Class notes
G&S transcripts of ALL lectures
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G&S LecturesContents
Lecture 1. From Government to Governance (1-12-2023)...............................................................................2
Introduction: a shift from “government” to “governance”...........................................................................2
Multi-Level Governance............................................................................................................................4
Government..............................................................................................................................................5
Governance..............................................................................................................................................5
Negotiation...............................................................................................................................................7
Strategy....................................................................................................................................................7
Course setup.................................................................................................................................................8
Governance in crisis / Governing care during an emerging pandemic (by dr. Bert de Graaff)......................9
Lecture 2. Networks & Decentralization (8-12-2023).....................................................................................14
Three institutional arrangements...............................................................................................................15
1) Hierarchy/Bureaucracy.......................................................................................................................15
2) Market................................................................................................................................................17
3) Network..............................................................................................................................................19
Three forms of decentralization.................................................................................................................20
Case study: Network governance in Dutch care for older persons.............................................................24
Understanding decentralizing care (‘regionalization’)............................................................................24
What does ‘the region’ mean.................................................................................................................26
Why ‘layeredness’ of (regional) care matters for governance and strategy...........................................27
Lecture 3. Bargaining vs. Mutual Gains (15-12-2023).....................................................................................28
Bargaining...................................................................................................................................................28
Mutual gains...............................................................................................................................................29
Lecture 5. Strategy as design & Strategy as practice (12-1-2024)...................................................................31
The use of strategy tools.............................................................................................................................31
Design school of strategy........................................................................................................................33
SWOT analysis.........................................................................................................................................36
Confrontation matrix..........................................................................................................................36
PESTEL analysis.......................................................................................................................................36
Strategy as practice.................................................................................................................................38
Guest lecture..............................................................................................................................................39
Example 1: Strategy by design................................................................................................................41
Example 2: Strategy as practice..............................................................................................................42
1
,Lecture 1. From Government to Governance
(1-12-2023)
In this first lecture, we introduce the contemporary challenges faced by healthcare managers today, by
exploring how our political system has changed over the past decades. These changes can be broadly
summarized as a shift from government to governance, in parallel to a ‘hollowing out of the state’ (Rhodes,
2007). To analyze challenges related to these broad developments, we introduce three conceptual
perspectives: a micro, meso, and macro level.
Rhodes discusses these levels in terms of the local, national and international context of ‘the state’.
Transposed to our purposes, the micro-level refers to the internal environment of organizations within
which day-to-day practices and interactions are situated. This is the level of professionals working to provide
care. The meso-level refers to the organizational setting, and how the organization is managed vis-à-vis
other organizations. The macro-level refers to the broader socio-political context, and encapsulates a wide
range of actors that directly or indirectly influence the healthcare organization and provision of care, such as
municipalities, the health insurer, (labor) markets, laws and regulations, and international environment.
In the second part of the lecture, we examine what governance looks like through these three conceptual
lenses (micro, meso, macro) in the case of COVID-19 crisis management.
Targets for this meeting:
1. describe the concept of governance.
2. describe the concept of networks in governance theory.
3. describe a shift from government to governance and the hollowing out of the state
4. analyze the interaction between institutional context and healthcare governance, through micro,
meso, and macro level lenses.
Introduction: a shift from “government” to “governance”
Slide 3 + 4
VIDEO about Denemarken
Take-aways from this video:
Daily practices Organizational Social & political context
• “patient turning system” • “efficiency”, • Demographic challenges
• “monitor risks” • “increased number of home • Labor shortages
• checklists on iPad care visits per nurse” • Ideal of “staying healthy in
• “citizens do exercises • “early detection” own home”
independently” • implement “assisted living • “Denmark is international
• “the new system has saved technology” frontrunner”
my world” • “Elderly don’t ask same • “A dementia-friendly nation”
• […] amount of help” • […]
• […]
2
,Slide 5
This course is situated to provide you with an insight into the socio-political dimensions of health care
governance. To briefly touch upon the previous courses in your program:
Much of the theory and the theoretical concepts and analysis takes place at the organizational level.
Slide 6
You have also seen the micro-level: situated daily-level practices, where the patient is an object of analysis.
There you also focus on the experience of a patient within that system. The daily practices, the routines,
how doctors relate to patients.
3
, Slide 7
Then there is a 3rd level: the macro-level, so everything that was just mentioned that touches upon supra-
national treaties, the economy, workforce-shortages, inequalities in society, social norms, etc. Everything
that impacts how a health care organization is managed and how you will operate in that organization as a
manager. So that is also the level you will have to content with and this course will provide you with
theoretical lenses that will help you analyze all these things.
Multi-Level Governance
Slide 8
Later on, we will also focus on how these 3 levels all interact. But today, we will just suppose that these
levels are separate and that we can analyze them separately.
4
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