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This article analyses how regional actors and national authorities shape and transform 'the region' from a geographical place into an object of governance for organising and delivering older person care. Drawing on an extensive ethnographic research project in the Netherlands, our findings show that these actors in interaction constitute the region through three practices: consistently creating urgency to foreground regional problems and solutions; renegotiating regulatory policies to facilitate regional care provision; and reconstructing care infrastructures to materialise regional care provision. Actors use and obtain power from co -existing and interacting institutional arrangements to develop new regional care arrangements. This evokes new interdependencies that reconfigure existing governance arrangements. Studying governance objects in -the -making reveals the required iterations, reconsiderations, and adjustments as processes within a given (ambiguous) institutional context, and which lead to institutional change. As regional organisation policies are increasingly scrutinised, this article provides an interesting and important contribution to this field.

Managing inter-organizational networks has been studied extensively, yet little attention has been paid to what it means for organizations and their management to participate in multiple networks simultaneously. This study therefore explores from a management-organizational perspective how hospitals in a Dutch urbanized region process and manage a ‘network of collaborations’. We analyse the managerial strategies and activities performed to align organizational interests with the emergence of networks. While the network narrative has become dominant in public policy, this study adds empirical insights to the meaning and practice of governing in a networked environment.

Background: This study aims to explore and identify the organizational attributes that contribute to learning and improvement capabilities (L&IC) in healthcare organizations. The authors define learning as a structured update of system properties based on new information, and improvement as a closer correspondence between actual and desired standards. They highlight the importance of learning and improvement capabilities in maintaining high-quality care, and emphasize the need for empirical research on organizational attributes that contribute to these capabilities. The study has implications for healthcare organizations, professionals, and regulators in understanding how to assess and enhance learning and improvement capabilities. Methods: A systematic search of peer-reviewed articles published between January 2010 and April 2020 was carried out in the PubMed, Embase, CINAHL, and APA PsycINFO databases. Two reviewers independently screened the titles and abstracts and conducted a full-text review of potentially relevant articles, eventually adding five more studies identified through reference scanning. Finally, a total of 32 articles were included in this review. We extracted the data about organizational attributes that contribute to learning and improvement, categorized them and grouped the findings step-by-step into higher, more general-level categories using an interpretive approach until categories emerged that were sufficiently different from each other while also being internally consistent. This synthesis has been discussed by the authors. Results: We identified five attributes that contribute to the L&IC of healthcare organizations: perceived leadership commitment, open culture, room for team development, initiating and monitoring change, and strategic client focus, each consisting of multiple facilitating aspects. We also found some hindering aspects. Conclusions: We have identified five attributes that contribute to L&IC, mainly related t

Networks are increasingly seen as promising generic solutions to complex public problems. This article analyzes network-building in action within a specific regional setting as an attempt to cope with increasing and varied demands for older person care, studying everyday organizational and policy activities of actors. Drawing on a qualitative in-depth case study of a regional network in Zeeland—the most aging region in the Netherlands—our findings illuminate how this network is created, nurtured, and sustained, and the particularities and complexities this involves. Our practice-based approach demonstrates that network-building requires the ongoing work of many agents within organizational contexts, as well as the outside interference of stakeholders to make the network “work” within the wider population of networks, institutional context, and geographical place. This highlights to network literature the importance of place-based interventions that characterize how a network develops and pursues opportunities to come up with suitable responses to local needs.

This study explores how actors deal with normative complexity in the design and implementation of practices of preventative care. Previous studies have identified conflicting (e)valuations of prevention within health care at large, but little empirical research describes how these conflicts are resolved in day-to-day interactions. Zooming in on the work of a single actor, our ethnographic study describes a Dutch psychiatrist developing a novel type of hospital bed that provides preventative psychiatric care for women in the post-partum period. Drawing on pragmatic sociology of justification, we construe ‘beds’—and the time, people and resources they represent—as points of convergence between conflicting valuations of care. The results show that embedded modes of valuation in a curative hospital setting generate significant normative complexity during implementation. We identify three main strategies through which normative complexity is managed: (a) translating between different modes of valuing prevention, (b) compromising in (material) design of care beds and (c) transcending embedded valuations through moral appeals. By showing the normative complexity of prevention in practice, our study highlights the need for a diverse and situated accounting for preventative care.

Introduction: Network platforms are interesting for integrated care governance as they seek solutions for the problem of competition and tensions between networks. In this paper, we analyse how a network platform functions for the actors involved, and how it is used in their work. Methods: We employed a case study in a Dutch urbanised hospital region, and conducted 17 interviews with hospital physicians, directors, and supporting staff who are involved in a network platform called “BeterKeten” (BK). Results: Actors assign different functions and purposes to BK: facilitating and legitimising professional (learning) communities; adapting to a changing policy context; enlarging professionals’ and the networks’ circle of influence; and extending governing possibilities. Network platform’ dynamics and frictions entail changing professional and managerial practices; embedding a BK network in a partner network; and alignment of (conflicting) network platforms. Discussion: Network platforms are a promising strategy to govern, facilitate, and nurture network-building actions to enhance integrated care, offering new ways of working to cope with its multi-level nature. Conclusion: BK is a dynamic actor with steering capacities that enables the co-existence of multiple purposes. Further research could pay attention to how network platforms are able to develop modalities of integrated care governance that suit healthcare system’s networked character.

Het aantal zorgnetwerken dat de kwaliteit van medisch-specialistische zorg moet verbeteren, neemt in rap tempo toe. Een evaluatie van tien jaar BeterKeten in de regio Rijnmond leert hoe hieraan sturing wordt gegeven.

Healthcare organisations rely on their financial stakeholders for capital to invest in state-of-the-art buildings, equipment, innovation and the delivery of healthcare services. Nevertheless, relations between healthcare organisations and their financial stakeholders have not been well studied. Here, we studied the relations between Dutch healthcare organisations and two of their main financial stakeholders (banks and health insurers) against the backdrop of system reforms and the financial crisis. We conducted a survey of healthcare executives to evaluate their relations with banks and health insurers in terms of power, legitimacy and urgency. These three attributes are based on the salience model of Mitchel, Agle and Wood (1997). We further tested for differences in power, legitimacy and urgency across organisational sector and size. The results showed that healthcare organisations value banks as legitimate stakeholders with a well-demarcated influence and a clear-cut function. The relationship with health insurers is more complex. Healthcare organisations experience considerable influence from health insurers but question the legitimacy of their claims. Since health insurers play a crucial role in the Dutch healthcare system, these findings question the workability of the relationship between healthcare organisations and health insurers and the position of health insurers in the overall healthcare sector. Our results are relevant to countries with public-private health systems and contribute to the development of the salience model by showing the individual value of stakeholder attributes and the relevance of context.