The Conditions for Health and Social Care Policy: Routines and Institutions in the Dutch Case of Need Assessment

Abstract

By focusing on institutions (rules for action) and routines (patterned behaviour) our intention is to contribute to the understanding of government policy and its outcomes in health and social care. We analysed data to show how the relationship between a new idea for a routine and new rules from the government on the one hand, and existing rules and routines in society on the other, as well as the interaction between rule makers and rule takers (i.e. those who are governed by those rules), have an impact on the change or maintenance of routines. The data concern the case of government policy for need assessment (that is, assessment of needs) in The Netherlands. As our discussion will show, even a national government, however, is not able to completely impose its will on other agents in order to change existing routines. The concept of ‘negotiated order’ helps us to understand why. In the case reported here, the Dutch government and the home care agencies had to exercise give and take, the outcome being a suboptimal result for both.

Can we make sense of multidisciplinary co‐operation in primary care by considering routines and rules?

“…The author suggests that rules, existing in the legal and organisational context, are one important condition for the occurrence of change in routines. A similar assertion has been made by Van Raak et al. (2007), who suggest that rules limit actors’ choice of actions and, as such, are likely to have an impact on the change or maintenance of routines (Feldman 2000, Van Raak et al.…”

“…The author suggests that rules, existing in the legal and organisational context, are one important condition for the occurrence of change in routines. A similar assertion has been made by Van Raak et al (2007), who suggest that rules limit actors' choice of actions and, as such, are likely to have an impact on the change or maintenance of routines (Feldman 2000, Van Raak et al 2007. Given its promising perspective, we chose the viewpoint of routines and rules as the theoretical basis for explaining the limited form of multidisciplinary co-operation in the primary care sector of Limburg.…”

“…Notwithstanding these implicit references to routines and rules, both concepts are underrepresented in the current literature on healthcare co‐operation. Relatively few studies (Van Raak et al. 2007, 2008) have focused explicitly on providers’ working routines and the rules that shape them.…”

“…Notwithstanding these implicit references to routines and rules, both concepts are underrepresented in the current literature on healthcare co-operation. Relatively few studies (Van Raak et al 2007 have focused explicitly on providers' working routines and the rules that shape them. Focussing on routines can potentially shed a new light on what hampers the emergence of multidisciplinary co-operation in health-care.…”

Organizational routines as embodied performatives: A communication as constitutive of organization perspective

“…The role and importance assigned to historical experience is still to be resolved; while previous iterations are acknowledged to influence current performances of routines, but not dictate them in a path-dependency sense, there are also those who see path-dependency as having a more dominant effect on how routines materialize (e.g. Becker, 2004;Becker et al, 2005;Leonardi, 2011;Pentland et al, 2012;Van Raak et al, 2007). Actors are said to have a repertoire of potential actions to draw from; the actual performance Feldman and Pentland (2003) assert, drawing from Giddens (1993) again, could always have been different.…”