Lecture 1 – Governance & Strategy - Introduction
Content:
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.
Learning targets:
Students are able to describe contemporary challenges in healthcare governance.
Students are able to explain how the (national) institutional context matters for goals and
challenges in healthcare governance and strategy.
Q/A session – 26/03/2021
Lack of strategic envision for vaccinations is there? This is a link with this course
Game:
Not really a preparation necessary, but you need to read some documents
Part 1 – Setting the scene
During the previous courses we have mainly focussed on the inner context (organisational behaviour,
or quality and safety). This course will look at the outer context (laws etc.). Underneath is an
important summary of the course in 1 sheet:
The outer context might influence the inner context and vice versa. So its about the interaction
between those 2.
Some past and current challenges for healthcare managers…
1. Brexit: possible no deal Brexit, has medical implications
A year back, a possible no deal BREXIT with UK leaving the EU without a deal has implications for
healthcare organisations:
- Availability of medicine; it was unclear if certain UK medicine would still be available in the
EU en the Netherlands. For 50 medicines there was no solution for it yet’
- Certain possibilities: try to make is ourselves or look elsewhere in the EU
- This list of 50 medicines was interesting because it was kept a secret; they were afraid
patients would stock up (like with the toilet papers), also the CE mark approval for medical
1
, devices. It means that its approved for the whole EU to use. There were some medical
devises were approved in UK; were they still valid with a no deal? Found out which
medical devices from the UK have a approval and look at that, are they still valid or can we
find the systems elsewhere?
Healthcare organisations wrote a letter to state that they need emergency legislation to
deal with this, because we as healthcare organisations cannot go after all those devices
to see where they have come from and how they are approved. This led to the
instalment of a emergency legislation, so healthcare organisations influencing the
external environment
Second important summary sheet of this course:
Healthcare systems (Macro)
Health policies, role of patients and citizens, view on care and health, role of professional and
patient associations
Healthcare organizations (Meso)
Health policies travel downwards and shape the everyday reality of care organizations, role
of managers, professionals, patients, municipalities, social care, etc.
Day-to-day interactions of individuals (Micro)
Between professionals and patients/care takers, between professionals and managers
This framework however is just a framework, it is a tool for us to study practice but in reality it might
not be that easy to distinguish between macro and meso. Macro will influence meso and micro level,
but again vice versa.
2. Staff shortages
Policy solutions on a state-level (macro)
e.g. discussion, role of task substitution (nurses taking over of doctors), introducing technology as a
solution, role of volunteers and informal care givers
What happens within organizations… (meso) e.g. who bears clinical responsibility (the doctor or the
nurse who takes over?), complexities with implementing and using technology, professional
boundaries (e.g. between volunteers and professionals)
How do people act… (micro) e.g. new professional roles often rely on trust, what do patients want,
technologies embedded in existing routines (‘I am Alice’)
I am Alice might have some negative aspects as well (robot reminds of loneliness)
3. COVID-19 pandemic
! In this course we explore and analyse how policy on a macro-level impacts what is done in
organisations on a meso-level and how people act and interact on a micro-level, and vice versa.
Part 2 – Introducing G&S
Governance..
Governance is a umbrella concept covering multiple things; it means different things on macro, meso
and micro level. All definitions of government it all has something about steering. Development from
government to government.
2
,From government…
We generally think about places of power (see pictures). This has some underlying assumptions:
- Power of the government is mostly centralises (top-down); powerful government
representatives determine the course and decision making. It assumes important political
decision are made in the Hague etc. and implemented somewhere else (top-down)
… to governance
The development to governance is something as; hollowing out the state. There is more and more
responsibilities going from the government and elsewhere. There level of control has decreases
(relying on different stakeholders)
Strategy
3
, Lots of people will think about heading at a certain direction/aiming at a certain goal (strategy)
However there are different definitions
Kodak: most strategy things come from the private sector, one of the famous examples is kodak.
Kodak moment: a situation which is beautiful and worth taking a picture off
KODAK was a really successful company until the 70s when digital photography came, they neglected
it a bit. They still exist right now, but do not make cameras anymore. They missed the boat on digital
photography.
Strategy is also meant to keep you afloat, changing your outer context of your healthcare
organisation, everything around you changes, and you have to adapt to that.
E.g. the role of technology changes a lot in healthcare (japan and robot doctor)
Strategy is also about how you present yourself to the rest of the world.
Aim of the course:
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.
Part 3 – Course outline & practical issues
Essay:
- Personal reflection on experience
- Relation to what you’ve done to the course until then; how this game relates to the things
we learned about governance
Questions of workgroup week 2 and 5 you can expect those questions in the exam!
Part 4 – Interview & reflection corona outbreak (example of approaching
a case study)
Interview dr. Bert de Graaff
4
Content:
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.
Learning targets:
Students are able to describe contemporary challenges in healthcare governance.
Students are able to explain how the (national) institutional context matters for goals and
challenges in healthcare governance and strategy.
Q/A session – 26/03/2021
Lack of strategic envision for vaccinations is there? This is a link with this course
Game:
Not really a preparation necessary, but you need to read some documents
Part 1 – Setting the scene
During the previous courses we have mainly focussed on the inner context (organisational behaviour,
or quality and safety). This course will look at the outer context (laws etc.). Underneath is an
important summary of the course in 1 sheet:
The outer context might influence the inner context and vice versa. So its about the interaction
between those 2.
Some past and current challenges for healthcare managers…
1. Brexit: possible no deal Brexit, has medical implications
A year back, a possible no deal BREXIT with UK leaving the EU without a deal has implications for
healthcare organisations:
- Availability of medicine; it was unclear if certain UK medicine would still be available in the
EU en the Netherlands. For 50 medicines there was no solution for it yet’
- Certain possibilities: try to make is ourselves or look elsewhere in the EU
- This list of 50 medicines was interesting because it was kept a secret; they were afraid
patients would stock up (like with the toilet papers), also the CE mark approval for medical
1
, devices. It means that its approved for the whole EU to use. There were some medical
devises were approved in UK; were they still valid with a no deal? Found out which
medical devices from the UK have a approval and look at that, are they still valid or can we
find the systems elsewhere?
Healthcare organisations wrote a letter to state that they need emergency legislation to
deal with this, because we as healthcare organisations cannot go after all those devices
to see where they have come from and how they are approved. This led to the
instalment of a emergency legislation, so healthcare organisations influencing the
external environment
Second important summary sheet of this course:
Healthcare systems (Macro)
Health policies, role of patients and citizens, view on care and health, role of professional and
patient associations
Healthcare organizations (Meso)
Health policies travel downwards and shape the everyday reality of care organizations, role
of managers, professionals, patients, municipalities, social care, etc.
Day-to-day interactions of individuals (Micro)
Between professionals and patients/care takers, between professionals and managers
This framework however is just a framework, it is a tool for us to study practice but in reality it might
not be that easy to distinguish between macro and meso. Macro will influence meso and micro level,
but again vice versa.
2. Staff shortages
Policy solutions on a state-level (macro)
e.g. discussion, role of task substitution (nurses taking over of doctors), introducing technology as a
solution, role of volunteers and informal care givers
What happens within organizations… (meso) e.g. who bears clinical responsibility (the doctor or the
nurse who takes over?), complexities with implementing and using technology, professional
boundaries (e.g. between volunteers and professionals)
How do people act… (micro) e.g. new professional roles often rely on trust, what do patients want,
technologies embedded in existing routines (‘I am Alice’)
I am Alice might have some negative aspects as well (robot reminds of loneliness)
3. COVID-19 pandemic
! In this course we explore and analyse how policy on a macro-level impacts what is done in
organisations on a meso-level and how people act and interact on a micro-level, and vice versa.
Part 2 – Introducing G&S
Governance..
Governance is a umbrella concept covering multiple things; it means different things on macro, meso
and micro level. All definitions of government it all has something about steering. Development from
government to government.
2
,From government…
We generally think about places of power (see pictures). This has some underlying assumptions:
- Power of the government is mostly centralises (top-down); powerful government
representatives determine the course and decision making. It assumes important political
decision are made in the Hague etc. and implemented somewhere else (top-down)
… to governance
The development to governance is something as; hollowing out the state. There is more and more
responsibilities going from the government and elsewhere. There level of control has decreases
(relying on different stakeholders)
Strategy
3
, Lots of people will think about heading at a certain direction/aiming at a certain goal (strategy)
However there are different definitions
Kodak: most strategy things come from the private sector, one of the famous examples is kodak.
Kodak moment: a situation which is beautiful and worth taking a picture off
KODAK was a really successful company until the 70s when digital photography came, they neglected
it a bit. They still exist right now, but do not make cameras anymore. They missed the boat on digital
photography.
Strategy is also meant to keep you afloat, changing your outer context of your healthcare
organisation, everything around you changes, and you have to adapt to that.
E.g. the role of technology changes a lot in healthcare (japan and robot doctor)
Strategy is also about how you present yourself to the rest of the world.
Aim of the course:
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.
Part 3 – Course outline & practical issues
Essay:
- Personal reflection on experience
- Relation to what you’ve done to the course until then; how this game relates to the things
we learned about governance
Questions of workgroup week 2 and 5 you can expect those questions in the exam!
Part 4 – Interview & reflection corona outbreak (example of approaching
a case study)
Interview dr. Bert de Graaff
4
