Governance & Strategy..........................................................................................................2
Lecture 2 Institutional theory to better understand G&S.......................................................................5
Lecture 3: Decentralization, the citizen perspective.............................................................................13
Lecture 5: Theoretical perspective on strategy....................................................................................21
Lecture 6: Strategic management in a changing healthcare system.....................................................28
Lecture 7: Wrap up...............................................................................................................................34
*There was no lecture in week 4; in this week we played the Serious game (GRIP).
,Lecture 1: Governance & Strategy
Governance is multi-levels: involves different levels and how they interact.
Governance is about getting things done in networks.
Course aim:
- To provide you with theoretical lenses as well as practical knowledge of governance and
strategy in healthcare organizations.
Challenges & solutions identified in the video:
- Challenges: growing proportion elderly people, dementia will increase
- Solutions: empower and support elderly people to stay at home longer,
welfare sector more efficient, detect diseases as early as possible
(monitor risks etc.), focus on dementia, nursing home of the future
(own apartment/furniture), more personal contact
- A range of different problems are identified and these technologies are
being introduced as its solution.
Governance: is about making policy and achieving some kind of change to solve
problems.
- all previous courses are focussed on
organizations and its management.
o Within this level you have the day-to-
day practices (e.g. relations between
caregiver and patients.) This matters for
the decisions you make and how they
come into being.
- This course is about another level. outside of
the organizations there are many things
impacting organizations and day-to-day
practices. These form the context (at the macro-scale) impacting what happens within
organizations.
o Peters & Pierre 2001.
Governance is multi-level.
o Macro
o Meso
o Micro
, These levels are interdependent: there’s
interaction.
o What happens on macro level (inequalities)
impact what happens at the micro level
(daily interactions between nurses) and
reversely.
2. Governance is about getting things done in networks:
Networks: are in contrast to a hierarchy.
- Literature: we moved from hierarchies to networks. ‘from government to governance’
o ‘Politics used to be about hierarchies (top down control)’. Think about the
government municipalities and executives of the laws, which is hierarchical.
Ministers are in charge of everything that happens below them ambtenaren (who
can rise in hierarchy if they perform well).
Something has changed: ‘the hollowing out of the state’: the
authority/power of the state has been hollowed out, they’re much less
capable of implementing solution to problems than before. Example:
decision-making is moved to higher levels (to European union who make
new laws) but they impact what the state can do and how they do things. (=
hollowing out from above).
Hollowing out from sideways: e.g. markets, private companies have a lot of
impact on the power of the state to implement policy. E.g. big pharma.
Changed the power of the state to implement policy.
Hollowing out from below: due to networks, communities, citizens have
become more assertive and critical. Populism, scepticism. The framework is
also changing; there’s much more power invested in lower levels
(decentralization) towards e.g. municipalities being responsible for the
implementation of healthcare policies than before.
Examples: networks
- Scholten et al (2018): ‘Dual hospital governance’
o They describe how in different hospitals managers have to contend with the
expertise of doctors. It is not just about implementing decisions, the decisions have
to be made in collaboration with doctors; they need to negotiate on what happens
within the hospital. They need to mediate, there’s a lot of ambiguity that leaves a lot
of space for policy implementation.
- Multi-problem households:
o There’s more realization that some households deal with many different problems at
the same time. To solve those you need medical expertise, but there might also be
financial problems, for which a caseworker who helps with debts is needed.
Someone might also have run-ins with police which is why police, caseworkers,
, judges are also needed. So then networks are needed. ‘How to facilitate information
exchange between these actors?’.
In practice you see that there are both hierarchies and networks at the same time.
Strategy: what can you do to address problems within organizations.
- Address challenges from both the inside and outside.
Part 2 lecture 1: Bert de Graaff, Governing care during an emerging pandemic
Learning how to dance with a virus: capacity of organizations to deal with a crisis lies not necessarily
in formal guidelines and regulations, but also in informal and relational practices of people doing the
work.
- Dancing with a virus; Focus on situated, reflexive responses of organisations and the
resilience of institutional arrangements.
- Question: what is the adaptive governance of care during a chronic crisis (pandemic)?
- Empirical focus: the regional networks of acute care delivery (ROAZ), in interaction with
national and local level.
o ROAZ; board of professionals who discuss on how to best organize care in the
regions.
Framing the crisis: ‘what were the main issues throughout the crisis’
1. Notice of scarcity: e.g. shortage of masks. Huge change that led
to feelings of solidarity to solve these issues.
2. Distribution of patients across the nation. Stopping regular care
to provide COVID care was difficult. Huge change where hospitals are normally competitors
(sharing data in a transparent way), whereas now they had to distribute patients and share
information. Insight in hospital capacity of other hospitals was difficult because it wasn’t
linked.
a. It’s hard from a hospital standpoint to know what your capacity is at a certain time.
b. Professionals often worked around it. There were already (informal) networks
existent before the crisis happened that sometimes didn’t align with the new
suggested system to distribute patients.
3. Code black
a. No one really expected that phase 3 would never really happen. Tension between
formal declaration on national level and more situated experience of we will always
keep on going no matter what.
b. Took lot of effort to draw guidelines on what to do, and who is being held
accountable as the quality of care would have inevitably be decreased. So doctors
were scared that they would be held accountable if they wouldn’t be able to provide
formerly needed care.
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