Governance and Strategy
Lectures and working groups
2021-2022
Health Care Management
Erasmus University
Merel21
Table of contents
Table of contents.........................................................................................................................................1
Week 1 - Governance..................................................................................................................................2
Lecture Introduction governance and strategy........................................................................................2
Working group.........................................................................................................................................2
Questions.............................................................................................................................................3
Week 2 – Governance..................................................................................................................................4
Lecture Institutional theory to better understand Governance & Strategy.............................................4
Week 3 – Governance..................................................................................................................................6
Lecture Decentralizing care and the role of informal care givers (the citizen perspective).....................6
Working group.........................................................................................................................................9
Questions.............................................................................................................................................9
Week 4 – Serious game.............................................................................................................................11
Extra notes about governance...............................................................................................................11
Week 5 – Strategy......................................................................................................................................11
, Lecture Theoretical perspectives on strategy........................................................................................11
Working group.......................................................................................................................................14
Questions...........................................................................................................................................14
Week 6 – Strategy......................................................................................................................................16
Week 1 - Governance
Lecture Introduction governance and strategy
Different levels:
1. Level of day-to-day practices (relations between caregivers and patients) (micro)
2. Organizational level (meso)
3. Level consisting of international treaties, technological innovation, labor market, inequalities,
economy, social norms, etc. (macro)
We analyze policy on a macro-level and how this impacts organizations on a meso-level. What does this
mean for people's daily lives on a micro-level? How do these levels interact?
Governance is about getting things done in a network/hierarchy.
Two examples of governance:
1. Dual hospital governance
2. Multi-problem households
Strategy: what can you do to address challenges?
Working group
Read the following articles:
Peters (2001). Developments in intergovernmental relations: towards multi-level governance.
Rhodes (2007). Understanding governance: Ten years on.
Scholten (2018). Structuring ambiguity in hospital governance.
Riley (2006). Governance in operating room nursing: Nurses’ knowledge of individual surgeons.
, Questions
1. How is governance defined and described in the articles?
Peters Scholten Riley Rhodes
Multi-level Processes and tools Controlling New process of governing or a
governance, related to (shared) behavior and the changed condition of ordered
negotiated, non- decision-making in shaping of rule or method by which
hierarchal steering the totality of practices. society is being governed.
exchanges between institutional capacity and Power to direct Governing with and through
institutions. major aspects of conduct, with the networks: interdependence
organizational behavior. concept of between organizations.
Vertical layering of mentality. Strategic. If company A makes
governance Complex relationship Governmentality. decision A, then company B
processes. between stakeholders. will make decision B.
Internal and external Practices of the
Responsibility dynamics. self. Interactions between networks
remains for the Lot of autonomy.
government. Governability = the overall Autonomous
capacity for governance. nurse.
2. What is the role of governance in these four articles: what or whom is being ‘steered’ and how? What
does this tell us about what the concept of governance entails?
Peters Scholten Riley Rhodes
The state is ‘enabling’ Decision-making Steering your Hollowing out the state:
and not proactively arrangements at hospital own and the state is not the only
governing. Used to be level rest on positions, other's actor. Governance of
command and control. behavior and networks.
Low formalization and the autonomy. Autonomy for smaller
Multi-level governance important role of behavioral actors.
due to decentralization. norms and trust.
3. Describe and explain the similarities and the differences between the articles in their use of the
concept of governance. Think about different ways of looking at governance from a macro, meso and
micro perspective.
Rhodes and Peters: hollowing out the state, less centralized power. Although the state is
hollowed out, it is still involved and responsible at the end. Therefore, the shadow of hierarchy
remains. Moreover, central departments need cooperation (resources).
Riley and Scholten: define behavior -> internal dynamics.
Peters: macro. Sometimes, lower-level organizations have more power than higher-level organizations.
Rhodes: macro. Helicopter view. Top-down.
Scholten: meso. Governance between managers and specialists. Reach a power balance. Governing
takes place on its own level.
Riley: micro.
--------------------------------------------------------------------------------------------------------------------------------------
*Governance: movement of power/authority from the government to more decentralized actors.
Lectures and working groups
2021-2022
Health Care Management
Erasmus University
Merel21
Table of contents
Table of contents.........................................................................................................................................1
Week 1 - Governance..................................................................................................................................2
Lecture Introduction governance and strategy........................................................................................2
Working group.........................................................................................................................................2
Questions.............................................................................................................................................3
Week 2 – Governance..................................................................................................................................4
Lecture Institutional theory to better understand Governance & Strategy.............................................4
Week 3 – Governance..................................................................................................................................6
Lecture Decentralizing care and the role of informal care givers (the citizen perspective).....................6
Working group.........................................................................................................................................9
Questions.............................................................................................................................................9
Week 4 – Serious game.............................................................................................................................11
Extra notes about governance...............................................................................................................11
Week 5 – Strategy......................................................................................................................................11
, Lecture Theoretical perspectives on strategy........................................................................................11
Working group.......................................................................................................................................14
Questions...........................................................................................................................................14
Week 6 – Strategy......................................................................................................................................16
Week 1 - Governance
Lecture Introduction governance and strategy
Different levels:
1. Level of day-to-day practices (relations between caregivers and patients) (micro)
2. Organizational level (meso)
3. Level consisting of international treaties, technological innovation, labor market, inequalities,
economy, social norms, etc. (macro)
We analyze policy on a macro-level and how this impacts organizations on a meso-level. What does this
mean for people's daily lives on a micro-level? How do these levels interact?
Governance is about getting things done in a network/hierarchy.
Two examples of governance:
1. Dual hospital governance
2. Multi-problem households
Strategy: what can you do to address challenges?
Working group
Read the following articles:
Peters (2001). Developments in intergovernmental relations: towards multi-level governance.
Rhodes (2007). Understanding governance: Ten years on.
Scholten (2018). Structuring ambiguity in hospital governance.
Riley (2006). Governance in operating room nursing: Nurses’ knowledge of individual surgeons.
, Questions
1. How is governance defined and described in the articles?
Peters Scholten Riley Rhodes
Multi-level Processes and tools Controlling New process of governing or a
governance, related to (shared) behavior and the changed condition of ordered
negotiated, non- decision-making in shaping of rule or method by which
hierarchal steering the totality of practices. society is being governed.
exchanges between institutional capacity and Power to direct Governing with and through
institutions. major aspects of conduct, with the networks: interdependence
organizational behavior. concept of between organizations.
Vertical layering of mentality. Strategic. If company A makes
governance Complex relationship Governmentality. decision A, then company B
processes. between stakeholders. will make decision B.
Internal and external Practices of the
Responsibility dynamics. self. Interactions between networks
remains for the Lot of autonomy.
government. Governability = the overall Autonomous
capacity for governance. nurse.
2. What is the role of governance in these four articles: what or whom is being ‘steered’ and how? What
does this tell us about what the concept of governance entails?
Peters Scholten Riley Rhodes
The state is ‘enabling’ Decision-making Steering your Hollowing out the state:
and not proactively arrangements at hospital own and the state is not the only
governing. Used to be level rest on positions, other's actor. Governance of
command and control. behavior and networks.
Low formalization and the autonomy. Autonomy for smaller
Multi-level governance important role of behavioral actors.
due to decentralization. norms and trust.
3. Describe and explain the similarities and the differences between the articles in their use of the
concept of governance. Think about different ways of looking at governance from a macro, meso and
micro perspective.
Rhodes and Peters: hollowing out the state, less centralized power. Although the state is
hollowed out, it is still involved and responsible at the end. Therefore, the shadow of hierarchy
remains. Moreover, central departments need cooperation (resources).
Riley and Scholten: define behavior -> internal dynamics.
Peters: macro. Sometimes, lower-level organizations have more power than higher-level organizations.
Rhodes: macro. Helicopter view. Top-down.
Scholten: meso. Governance between managers and specialists. Reach a power balance. Governing
takes place on its own level.
Riley: micro.
--------------------------------------------------------------------------------------------------------------------------------------
*Governance: movement of power/authority from the government to more decentralized actors.
