'Becoming a co-operative?': Emergent identity and governance struggles in the context of institutional ambiguity in a citizen-led health-care cooperative

This chapter explores the emergence of the Dutch citizen-led health-care cooperative Texel Samen Beter (TSB). TSB was started in 2014 by a group of concerned citizens on the island of Texel, the Netherlands, to improve health-care services. Specifically, the chapter traces how the TSB board engaged in a number of activities to give meaning to the cooperative’s emergent identity. Moving from an abstract idea to having an impact on the health-care sector, to actually ‘becoming’ a fully functioning cooperative, proved to be a challenging endeavor. Not only did the cooperative struggle with internal ambiguity and a lack of consensus about what TSB should stand for but external actors also tried to take advantage of the uncertain institutional landscape and to impose their own ideas on the budding cooperative. Ultimately, the chapter shows that, through important decisions, communications and activities, the TSB board has managed to navigate the institutional complexity it faced and come to establish itself as a legitimate actor in the Dutch health-care sector. The wider implications of the story of TSB speak to the importance of understanding the process by which an identity emerges, which is of particular relevance to hybrid organizations like cooperatives.