Governance & Strategy
Summary
Objectives of this course:
Students are able to explain theories on governance and strategy;
Students are able to analyse governance issues in healthcare from different theoretical
perspectives on governance.
Students are able to analyse strategic issues in healthcare from different theoretical
perspectives on strategy.
Students are able to evaluate contemporary challenges and changes in healthcare
governance and strategy;
Students are able to deal with, and reflect on, complex healthcare issues in a serious game
Content
Healthcare managers increasingly face changes in the policy environment that affect the ways they
organize and manage daily care processes. For example, legal requirements for patient participation
force healthcare managers to install patient representatives in their advisory boards, and safety
regulations ask for structured ways of organizing and accounting for the quality of care provided.
Policy measures influence the strategic choices of managers; if patient safety is displayed as an
important problem in healthcare, rendering patient safety a top priority of the healthcare institution
can be a valuable way of presenting the institution to third-party payers and patients. Yet,
incorporating national policy aims and measures in the organization’s policies also transforms the
role of the healthcare organization; a healthcare organization is not a neutral adaptor of national
policy requirements, but actively gives shape to these very policies. For instance, what patient
participation means and how the actual role of patients in the healthcare organization’s decision
making process is fleshed out in practice, takes shape in the day-to-day interactions between
healthcare managers, healthcare practitioners and quality staff. This course aims to provide HCM
students with theoretical lenses as well as practical knowledge to the understanding and dealing with
governance and strategy issues in healthcare organizations.
In this course, we focus on how governance arrangements influence the strategic choices of
healthcare managers, and how healthcare organizations themselves govern healthcare practices. We
explore the challenges healthcare managers face in their ‘inner’ and ‘outer’ circle of governing care.
In doing so, we prepare (future) healthcare managers for the turbulent practices they are in or will
run into in the near future. Moreover, by attending to social scientific literature on governance and
strategy we seek to develop (future) managers’ reflexive skills and to provide them with new ideas
and tools to come to grips with governance and strategy issues in healthcare and healthcare
organizations.
1
,Table of Contents
Week 1 What is governance?.................................................................................................................3
Lecture 1.............................................................................................................................................3
Workgroup 1.......................................................................................................................................6
Literature............................................................................................................................................8
Riley – governance in operating room nursing: nurses’ knowledge of individual surgeons...........8
Scholten – structuring ambiguity in hospital governance ............................................................10
Peters: Developments in intergovernmental relations: towards multi-level governance............14
Week 2: Working with layers................................................................................................................16
Lecture 2...........................................................................................................................................17
Workgroup 2 Caring for the community...........................................................................................20
Literature..........................................................................................................................................22
Van den Bovenkamp: working with layers – the governance and regulation of healthcare quality
in an institutionally layered system .............................................................................................22
Week 3: Decentralizing care and the role of informal care givers........................................................25
Lecture 3 Decentralisation: the citizen perspective..........................................................................26
Week 5: What is strategy?....................................................................................................................35
Lecture 5...........................................................................................................................................36
Workgroup 5.....................................................................................................................................46
Literature..........................................................................................................................................51
Mintzberg: reconsidering the basic premises of strategic management .....................................51
Jarzabkowski: Strategizing: the challenges of a practice perspective...........................................56
De Korne: hospital benchmarking – are US eye hospitals ready?.................................................59
Spee: Strategy tools as boundary objects.....................................................................................61
Week 6: Strategy development............................................................................................................64
Lecture 6...........................................................................................................................................65
Workgroup 6.....................................................................................................................................66
Literature..........................................................................................................................................67
Johnson 2017 – Business strategy and models.............................................................................67
Johnson 2010 – The ritualization of strategy workshops..............................................................70
Scholes 1998 – Stakeholder mapping...........................................................................................71
2
,Week 1 What is governance?
Lecture 1
Governance is about implementing policy and solutions to seek towards solutions for problems
Things outside the organization are impacting the way you want to manage your organization
Governance is multilevel
- Meso: strategies to run your
organization
- Macro: outside context that impacts
your organization (international
treaties, social norms, economy,
technological innovation, inequalities,
labour market)
- Micro: daily practices and routines
In this course we analyze policy on a macro-
level. How this impacts organisations on a meso
level. What this means for people’s daily
practices on a micro-level, and how these levels
interact
Governance is about getting things done in networks
- Network is in contrast to hierarchy. We have moved from hierarchies to networks
- It used to be about top down control. Politics is hierarchical, they make laws, ministries
implement these laws. Minister, civil servers (ambtenaren) implement the policies
3
, From government…
- Empirical change that Rhodes identifies. A different way of thinking. The authority/power of
the state is hollowed out. Much decision making is moved to higher levels, European Union
and the WHO. At the same time hollowing out sideways, to markets and private companies.
And also from down below, communities/citizens have become much more assertive and
critical. And decentralization towards municipalities
o It is an empirical observation, something that has changed. It is not positive or
negative
- 2 examples of working in networks.
o Dual hospital governance. The power of medical specialists versus the managers.
o Multi problem households. Families have many different problems at the same time.
Police, judges, caseworkers, physicians. They need to work in networks, coordination
mechanisms need to be used. How to facilitate information exchange
o These are ideal theoretical models. In practice there is still a lot of hierarchy.
4
Summary
Objectives of this course:
Students are able to explain theories on governance and strategy;
Students are able to analyse governance issues in healthcare from different theoretical
perspectives on governance.
Students are able to analyse strategic issues in healthcare from different theoretical
perspectives on strategy.
Students are able to evaluate contemporary challenges and changes in healthcare
governance and strategy;
Students are able to deal with, and reflect on, complex healthcare issues in a serious game
Content
Healthcare managers increasingly face changes in the policy environment that affect the ways they
organize and manage daily care processes. For example, legal requirements for patient participation
force healthcare managers to install patient representatives in their advisory boards, and safety
regulations ask for structured ways of organizing and accounting for the quality of care provided.
Policy measures influence the strategic choices of managers; if patient safety is displayed as an
important problem in healthcare, rendering patient safety a top priority of the healthcare institution
can be a valuable way of presenting the institution to third-party payers and patients. Yet,
incorporating national policy aims and measures in the organization’s policies also transforms the
role of the healthcare organization; a healthcare organization is not a neutral adaptor of national
policy requirements, but actively gives shape to these very policies. For instance, what patient
participation means and how the actual role of patients in the healthcare organization’s decision
making process is fleshed out in practice, takes shape in the day-to-day interactions between
healthcare managers, healthcare practitioners and quality staff. This course aims to provide HCM
students with theoretical lenses as well as practical knowledge to the understanding and dealing with
governance and strategy issues in healthcare organizations.
In this course, we focus on how governance arrangements influence the strategic choices of
healthcare managers, and how healthcare organizations themselves govern healthcare practices. We
explore the challenges healthcare managers face in their ‘inner’ and ‘outer’ circle of governing care.
In doing so, we prepare (future) healthcare managers for the turbulent practices they are in or will
run into in the near future. Moreover, by attending to social scientific literature on governance and
strategy we seek to develop (future) managers’ reflexive skills and to provide them with new ideas
and tools to come to grips with governance and strategy issues in healthcare and healthcare
organizations.
1
,Table of Contents
Week 1 What is governance?.................................................................................................................3
Lecture 1.............................................................................................................................................3
Workgroup 1.......................................................................................................................................6
Literature............................................................................................................................................8
Riley – governance in operating room nursing: nurses’ knowledge of individual surgeons...........8
Scholten – structuring ambiguity in hospital governance ............................................................10
Peters: Developments in intergovernmental relations: towards multi-level governance............14
Week 2: Working with layers................................................................................................................16
Lecture 2...........................................................................................................................................17
Workgroup 2 Caring for the community...........................................................................................20
Literature..........................................................................................................................................22
Van den Bovenkamp: working with layers – the governance and regulation of healthcare quality
in an institutionally layered system .............................................................................................22
Week 3: Decentralizing care and the role of informal care givers........................................................25
Lecture 3 Decentralisation: the citizen perspective..........................................................................26
Week 5: What is strategy?....................................................................................................................35
Lecture 5...........................................................................................................................................36
Workgroup 5.....................................................................................................................................46
Literature..........................................................................................................................................51
Mintzberg: reconsidering the basic premises of strategic management .....................................51
Jarzabkowski: Strategizing: the challenges of a practice perspective...........................................56
De Korne: hospital benchmarking – are US eye hospitals ready?.................................................59
Spee: Strategy tools as boundary objects.....................................................................................61
Week 6: Strategy development............................................................................................................64
Lecture 6...........................................................................................................................................65
Workgroup 6.....................................................................................................................................66
Literature..........................................................................................................................................67
Johnson 2017 – Business strategy and models.............................................................................67
Johnson 2010 – The ritualization of strategy workshops..............................................................70
Scholes 1998 – Stakeholder mapping...........................................................................................71
2
,Week 1 What is governance?
Lecture 1
Governance is about implementing policy and solutions to seek towards solutions for problems
Things outside the organization are impacting the way you want to manage your organization
Governance is multilevel
- Meso: strategies to run your
organization
- Macro: outside context that impacts
your organization (international
treaties, social norms, economy,
technological innovation, inequalities,
labour market)
- Micro: daily practices and routines
In this course we analyze policy on a macro-
level. How this impacts organisations on a meso
level. What this means for people’s daily
practices on a micro-level, and how these levels
interact
Governance is about getting things done in networks
- Network is in contrast to hierarchy. We have moved from hierarchies to networks
- It used to be about top down control. Politics is hierarchical, they make laws, ministries
implement these laws. Minister, civil servers (ambtenaren) implement the policies
3
, From government…
- Empirical change that Rhodes identifies. A different way of thinking. The authority/power of
the state is hollowed out. Much decision making is moved to higher levels, European Union
and the WHO. At the same time hollowing out sideways, to markets and private companies.
And also from down below, communities/citizens have become much more assertive and
critical. And decentralization towards municipalities
o It is an empirical observation, something that has changed. It is not positive or
negative
- 2 examples of working in networks.
o Dual hospital governance. The power of medical specialists versus the managers.
o Multi problem households. Families have many different problems at the same time.
Police, judges, caseworkers, physicians. They need to work in networks, coordination
mechanisms need to be used. How to facilitate information exchange
o These are ideal theoretical models. In practice there is still a lot of hierarchy.
4
