Nicolette van Gestel

Medical doctors in healthcare leadership: theoretical and practical challenges

BackgroundWhile healthcare systems vary in their structure and available resources, it is widely recognized that medical doctors play a key role in their adaptation and performance. In this article, we examine recent government and organizational policies in two different health systems that aim to develop clinical leadership among the medical profession. Clinical leadership refers to the engagement and guiding role of physicians in health system improvement. Three dimensions are defined to conduct our analysis of engaging medical doctors in healthcare leadership: the position and status of medical doctors within the system; the broader institutional context of governmental and organizational policies to engage medical doctors in clinical leadership roles; and the main factors that may facilitate or limit achievements.MethodsOur aim in this study is exploratory. We selected two contrasting cases according to their level of institutional pluralism: one national health insurance system, Canada, and one etatist social insurance system, the Netherlands. We documented the institutional dynamics of medical doctors’ engagement and leadership through secondary sources, such as government websites, key policy reports, and scholarly literature on health policies in both countries.ResultsInitiatives across Canadian provinces signal that the medical profession and governments search for alternatives to involve doctors in health system improvement beyond the limitations imposed by their fundamental social contract and formal labour relations. These initiatives suggest an emerging trend toward more joint collaboration between governments and medical associations. In the Dutch system, organizational and legal attempts for integration over the past decades do not yet fit well with the ideas and interests of medical doctors. The engagement of medical doctors requires additional initiatives that are closer to their professional values and interests and that depart from an overly focus on top down performance indicators and competition.ConclusionsDifferent institutional contexts have different policy experiences regarding the engagement and leadership of medical doctors but seem to face similar policy challenges. Achieving alignment between soft (trust, collaboration) and hard (financial incentives) levers may require facilitative conditions at the level of the health system, like clarity and stability of broad policy orientations and openness to local experimentation.

The activation logic in national sickness absence policies: Comparing the Netherlands, Denmark and Ireland

We compare sickness absence policies in the Netherlands, Denmark and Ireland, examining whether and how the institutional logic of ‘activation’ that is paramount in Europe is understood and given shape in each country. They differ in their support for the underlying ideas of ‘activation’, and especially vary in the design of their governance systems, as can be seen in the allocation of responsibilities, the description of return-to-work routines and the use of regulative instruments. We contribute to institutional theory by demonstrating the important but often neglected role of national governance systems in the macro–micro linkage between institutional logics and organizational and individual behaviour. Since sickness absence is a major cause of workforce inactivity, the practical relevance of this study is the comparative reflection on recent policy developments to improve sickness absence management.

The Emergence of Hybrid Professional Roles: GPs and secondary school teachers in a context of public sector reform

ABSTRACT Responding to recent calls for more context and history in studying (semi-)professionals in the public sector, this article examines the emergence of hybrid professional roles along with large-scale reforms of Dutch healthcare and education since 1965. Using a theoretical framework based on public management literature and key professional attributes, the article shows how hybrid role expectations are developed by accumulation rather than replacement of successive reform models. Within a single national context, it also highlights considerable sectoral variation in how reform affects professionals’ roles, suggesting a complex mutual relationship between reform and professions rather than a one-sided policy impact.

Leadership and Innovation in Healthcare Governance

Healthcare systems in high-income countries are once again under pressure to develop major reforms to achieve cost control and high standards of qual- ity and safety (Birnbaum, 2012; Maynard, 2013; Saltman and Cahn, 2013). Yet the reform models of the past — system restructuring and severe budget cuts — are no longer a viable option (Denis et al., 1999), and alternative routes are necessary (Institute of Medicine, 2012; McQueen et al., 2012; Nasmith et al., 2010; Starfield, 2011). For example, the political scientist Carolyn Tuohy (2012) argues that institutional entrepreneurs at the me so and operational levels increasingly play a key role in the design and implementation of innovative healthcare delivery. Due to their in-depth knowledge of the healthcare needs and organizational practices, these entrepreneurs may be in a better position to test new ideas about the organization and delivery of healthcare, and consequently bring more appropriate solutions to broad policy dilemmas.

Dis-able bodied or "dis-able minded": stakeholders' return-to-work experiences compared between physical and mental health conditions

Abstract Purpose: This study aimed to explore if and why the return-to-work (RTW) experiences of various workplace stakeholders in the Netherlands and Denmark differ between physical and mental health conditions, and to understand the consequences of potentially different experiences for the RTW process in both health conditions. Methods: We studied 21 cases of long-term sickness absence, and held a total of 61 semi-structured interviews with the various actors involved in these cases. Results: Physical cases were seen as “easy” and mental cases as “difficult” to manage, based on the visibility and predictability of health complaints. On this ground, assessing work ability and following required RTW actions were perceived as more urgent in mental than in physical cases. Despite these perceptions, in practice, the assessment of work ability seemed to impair the RTW process in mental cases (but not in physical ones), and the (non-)uptake of RTW actions appeared to have similar results in both mental and physical cases. Conclusions: With these outcomes, the effectiveness of a differential approach is questioned, and the relevance of a bidirectional dialog on work ability and a phased RTW plan is highlighted, regardless of the absence cause. Our study also demonstrates how policymakers need to strike a balance between obligatory and permissive legislation to better involve workplaces in RTW issues. Implications for rehabilitation Both physically and mentally sick-listed employees could benefit from a bidirectional dialog on work ability as well as from a phased RTW plan. A greater role for employers in the RTW process should be accompanied with a support for sick-listed employees, in both physical and mental sickness absence cases. Dutch and Danish RTW legislation could be improved by carefully balancing obligatory and permissive rules and regulations to involve workplaces in RTW matters.

Institutional Logics and Micro-processes in Organizations: A Multi-actor Perspective on Sickness Absence Management in Three Dutch Hospitals

Since healthcare organizations often have significant problems with the recruitment and retention of staff (McKee et al., 2008), preventing sickness absence and improving return-to-work processes are highly relevant for hospitals in order to deliver adequate services and ensure the quality and quantity of healthcare (Boselie et al., 2003). A high turnover of employees increases costs (e.g. recruitment and training) and potentially decreases patient care. Turnover can seriously affect both patients and other employees through higher error rates and increased workloads. In this chapter, we examine the implementation of new legislation aimed at preventing sickness absence and solving obstacles towards the return to work for sick-listed employees. We selected three hospitals in the Netherlands to study how national legislation for sickness absence management is understood and enacted locally by the involved actors.