Creativity at the margins: A cross-country case study on how Dutch and Norwegian peripheries address challenges to quality work in care for older persons

Hester van de Bovenkamp*, Nienke van Pijkeren, Eline Ree, Ingunn Aase, Terese Johannessen, Hans Vollaard, Iris Wallenburg, Roland Bal, Siri Wiig

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
28 Downloads (Pure)


Peripheral areas are often overlooked in health-care research but they in fact deserve specific attention. Such areas struggle to maintain access to good quality health-care services due to their geographical context. At the same time, new interventions or promising innovations often emerge in places where creativity is urgently needed. In this paper, we explore this creativity at the margins in older persons care organizations in peripheral areas, which other healthcare providers and policymakers can learn from.

This exploratory study is based on two large research projects on the quality of care for older persons in Norway and the Netherlands. We performed secondary analysis of interviews with quality managers and other quality workers and used additional document analysis and expert interviews to deepen our analysis.

The results show that older persons care organizations working in peripheral areas must deal with a number of challenges caused by their geographical context, e.g. geographical distances (between services and to the geographical center), workforce shortages, and landscape characteristics. We found that organizations use different strategies to tackle these challenges, such as scaling up, brightening up and opening up. These strategies, conceptualized as creativity at the margins, impact quality work in different ways, for example by enabling more person-centered care.

We conclude that both policymakers and research should overcome their peripheral blindness by learning from and supporting creativity at the margins in future policies and research.
Original languageEnglish
Pages (from-to)66-73
Number of pages8
JournalHealth Policy
Early online date16 Dec 2022
Publication statusPublished - Jan 2023

Bibliographical note

The authors wish to thank all the respondents for taking the time to share their stories. We thank The Research Council of Norway, HELSEVEL and the University of Stavanger and the Regional Care Offices for funding this research. We thank Dr. Dara Ivanova and members of the Health Care Governance group and members of SHARE- Center for Resilience in Healthcare for their useful feedback on an earlier draft of this paper.

Publisher Copyright: © 2022


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