Regionalization in elderly care: what makes up a healthcare region?

Abstract

PurposeThe purpose of this paper is to explore the formation and composition of “regions” as places of care, both empirically and conceptually.Design/methodology/approachThis paper draws on action-oriented research involving experiments aimed at designing, implementing and evaluating promising solutions to the entwined problems of a burgeoning elderly population and an increasing shortage of medical staff. It draws on ethnographic research conducted in 14 administrative areas in the Netherlands, a total of 273 in-depth interviews and over 1,000 h of observations.FindingsThis research challenges the understanding of a healthcare region as a clearly bounded topological area. It shows that organizations and professionals collaborate in a variety of different networks, some conterminous with the administrative region established by policymakers and others not. These networks are by nature unstable and dynamic. Attempts to form new regional collaborations with neighbouring organizations are complicated by existing healthcare governance and accountability structures that position organizations as competitors.Practical implicationsPolicymakers should take the pre-established partnerships of healthcare organizations into account before delineating the area in which regionalization is meant to take place. A better alignment of governance and accountability structures is also needed for regionalization to occur in healthcare.Originality/valueThis paper combines insights from valuation studies with sociogeographical literature and provides a framework for understanding the assembling and disassembling of “regions”.

Boundary organising in healthcare: theoretical perspectives, empirical insights and future prospects

“…The final paper by Schuurmans et al (2021) takes us from neighbourhoods to regions. Its starting point is that healthcare domains can have multiple boundaries -administrative, geographic, and social -that coexist, overlap and at times conflict.…”

“…Luhmann's (2006Luhmann's ( , 2018 systems theoretical approach is used by Jansson et al (2021) to reveal strategies of justification involved in making and legitimating decisions about a hybrid hospital unit. The last two papers engage with place-based approaches, with Carlsson and Pijpers (2021) developing a relational perspective on neighbourhood governance, and Schuurmans et al (2021) exploring the formation and composition of "regions" as places of care. Detailed summaries of these contributions are presented in the following section.…”

“…In many ways, malleability of boundaries to repeated cycles of reconfiguration is a direct consequence of their dual, selectively permeable nature: boundaries and boundary bridges can serve, often at the same time, both as enablers of and barriers to knowledge sharing, collaborative working and diffusion of innovation. In addition, processes unfolding at local boundaries of practice are shaped by the features of technology increasingly deployed in contemporary healthcare (Allen, 2021;Sharp et al, 2021) as well as by existing governance and accountability arrangements (Carlsson and Pijpers, 2021;Schuurmans et al, 2021). Due to their highly reified nature, these factors may significantly constrain the agency of actors involved in boundary management.…”

“…On the other hand, it may be useful to consider local boundary phenomena as part of complex, multi-layered boundary landscapes in which different types of boundaries, such as spatial, administrative, professional, organisational and cultural, not only co-exist but overlap and conflict. The emergent, pluralistic and inconsistent nature of these complex boundary systems can be creatively exploited by local actors, who can choose from a range of boundary objects (Sharp et al, 2021), sense-making devices (Rowland et al, 2021), justification strategies (Jansson et al, 2021) and evaluative principles (Schuurmans et al, 2021) to realise their aspirations.…”

“…In terms of practical implications for healthcare managers involved in boundary reconfigurations, this special issue highlights the importance of ongoing reflection (Allen, 2021;Rowland et al, 2021), mitigation (Allen, 2021;Sharp et al, 2021), justification (Jansson et al, 2021;Schuurmans et al, 2021) and relational work (Carlsson and Pijpers, 2021;Schuurmans et al, 2021). Reflection should aim at "diagnosing" the boundary landscape, paying attention to discontinuities caused by the operation of particular boundaries and boundary objects as well as to misalignments between policies, governance structures and realities of work practice on the ground.…”