From ‘if only’ to ‘what if’:An ethnographic study into design thinking and organizational change

We aim to understand how public sector organizations practise ‘design thinking’ to respond to changing demands and develop alternative courses of action. The literature on design thinking is largely prescriptive; few studies analyse how change is actually brought about through situated design practices. Design scholars have therefore argued that such practices themselves should take centre stage as objects of analysis. We take an ethnographic approach to studying the design thinking journey of the Dutch Health Inspectorate, using participatory observations and interviews to collect our data. Drawing on the anthropological concept of ritualization, we identify two important mechanisms through which design thinking helped the Inspectorate disrupt existing organizational strategies and engage with stakeholders in a fundamentally new way.</p

“We don't experiment with our patients!” An ethnographic account of the epistemic politics of (re)designing nursing work

This article draws on ethnographic research investigating experimental reform projects in local nursing practices. These are aimed at strengthening nursing work and fostering nurses' position within healthcare through bottom-up nurse-driven innovations. Based on literature on epistemic politics and critical nursing studies, the study examines and conceptualizes how these nurses promote professional and organizational change. The research draws on data from two pilot projects to show how epistemic politics frame the production and use of knowledge within reform efforts. The study finds that knowledge produced through such experimenting is often not considered valid within the contexts of broader organizational transitions. The nurse-driven innovations fail to meet established legitimate criteria for informing change, both among stakeholders in the nurses' socio-political environment, as well as within the nursing community. The research reveals that the processes inadvertently reinforce normative knowledge hierarchies, perpetuating forms of epistemic injustice, limiting both nurses' ability to function as change agents and healthcare organizations’ capacity to learn.</p

From ‘if only’ to ‘what if’: An ethnographic study into design thinking and organizational change

We aim to understand how public sector organizations practise ‘design thinking’ to respond to changing demands and develop alternative courses of action. The literature on design thinking is largely prescriptive; few studies analyse how change is actually brought about through situated design practices. Design scholars have therefore argued that such practices themselves should take centre stage as objects of analysis. We take an ethnographic approach to studying the design thinking journey of the Dutch Health Inspectorate, using participatory observations and interviews to collect our data. Drawing on the anthropological concept of ritualization, we identify two important mechanisms through which design thinking helped the Inspectorate disrupt existing organizational strategies and engage with stakeholders in a fundamentally new way

Taking the relationship between populism and healthcare seriously

In this commentary, we reflect on Rinaldi and Bekker’s scoping review of the literature on populist radical right (PRR) parties and welfare policies. We argue that their review provides political scientists and healthcare scholars with a firm basis to further explore the relationships between populism and welfare policies in different political systems. In line with the authors, we furthermore (re)emphasize the need for additional empirical inquiries into the relationship between populism and healthcare. But instead of expanding the research agenda suggested – for instance by adding categories or niches in which this relationship can be observed – we would like to challenge some of the premises of the studies conducted and reviewed thus far. We do so by identifying two concerns and by illustrating these concerns with two examples from the Netherlands

Job crafting as retention strategy: An ethnographic account of the challenges faced in crafting new nursing roles in care practice

Nursing shortages in the global north are soaring. Of particular concern is the high turnover among bachelor‐trained nurses. Nurses tend to leave the profession shortly after graduating, often citing a lack of appreciation and voice in clinical and organisational decision‐making. Healthcare organisations seek to increase the sustainability of the nursing workforce by enhancing nursing roles and nurses' organisational positions. In the Netherlands, hospitals have introduced pilots in which nurses craft new roles. We followed two pilots ethnographically and examined how nurses and managers shaped new nursing roles and made sense of their (expected) impact on workforce resilience. Informed by the literature on professional ecologies and job crafting, we show how managers and nurses defined new roles by differentiating between training levels and the uptake of care‐related organisational responsibilities beyond the traditional nursing role. We also show how, when embedding such new roles, nurses needed to negotiate specific challenges associated with everyday nursing practice, manifested in distinct modes of organising, work rhythms, embodied expertise, socio‐material arrangements, interprofessional relationships, and conventions about what is considered important in nursing. We argue that our in‐depth case study provides a relational and socio‐material understanding of the organisational politics implicated in organising care work in the face of workforce shortages

Mapmaking and the (re)organization of professional practice

Combining insights from sociology and geography, we examine how professionals organize professional relations, beyond the boundaries of their profes

Together alone: organizing integrated, patient-centered primary care in the layered institutional context of Dutch healthcare governance

We aim to better understand the dynamic between professionals and institutions by scrutinizing how professionals conduct institutional work in a layered institutional context. To date, institutional scholars have either studied professionals or institutions as objects of maintenance or change. Here, we suggest an alternative ‘relational’ and ‘evolutionary’ interpretation of the relation between institutions and professionals. We do so by introducing a two-dimensional analytical framework. We illustrate the relevance of this framework by analyzing a policy implementation program called ‘Primary Focus’. This program sought to improve the provision of integrated and patient-centered primary care by organizing multidisciplinary collaboration. Progres

Who contextualises clinical epidemiological evidence?

We critically examine the discussion on the role of evidence-based medicine (EBM) in healthcare governance. We take the institutionally layered Dutch healthcare system as our case study. Here, different actors are involved in the regulation, provision and financing of healthcare services. Over the last decades, these actors have related to EBM to inform their actor specific roles. At the same time, EBM has increasingly been problematised. To better understand this problematisation, we organised focus groups and interviews. We noticed that particularly EBM’s reductionist epistemology and its uncritical use by ‘professional others’ are considered problematic. However, our analysis also reveals that something else seems to be at stake. In fact, all the actors involved underwrite EBM’s reductionist epistemology and emphasise that evidence should be contextualised. They however do so in different ways and with different contexts in mind. Moreover, the ways in which some actors contextualise evidence has consequences for the ways in which others can do the same. We therefore emphasise that behind EBM’s scientific problematisation lurks a political issue. A dispute over who should contextualise evidence how, in a layered healthcare system with interdependent actors that cater to both individual patients and the public. We urge public administration scholars and policymakers to open-up the political confrontation between healthcare actors and their sometimes irreconcilable, yet evidence-informed perspectives