This document contains a summary of the lectures and mandatory literature of the course Governance and Strategy that is part of the Master Health Care Management at the Erasmus University Rotterdam.
Situated daily practices: relationships between caregiver and patients
Patient centered care delivery: organizations aim to deliver care that is patient centered in
order to improve patient outcomes.
,Multilevel
- In this course we analyse policy on three levels
In people’s daily practices (micro-level)
Within organizations (meso-level)
In the broader socio-political context (micro-level)
And how these levels interact
Government: The state
Government: the state
To governance: hollowing out the state
Communities
Markets
Local authorities
Supranational policy
Public/private providers
The state
Two examples
1: Dual hospital governance
2: Multi-problem households
,Governing care during crisis
- Learning how to dance
Dancing with a virus: focus on situated, reflexive responses of organizations and
the resilience of institutional arrangements (strategy as practice)
Question; adaptive govenance of care during a chronic crisis (pandemic)
Empirical focus; the regional networks of acute care delivery, in interaction with
national and local level.
Ethnography of crisis organization
- Hanging out: observing meetings
- Travelling; local, regional, national (focus on 3 acute care regions)
- Talkings: 175 targeted interviews and many informal conversations
- Reading: hundreds of meeting documents
- Reflecting: sessions with participants, policymakers
Adaptive governance
- Resilience at the ROAZ
- Mixed picture
The ROAZ has become spider in the web of acute care during pandemic; new links
with long-term care, data infrastructure
Focus on hospitals, IC as a central value; little input from other sectors, patients,
nurses
Adjustment interferes with existing system: fair share, regulation to regular and
postponed care
Lessons for governing care
- Resilient system is no quick fix, but requires long, layered approach and system
learning
But also important to make room for learning during the crisis
- Crisis changes over time, situation, actor -> importance of framing
- How the crisis is framed shapes the relevant collective to deal with that problem
Working on relations important for trust and solidarity
But, clear need to organize countervailing powers
, - Macro; tensions between institutional logics (competition, coorperation, professional
self-regulation)
- Organizational: data-infrastructure requires work and politics, representations of the
complete chain of care is crucial.
- Daily work; role of frontline workers should be acknowledged.
Lessons for governing care: region
- Macro; who, what, where is the region -> fragmented institutional landscape
produces neer constant coordination.
- Macro: who owns care during a crisis? Governance question, there cannot be a clear
answer, decentralized multicentered system, coordination between all those different
systems.
Acute vs long term care
Role of regulatory agencies, insurers
Centralized vs decentralized coordination.
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