Governance & Strategy
Week 1;
- Course set up
- Today’s take-aways:
> A shift from ‘government’ to ‘governance’
> Governance is about getting things done in networks
- Interview with dr. Bert de Graaff: Governance in crisis
‘A foreseen demise’
(De aangekondigde ondergang)
In 2018, two hospitals went bankrupt on the same day
What did we see in the video?
Organizational;
- Efficiency
- Specialization
- Number of ICU beds
- Technology
Daily practices;
- Nurse workload
- Surgeon’s work
- Patient demands
Socio-political context;
- Demographic challenges
- Labor shortages
- The economy
- Market forces
This course is situated to provide with you with an insight on governance & strategy. Previous courses
is about organizations, on the level of the organization.
,Micro-level, more about the patient level, this is what we have seen in patient centered care delivery.
The macro level; treaties, social norms, inequalities etc. they impact how organizations are managed.
This course tries to provide you with theoretical lenses and help you analyze all three levels.
Multi-level governance;
,In this course we analyze policy on three levels:
1. In people’s daily practices (micro-level)
2. Within organizations (meso-level)
3. In the broader socio-political context (macro-level)
And how these levels interact
From government to governance;
Government…
‘The state’ ‘l’etat c’est moi’?
> Someone on top of the system, they decide what to do with the system, they decide and implement
top-down. But there came critique on that.
‘The Rutte IV government is focusing on making real improvements in people’s lives. The government
has set its sights on the major challenges facing society. In addition to dealing with the COVID-10
pandemic, it is committed to fighting climate change, tackling the nitrogen pollution crisis, building
affordable new housing, make major investments in security and increasing quality of opportunity in
education.’
> That is what the state wants, group of people and the top of a hierarchy, these things are being
decided.
> But reality, is not that simple.
… to governance
This is more like reality, there are all networks.
The capacity of the government to decide on policy has been eroded, hollowed out from below.
> Economy, market system, have much more power today dan 50 years ago. Think about developing
covid vaccines. But also international treaties, WHO, UN, these supernational bodies have much
influence on policymaking. So, from above, the sides and above, hollowed out.
This created governance.
, Two examples;
Try to do things together with multiple stakeholders.
Example 1: ‘Dual hospital governance’
Dual decision-making power, doctors and management. They have to agree with each other, this will
lead to all kinds of conflicts.
The ambiguity (lack of rules and formal positions) that allows different stakeholders to meet one
another, make compromises, reciprocity.
Example 2: ‘multi-problem households’
Many of these households, one child problems with police, drops out of school, stress, mental
problems with parents etc. Stakeholders that they will face from governance are multiple, social
worker, policy officer, ‘leerplicht’ ect. All stakeholders involved with one family. So, this is a network
setting.
Negotiation;
All these conflicts that can arise in daily life, among these stakeholders. They constantly require
negotiation. You have to deal with other people to get things done. Inequalities in resources among
stakeholders, negotiate about this. Analyze how these negotiations take place.
> Push and pull, zero sum game, one party wins and the other loses. Or trying to create win-win
situations.
Strategy as design: how to deal with difficult situations? How to act giving complexity and
uncertainty? How do we act in organizations?
Strategy as practice: more understanding the context and how stakeholders behave, within the
context.
Governing care during an emerging pandemic
Governing care during a crisis?
‘I found the start very though, also because of the quick changes. I no longer recognized my own
department, and we suddenly no longer saw our regular patients. You could no longer rely on your
