Entrepreneurship in care for elderly people with dementias:Situated responses to NPM-based healthcare reforms in the Netherlands

Background: Despite the great confidence of Western governments in the principles of New Public Management (NPM) and its ability to stimulate “healthcare entrepreneurship”, it is unclear how policies seeking to reform healthcare services provoke such entrepreneurship in individual institutions providing long-term healthcare. This study examines such situated responses in a Dutch nursing home for elderly people suffering from dementias such as Alzheimer’s disease.Methods: A four-year inductive longitudinal single-case study has been conducted. During this time period, the Dutch government imposed various NPM-based healthcare reforms and this study examines how local responses unfolded in the nursing home. Through interviews conducted with managers, administrators and supporting staff, as well as the examination of a large volume of government instructions and internal documents, the paper documents how these reforms resulted in several types of entrepreneurship, which were not all conducive to the healthcare innovations the government aspired to have.Results: The study records three subsequent strategies deployed at the local level: elimination of healthcare services; nonhealthcare related collaboration with neighboring institutions; and specialization in specific healthcare niches. These strategies were brought about by specific types of entrepreneurship – two of which were oriented towards the administrative organization rather than healthcare innovations. The study discusses the implications of having multiple variations of entrepreneurship at the local level.Conclusion: Governmental policies for healthcare reforms may be more effective, if policymakers change output- based funding systems in recognition of the limited control by providers of long-term healthcare over the progression of clients’ mental disease and ultimate passing

Tijdig bestuur : Strategisch omgaan met voorspelbare verrassingen

Hoe bereiden we ons voor op voorspelbare verrassingen: verrassingen die er onvermijdelijk aankomen, maar waarvan de inhoud vooraf niet te voorzien is? En hoe komen we voorbij de voorspelbare vooruitzichten, die er bij beleidsvorming altijd zijn, maar die achteraf steevast de cruciale dynamiek blijken te hebben gemist? Hoe maken we discontinuïteit en dynamiek weer onderdeel van het omgaan met onzekere toekomst en van beleidsprocessen

Identity work of management accountants in a merger:the construction of identity in liminal space

In response to calls for research on the ways in which management accountants make sense of their professional identities in organisational disruptions, this paper explores their identity work during a merger. Drawing on a case study of a merger between two Dutch banks, the paper examines their identity work as they found themselves in a liminal state – i.e. “betwixt and between” workplace identities. The paper identifies two types of identity work in a merger. Inside-out identity work was the process of identity negotiation through which each partnering group sought to make sense of their own distinctive liminal experiences. This type of identity work brought about intra- and inter-professional conflict. By contrast, outside-in identity work was founded on intergroup bases of identification, which were authenticated by credible role-models. This type of identity work gave rise to the construction of a superordinate workplace identity through which incoherent workplace identities could co-exist with shared intergroup identities. The paper contributes to the literature by highlighting the persistence of incoherent identity positions of management accountants in a merger and the intergroup struggles this generates. Moreover, it illuminates the processes through which these positions can ultimately be brought closer together

The transferral of risks in health care: risk management in a centre for the elderly

Dit artikel analyseert een kleine instelling voor ouderenzorg die blootstaat aan verscheidene risico’s als gevolg van de wettelijke veranderingen in de zorgsector. Hoewel kleinere instellingen voor langdurige ouderenzorg niet altijd gestructureerde methodieken als COSO ERM of ISO 31000 voor de beheersing van hun bedrijfsvoeringrisico’s volgen, blijkt uit de analyse dat kleine instellingen zeer actief kunnen zijn in de beheersing van deze risico’s. Deze beheersing is vooralsnog reactief, maar veel van de activiteiten die al worden ondernomen in kleine instellingen passen goed in een risicobeheersingsmethodiek zoals het bovengenoemde ISO 31000.Dit artikel analyseert een kleine instelling voor ouderenzorg die blootstaat aan verscheidene risico’s als gevolg van de wettelijke veranderingen in de zorgsector. Hoewel kleinere instellingen voor langdurige ouderenzorg niet altijd gestructureerde methodieken als COSO ERM of ISO 31000 voor de beheersing van hun bedrijfsvoeringrisico’s volgen, blijkt uit de analyse dat kleine instellingen zeer actief kunnen zijn in de beheersing van deze risico’s. Deze beheersing is vooralsnog reactief, maar veel van de activiteiten die al worden ondernomen in kleine instellingen passen goed in een risicobeheersingsmethodiek zoals het bovengenoemde ISO 31000.<br/