by Oemar van der Woerd, Jitse Schuurmans, Iris Wallenburg, Wilma van der Scheer and Roland Bal
In an attempt to deal with societal issues like changing demographics and the sustainability of welfare state regimes, policymakers increasingly seek solutions to organise care closer to citizens’ homes, in close cooperation between health and social care providers and informal caregivers. ‘The region’ is presented as a promising place to organise and provide a networked model of care (see for instance the Integrated Care Boards in the UK, or caring regions in Scandinavian countries). Yet, the region, as a new entity of governance, must be incorporated into existing governance arrangements. Our central research question in our recent article published in Policy & Politics addressed this issue: How is the region made into a ‘governance object’?
In exploring how the region is made a governance object, we draw on years of (ongoing) research on older person care and care for disabled people in the Netherlands, where we follow regional experiments, such as task reallocation between professionals (see here for more information). We analyse the work of professionals, managers and policymakers in their attempts to shape ‘the region’.
A governance object can be described as the translation of a particular policy problem into a tangible object that can be regulated. Examples are CO2 for climate change or hygiene regulations for food safety. The region can be described as a governance object because it is used as an administrative (geographical) place to make collaboration in healthcare more commonplace and legitimised. Whereas the construction of a governance object has consequences for the distribution of resources and is thus political, those involved have to work in an institutional void. In our research, we identified three ways of how affected actors make use of this institutional void to construct the region as a governance object:
- Creating urgency to highlight regional problems and solutions: when regional actors and national authorities create urgency for the region as a collaborative place that shapes regional interests. The formulation of regional interests is, however, contested, as it involves the (re)negotiation of organisational boundaries.
- Renegotiating regulatory policies to facilitate regional care: when regional actors and national authorities initiate experiments to renegotiate current regulatory policies and instruments to facilitate regional care provision. In doing so, they create a ‘collaborative timespace’ to transform the hitherto non-existing region into a legitimate caring place.
- Reconstructing care infrastructures to establish regional care: when regional actors and national authorities translate the region as an abstract policy ambition into tangible care infrastructures—including buildings, health records and the like. These require new governance roles that can develop from these new infrastructures and make adjustments accordingly, and new interprofessional relations.
In summary, to encourage collaboration within a given regulatory environment, the making of a governance object is an important yet underexplored approach. In our case, the region as a distinct administrative and geographical space served this purpose. Studying the interactions between regional actors and national authorities reveals the required iterations over time that are part and parcel of how a governance object is made within a given (ambiguous) institutional context, and to which institutional changes this may lead. This raises questions about the (democratic) legitimacy of the region: How can regions with less network capital and health infrastructures participate? What roles do citizens, municipalities, and national governments play in this regard? As regional organisation policies are increasingly scrutinised, more attention to these underexplored questions is warranted.
You can read the original research in Policy & Politics at:
van der Woerd, O., Schuurmans, J., Wallenburg, I., van der Scheer, W., & Bal, R. (2024). Heading for health policy reform: transforming regions of care from geographical place into governance object. Policy & Politics (published online ahead of print 2024) from https://doi.org/10.1332/03055736Y2024D000000030
If you enjoyed this blog post, you may also be interested to read:
Bates, G., Ayres, S., Barnfield, A., & Larkin, C. (2023). What types of health evidence persuade policy actors in a complex system?. Policy & Politics, 51(3), 386-412 from https://doi.org/10.1332/030557321X16814103714008
Kilty, J. M., & Orsini, M. (2024). Emotions and anti-carceral advocacy in Canada: ‘All of the anger this creates in our bodies is also a tool to kill us’. Policy & Politics, 52(2), 219-238 from https://doi.org/10.1332/03055736Y2023D000000024
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