Abstract
In this paper we explore the impact of the emerging COVID-19 pandemic on the governance of healthcare in the Netherlands. In doing so, we re-examine the idea that a crisis necessarily leads to processes of transition and change by focusing on crisis as a specific language of organizing collective action instead. Framing a situation as a crisis of a particular kind allows for specific problem definitions, concurrent solutions and the inclusion and exclusion of stakeholders. Using this perspective, we examine the dynamics and institutional tensions involved in governing healthcare during the pandemic.
We make use of multi-sited ethnographic research into the Dutch healthcare crisis organization as it responded to the COVID-19 pandemic, focusing on decision-making at the regional level. We tracked our participants through successive waves of the pandemic between March 2020 and August 2021 and identified three dominant framings of the pandemic-as-crisis: a crisis of scarcity, a crisis of postponed care and a crisis of acute care coordination. In this paper, we discuss the implications of these framings in terms of the institutional tensions that arose in governing healthcare during the pandemic: between centralized, top-down crisis management and local, bottom-up work; between informal and formal work; and between existing institutional logics.
We make use of multi-sited ethnographic research into the Dutch healthcare crisis organization as it responded to the COVID-19 pandemic, focusing on decision-making at the regional level. We tracked our participants through successive waves of the pandemic between March 2020 and August 2021 and identified three dominant framings of the pandemic-as-crisis: a crisis of scarcity, a crisis of postponed care and a crisis of acute care coordination. In this paper, we discuss the implications of these framings in terms of the institutional tensions that arose in governing healthcare during the pandemic: between centralized, top-down crisis management and local, bottom-up work; between informal and formal work; and between existing institutional logics.
| Original language | English |
|---|---|
| Article number | 115998 |
| Journal | Social Science & Medicine |
| Volume | 328 |
| DOIs | |
| Publication status | Published - Jul 2023 |
Bibliographical note
Funding Information:We are grateful to our participants for their hospitality and openness during the pandemic, and to our colleagues Jenske Bal, Iris Wallenburg, Syb Kuijper and Karin Kalthoff, who worked on the study. This paper builds on two research projects conducted by Erasmus School of Health Policy & Management at Erasmus University Rotterdam: an NWO-funded project under the Corona: Fast-track Data program (440.20.018) and a project funded by ZonMw under the COVID-19 program into the organization of care and prevention (10430022010029). The second project was carried out in close collaboration with Zorgbelang Inclusief, who were involved in the sub-study into patient and client representation. The final version of this paper was edited for language by C.M. Willems.
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© 2023 The Authors