Governance & Strategy

Question 1

What is governance?

Answer 1

Governance is about getting things done/working in a structure of networks. It could be your own financial work, the broader economy, how you work together with staff/colleagues etc.

Question 2

How did governance arise?

Answer 2

It has arised since the decline of the welfare state. Governmental expenses were too high and a lot was privatized. The dissapearance of command control (everything is imposed from above) led networking to happen.

Question 3

Rhodes (2007) says governance is about networking, what did he say exactly?

Answer 3

It is about networking: a new process or method in which society is governed. It has arised since the decline of the welfare state and uses concepts of policy networks, reduced responsibility of core executives and hollowing out of the state. He also says there are interactions between micro/meso/macrolevel and forms the basis of a multi-level approach.

Question 4

Scholten (2018) says governance is about three main incentives, what are those and what does he say about hospital governance?

Answer 4

Scholten wrote about governance in hospitals and said it is all about trust, negotiation and consensus. For example, there needs to be some kind of grey area/ambiguity within dual management of a hospital governance, to be able to deliberate with each other. The main concepts discussed are the internal (the hospital organization itself) and external (governments/stakeholders) dynamics.

Question 5

Riley (2006) writes about governance within nurse-doctor relationship, what does he say exactly?

Answer 5

It is about governmentality: how governing is thought about and approached. They write about nurses’ knowledge of surgeons and say the role of governance is defining authority and controle in nurse-doctor relationship. Main concepts: nurses are seen and treated as a handmaiden.

Question 6

Peters (2001) writes about multi-level governance. What does this entail and what does he say about layering?

Answer 6

A baseline definition of multi-level governance is that it refers to negotiated, non-hierarchical exchanges between institutions at the transnational, national, regional and local levels. Communication between those levels is however not just vertically ‘layered’, how we usually think it is (top-down communication), but institutional relationships do not have to operate through intermediary levels but can take place directly between, say, the transnational and regional levels, thus bypassing the state level.

Question 7

What is microlevel governance about?

Answer 7

Governance in situated day-to-day practices. Eg daily practices of people that work in an hospital

Question 8

What is mesolevel governance about?

Answer 8

Governance in institutions and organizational management. Eg the decisions they make, the practices they perform, the happenings within a hospital

Question 9

What is macrolevel governance about?

Answer 9

Governance in socio-political context, culture, technology, law etc. Eg which party has the power in the government (right/left)

Question 10

What does decentralization entail?

Answer 10

A shift in focus and locus: from central to local government; from government to governance

Question 11

What are different dimensions of decentralization? (Saltman & Bankauskaite, 2006)

Answer 11

1. Political decentralization: Shifting policy making responsibility from central to local levels
2. Administrative decentralization: The state retains control over policy making and political decisions, but shifts management and service delivery to lower-level government and private organizations
   * Eg. Asylum seekers healthcare
3. Fiscal decentralization: Shifting fund-raising and / or expenditure responsibilities from central to local levels
   * Eg. Local taxes; a city can set their own parking rates

Question 12

What are rationales for decentralization? (Saltman & Bankauskaite)

Answer 12

1. Civic
   * We are affected by decentralization
2. Social
   * It is good for wellbeing of communities to decentralize; they know their community, they can implement local leadership
3. Political
   * Might be more politically effective ot have decisions made by people closer to you
4. Economic
   * It might be cheaper (for society as a whole) to decentralize things
   * E.g. combine many functions at local level (gezondheidscentrum), you only have to pay for one building etc.
   * E.g. combination of library, elderly care facility, school

Question 13

What are challenges for decentralization in neighbourhood governance? (Saltman & Bankauskaite)

Answer 13

Capabele co-assistent die gezellig is
- capaciteit
- competentie
- diversiteit
-gelijkheid

1. Capacity: The local governance is likely to control fewer of the aspects of citizens’ situation over which they desire influence. Trade-off between the extent of participation and the scope of control
2. Competence: In comparison with larger units, neighbourhood governance is likely to attract leaders (and representatives) of lower calibre given the small pool from which they can be drawn. Trade-off between accessibility and competence
3. Diversity: Neighbourhoods are likely to exhibit less diversity and provide less opportunity for divergence of views on individual, group, and general interests and goals. There may be greater likelihood in neighbourhood governance that a single interest (or segment of citizens) will dominate. Trade-off between cohesion and pluralism.
4. Equity: Devolution to neighbourhoods implies increased differentiation in public service delivery across areas. Trade-off between local choice and equity. Richer communities can dominate the poorer communities.

Question 14

What are dilemmas deriving from involving informal care givers?

Answer 14

1. Quality of life vs quality of care: outcome? who is responsible for what?
2. Professionalisation vs de-professionalization: Responsibilities and cooperation?
3. Individual responsibility vs solidarity: value orientation; new challenges concerning solidarity in healthcare?

Question 15

What is boundary work?

Answer 15

Boundary work is often understood as demarcation work and includes efforts of ‘erecting and maintaining boundaries’ […], for instance, through monopolisation, expansion, exclusion and protection […]. However, boundary work is also about bridging and crossing boundaries [welcoming work]

Question 16

What does institutional work entail?

Answer 16

Activities of actors to change or maintain institutions has been conceptualized as institutional work: daily coping and keeping up with institutional structures thereby creating, disrupting and maintaining institutions

Question 17

What is institutional layering?

Answer 17

Institutional layering is a type of institutional change in which new institutions are added on top of or alongside existing ones. Institutional layering does not mean that new arrangements simply overlie others but that arrangements interact with each other, which can lead to large and unpredictable transformations

Question 18

Four ways of (changing) institutional work?

Answer 18

DD (dubbel D) CoLa

1. Displacement: one institution is being replaced by another
2. Drift: institution changes their meaning over time
3. Conversion: institution is being used for different purposes
4. Layering: one institution on top of the other

Question 19

What is strategy?

Answer 19

You can see strategy as a plan, as a ploy, as a pattern or as a perspective. In this last respect, strategy is to the organization what personality is to the individual: it is the main part of what the organization does.

Question 20

What is the design perspective of strategy?

Answer 20

A simple model that views the process as one of design to achieve an essential fit between external threat and opportunity and internal distinctive competence.

Question 21

What are the premises/assumptions in the design school?

Answer 21

1. Strategy formation should be a controlled process of thought: actions follow strategies (but, it is not that rational)
2. Responsibility for that control and conciousness must rest with the CEO: that person is THE strategist (but, excludes external actors)
3. The model of strategy formation must be kept simple and informal (but, no theory/research infiltrated)
4. Strategies must be unique, it should be a creative process (but, says little about the content of strategy)
5. Strategies emerge fully formulated (but, little room for emergent strategies)
6. Strategies should be explicit and simple (but, inflexibility)
7. Structure follows strategy (but, you cannot wipe out the existing structure)

Question 22

What is the strategy-as-practice approach?

Answer 22

It is a reaction on the design-perspective approach. The strategy-as-practice approach emphasizes explicit links between micro- and macro perspectives on strategy as a social practice. It is about working in a network, dealing with eachother, dealing with (unexpected) uncertainties and being able to react to them. It includes praxis-practices-practitioners.

Question 23

Explain the praxis-practices-practitioners and the middle part of the figure.

Answer 23

• Praxis: The broader social context that is (re)produced through practices. Situated learning and action, e.g. gender norms concerning nursing. “We have this praxis, what is appropriate given the situation we are in?”
• Practices: e.g. what practitioners do, are engaged in, e.g. nursing practices
• Practitioners: Who acts, e.g. Managers, doctors, nurses, CEO

The middle overlapping point in the figure illustrates that strategy is a process: you have to constantly negotiate with eachother and understand how everyone acts.

Question 24

What are boundary objects?

Answer 24

The concept of a boundary object is about finding ways to bridge the gaps and differences between different groups or disciplines, in order to facilitate communication and collaboration. By using common tools or artefacts, individuals can work together more effectively and achieve better outcomes than they would be able to alone. A strategy tool could also function as a boundary object, eg. SWOT-analysis, benchmarking, stakeholder mapping.

Question 25

What are different types of boundaries in boundary work?

Answer 25

1. Syntactic boundaries are the simplest, assuming that knowledge can be transferred between actors providing that there is a common syntax.
2. A semantic boundary is more complex because common meanings need to be developed in order to translate knowledge; for example, between a marketing department and a sales division, as they interpret what each other requires in order to market and sell a product
3. Pragmatic boundaries are the most socially and politically complex, as common interests need to be developed to transform knowledge at a pragmatic boundary […]. For example, during periods of strategic uncertainty, actors within different divisions might have different political interests about what constitutes the appropriate course of strategic action

Question 26

What does the concept of strategic management entail?

Answer 26

The concept of strategic management helps you to elaborate on how you are going to make and implement your strategy. Is is about the choices you make and how you are going to make these choices, and what tools you can use.

Question 27

What is stakeholder mapping? (Scholes 1998)

Answer 27

It is an important strategy tool that was developed as a critique on strategy-as-design approach. It emphasizes power and interests of stakeholders. It is a way to ‘on-board’ stakeholders early in the process of strategy development.