Unmasking a health care system: the Dutch policy response to the Covid-19 crisis

Abstract

The Covid-19 pandemic has put policy systems to the test. In this paper, we unmask the institutionalized resilience of the Dutch health care system to pandemic crisis. Building on logics of crisis decision-making and on the notion of ‘tact’, we reveal how the Dutch government initially succeeded in orchestrating collective action through aligning public health purposes and installing socio-economic policies to soften societal impact. However, when the crisis evolved into a more enduring one, a more contested policy arena emerged in which decision-makers had a hard time composing and defending a united decision-making strategy. Measures have become increasingly debated on all policy levels as well as among experts, and conflicts are widely covered in the Dutch media. With the 2021 elections ahead, this means an additional test of the resilience of the Dutch socio-political and health care systems.

Healthcare leaders’ use of innovative solutions to ensure resilience in healthcare during the Covid-19 pandemic: a qualitative study in Norwegian nursing homes and home care services

“…Some innovations are incremental solutions for improving situational practices and products, while others contribute to disrupting the entire industry. A crisis is traditionally described as an unexpected event with accompanying uncertainties, posing a threat to humans and places, where decisions need to be made at a fast pace [3]. This leaves few opportunities for careful and resourceintensive development of new solutions, a feature known to be important in the early phases of innovation development [13].…”

“…The Norwegian healthcare system, and healthcare systems worldwide, had to use their available staff, knowledge, and equipment resources to provide the best possible care for patients suffering from a new and unfamiliar disease, while preventing the virus from spreading among staff and patients. Most research on the Covid-19 outbreak has been directed towards hospitals and especially intensive care units [3].…”

Dancing with a Virus: Finding New Rhythms of Organizing and Caring in Dutch Hospitals

“…However, the Dutch healthcare system is a layered system (van de Bovenkamp et al, 2014), in which 'the healthcare market' operates next to, and intermingles with, other institutional arrangements. This became highly visible in governing the COVID-19 outbreak (Wallenburg, Helderman, et al, 2021).…”

“…Responding to the Dutch public debate (e.g., RVS, 2020) and to reports that have been published during the summer on a decline in public acceptance of stringent measures, the cabinet has endeavored to broaden the scope of the experts included in their advisory committees, like social scientists. However, when infection rates went up again after the summer, resulting in a second wave and with a probable third wave ahead, policy focus has again increasingly narrowed on curbing the spread of the virus again (Wallenburg, Helderman, et al, 2021).…”

“…Whereas especially during the peak of the crisis, work routines as well as expert opinion had been authoritative and more or less unified, flattening the curve seemed to be inversely related to the number and diversity of opinions coming to the fore. Both in the media and in the regional coordination structures, more and more voices were heard, and also explicitly called for (RVS, 2020;Wallenburg, Helderman, et al, 2021). Within the hospitals, different disciplines tried to start up non-COVID care and were calling for attention and resources.…”