LECTURES
Week 1: What is governance?
In the first lecture, we set the scene for Governance & Strategy. We sketch contemporary
challenges for healthcare managers in their ‘inner’ and ‘outer’ context and introduce
theoretical concepts to come to grips with these challenges. The ‘inner context’ refers to the
direct hospital environment in which day-to-day organizational actions take place to provide
good quality care. The outer context encapsulates a wide range of actors that directly or
indirectly influence the healthcare organization and provision of care, like the municipality,
the health insurer, the inspectorate, and the state.
1.1 Governance: principles and challenges ahead
Until now: mainly focused on the inner context (organizational characteristics)
- Organizational behaviour
- Quality & Safety
Now: include the outer context
- Social environment/community
- Culture
- Technology
- Politics
- Law
Some examples:
- International agreements
- Budget costs
- Staff shortage
- Social expectations
- Technological innovation
This outer context might influence the inner context of the organization, and also the other
way around
This course: focus on the interaction between those two
,Past and current challenges for healthcare managers:
- Brexit: possible no-deal Brexit
o Availability of medicine: uncertainty in 2019 if with a no-deal Brexit, we could
still get these 15 different medications for patients.
Pharmacies tried to make it themselves in the EU instead of buying
them from the UK
Looking elsewhere in the EU if it is available
Those 15 medicines were secret, preventing patients from buying up
everything
o CE-mark approval for medical devices means that it is approved for the whole
EU to use it. Uncertainty if the CE-marks in the UK would still remain valid
when the UK would leave the EU with a no-deal.
It would be too hard for healthcare organization to analyze every
device for where it has been approved and what the implications are.
The minister said that is their problem to find out.
The Academic Medical Centers wrote a letter which says that they
need legislation to deal with it. The healthcare organizations here
influence the policy.
- Staff shortages
o Policy solutions on a state-level (macro-level)
E.g., role of task substation (e.g., nurses taking over tasks of doctors),
introducing technology as a solution, role of volunteers and informal
care givers
o What happens within organizations… (meso-level)?
E.g., who bears clinical responsibility, complexities with implementing
and using technology, professional boundaries
o How do people act… (micro-level)?
E.g., new professional roles often rely on trust, what do patients want,
technologies embedded in existing routines (I am Alice (documentary))
- COVID-19 pandemic
Macro: healthcare systems
- Health policies, role of patients and citizens, view on care and health, role of
professional and patient associations
Meso: healthcare organizations
- Health policies travel downwards and shape the everyday reality of care
organizations, role of managers, professionals, patients, municipalities, social care,
etc.
Micro: day-to-day interactions of individuals
- Between professionals and patients/care takers, between professionals and
managers
,In this course we explore and analyze how policy on a macro-level impacts what is done in
organizations on a meso-level and how people act and interact on a micro-level, and vice
versa.
, 1.2 Introducing governance & strategy
Governance:
- Governance code in healthcare
- Umbrella concept including different forms
o Managerial
o Professional
o Institutions
o Actors
- Governance means different things on macro, meso and micro level
- Central point: got some element of steering
From government to governance….
Government:
- Places of power
- ‘Torentje’ in the Hague
- White house
- Power of the government is mostly centralized: top-down
Governance:
- “Hollowing out the state” (Rhodes, 2007) – more and more responsibility’s going
from a government (central position) to elsewhere
A lot of responsibilities have shifted to other stakeholders! Their level of control has
decreased as well.
Strategy:
- Heading into a certain direction
- Aiming for a certain goal
- There are different concepts of strategy in both literature and practice
- Example: Kodak. Most example come from the private/business sector. The word
“kodak-momentje” was used to describe a beautiful situation which is worth taking a
photo. It was a very successful company until the ‘70’s, when digital photography
Week 1: What is governance?
In the first lecture, we set the scene for Governance & Strategy. We sketch contemporary
challenges for healthcare managers in their ‘inner’ and ‘outer’ context and introduce
theoretical concepts to come to grips with these challenges. The ‘inner context’ refers to the
direct hospital environment in which day-to-day organizational actions take place to provide
good quality care. The outer context encapsulates a wide range of actors that directly or
indirectly influence the healthcare organization and provision of care, like the municipality,
the health insurer, the inspectorate, and the state.
1.1 Governance: principles and challenges ahead
Until now: mainly focused on the inner context (organizational characteristics)
- Organizational behaviour
- Quality & Safety
Now: include the outer context
- Social environment/community
- Culture
- Technology
- Politics
- Law
Some examples:
- International agreements
- Budget costs
- Staff shortage
- Social expectations
- Technological innovation
This outer context might influence the inner context of the organization, and also the other
way around
This course: focus on the interaction between those two
,Past and current challenges for healthcare managers:
- Brexit: possible no-deal Brexit
o Availability of medicine: uncertainty in 2019 if with a no-deal Brexit, we could
still get these 15 different medications for patients.
Pharmacies tried to make it themselves in the EU instead of buying
them from the UK
Looking elsewhere in the EU if it is available
Those 15 medicines were secret, preventing patients from buying up
everything
o CE-mark approval for medical devices means that it is approved for the whole
EU to use it. Uncertainty if the CE-marks in the UK would still remain valid
when the UK would leave the EU with a no-deal.
It would be too hard for healthcare organization to analyze every
device for where it has been approved and what the implications are.
The minister said that is their problem to find out.
The Academic Medical Centers wrote a letter which says that they
need legislation to deal with it. The healthcare organizations here
influence the policy.
- Staff shortages
o Policy solutions on a state-level (macro-level)
E.g., role of task substation (e.g., nurses taking over tasks of doctors),
introducing technology as a solution, role of volunteers and informal
care givers
o What happens within organizations… (meso-level)?
E.g., who bears clinical responsibility, complexities with implementing
and using technology, professional boundaries
o How do people act… (micro-level)?
E.g., new professional roles often rely on trust, what do patients want,
technologies embedded in existing routines (I am Alice (documentary))
- COVID-19 pandemic
Macro: healthcare systems
- Health policies, role of patients and citizens, view on care and health, role of
professional and patient associations
Meso: healthcare organizations
- Health policies travel downwards and shape the everyday reality of care
organizations, role of managers, professionals, patients, municipalities, social care,
etc.
Micro: day-to-day interactions of individuals
- Between professionals and patients/care takers, between professionals and
managers
,In this course we explore and analyze how policy on a macro-level impacts what is done in
organizations on a meso-level and how people act and interact on a micro-level, and vice
versa.
, 1.2 Introducing governance & strategy
Governance:
- Governance code in healthcare
- Umbrella concept including different forms
o Managerial
o Professional
o Institutions
o Actors
- Governance means different things on macro, meso and micro level
- Central point: got some element of steering
From government to governance….
Government:
- Places of power
- ‘Torentje’ in the Hague
- White house
- Power of the government is mostly centralized: top-down
Governance:
- “Hollowing out the state” (Rhodes, 2007) – more and more responsibility’s going
from a government (central position) to elsewhere
A lot of responsibilities have shifted to other stakeholders! Their level of control has
decreased as well.
Strategy:
- Heading into a certain direction
- Aiming for a certain goal
- There are different concepts of strategy in both literature and practice
- Example: Kodak. Most example come from the private/business sector. The word
“kodak-momentje” was used to describe a beautiful situation which is worth taking a
photo. It was a very successful company until the ‘70’s, when digital photography
