The mutual shaping of governance and regulation of quality and safety in Dutch healthcare

Developing the concepts of governance and regulation is path dependent: working with the complexity of governance and regulation shapes and reshapes both their meaning and form. We conducted a case study on governance and regulation of quality and safety in Dutch hospitals to reveal these processes. We found that governance was given meaning in several phases, ranging from a focus on institutional design (e.g. corporate governance) through coping with incidents and using quality measurements, to prospective risk management. Governance changed incrementally in form and practice. We also saw that governance and regulation are intertwined; regulation shapes governance and is simultaneously shaped by changes in the meaning of governance. Insight into these processes is important to better understand what is defined as ‘‘good governance’’ and ‘‘good regulation’’ in a certain context. Understanding the mutual development of these concepts and practices reveals potential pathways to continuous shaping of good governance.