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The scaling-up of Neighbourhood Care: From experiment towards a transformative movement in healthcare

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Abstract

To meet present and future challenges in healthcare, radically new approaches are needed that contribute to transforming the healthcare system. In the Netherlands this transition was envisioned by the Transition Programme Long-term Care (2007–2010) as “a fundamental change towards a more human centred, affordable and socially embedded healthcare system”. One of the experiments in this programme was Neighbourhood Care (in Dutch “Buurtzorg”): small-scale, self-managed teams of nurses who provide high-quality homecare in neighbourhoods. This article looks at Buurtzorg from the perspective of transition studies, building on the framework of ‘deepening, broadening and scaling-up’ transition experiments. We analyse how Buurtzorg could rapidly develop from a local experiment to a network of more than 800 teams and also spread to different care domains and abroad. The rapid development of Buurtzorg is explained by identifying their strategic activities, the alignment of contextual factors and their strategic position as outsider towards the regime. We conclude that Buurtzorg has become a ‘symbol’ in a transformative movement that can contribute to a future transition in healthcare. This case study contributes to theoretical and practice-oriented knowledge on how a transition experiment in a social domain can surpass the experimental phase, identifying key strategic activities for niche-mainstreaming.

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... This demonstrates intention and motivation to collaborate, and implies that the HD-IJGZ can be perceived as a good transition arena. Developing transition arenas is an important TM strategy (Rotmans & Loorbach, 2010) and is also applied in other healthcare transition programs aiming scaling up innovations in long-term care for experimenting, research, reflection and sharing lessons learned (Johansen et al., 2017;van den Bosch et al., 2017). ...
... Learning activities, such as the webinar, proof to create better understanding of different perspectives and interests of stakeholders. Numerous scholars agree that a learning approach may result in changes in ways of thinking and in composing joint actions that contribute to the transition experiments at niche level (de Wildt-Liesveld et al., 2015;Johansen et al., 2017;Loorbach, 2010). ...
... Strategies for successful scaling up digital innovations were: constantly repeating vision to create awareness, proactively recruiting organizations, using early adopter organization, sharing lessons learned and applying a transparent communication strategy. For the specific TM literature, not all of these strategic activities are novel (Johansen et al., 2017). However, the experiments studied in this research showed that these strategies are not always applied, since barriers were perceived for the development and scaling up of the transition experiments. ...
... However, in all cases the need for radical change is agreed upon. This foreseen systemic change primarily relates to the dominant structures, cultures and practices (Chreim et al., 2012;Essink, 2012;Van Raak, 2015;Johansen and Van den Bosch, 2017) and seeks to deal with the persistency and path-dependency that has been created and is being reproduced in the current system. Such a fundamental change in any system can be identified as a transition. ...
... Specifically, the expedition looked to inspire participants and make them more knowledgeable. The expedition introduced the concept of positive health (Huber, 2014) to help participants envision an alternative way of delivering healthcare. To transition scholars, the transition in healthcare is about realising human-centred healthcare that is economically viable and adds value to society, and is connected to the rest of society (Neuteboom et al., 2009;Van Raak, 2015). ...
... In the expedition session that centred around the theme "Patient and Client Care" (Figure 2) the participants were introduced to the concept of "positive health". The concept of positive health refers to a shift away from a healthcare paradigm that is focussed on illness and disease towards a paradigm based on health defined in terms of resilience and the ability to adapt and self-manage (Huber, 2014). The participants are in general agreement that the introduction to positive health was one of the most valuable rewards they collected in the expedition: ...
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Purpose Healthcare systems are facing persistent challenges, such as dealing with an ageing population, related increases in chronic diseases and healthcare costs facilitated by technological progress. The authors argue that the boundaries of optimisation are being reached and a more fundamental change or transition is necessary. The purpose of this paper is to explore the contours of this transition in the Netherlands. The authors do this from the perspective of healthcare organisations that have participated in the “Expedition to Sustainable Healthcare”: a learning programme organised by the Dutch Network for Sustainable Healthcare aimed at creating frontrunners in this transition. Design/methodology/approach The paper combines conceptual with experimental empirical work. The authors use the transition research frameworks to conceptualise persistent problems and transitional dynamics in the healthcare system. In a longitudinal study, the authors analysed how the participating organisations developed after the expedition. Findings The process validated the initial understanding of persistent sustainability challenges. An integral approach to sustainable healthcare is translated as a transformation of culture, structures and practices and the development of capacity for crossing borders and domains, inside and outside of the organisation. To facilitate and stimulate such a process the authors found that problem structuring and collective identification of persistent problems and the unsustainability in the healthcare system is a crucial step towards a shared view and discourse that supports change. Originality/value A transition in the Dutch healthcare system is just starting to emerge and has barely been subject of research. This paper provides an empirical description of a transition management process in this context. The authors hope to lay a foundation for future work that seeks to explore transitions in healthcare in theory and practice.
... Regimes are considered as having the dominant position and reproducing incumbent structures, including institutions, while niches attempt to challenge and change these structures. The normative-strategic perspective of Transition Management looks into the upscaling of niche innovations with the purpose of increasing their societal impact (Elzen et al., 2012;Ingram, 2015;Johansen and van den Bosch, 2017;Schot and Geels, 2008). For instance, Johansen and van den Bosch (2017) have proposed the framework of deepening, broadening and scaling-up as effective strategies for niche movements to increase the impact of their engagement. ...
... The meso level serves to connect the micro and macro dimension of the SET-conception by highlighting the transformative impact of change processes. It evaluates how change processes with a transformative character can take effect beyond the scope of their niche, scaleup their efforts and challenge larger societal structures and incumbent paradigms (bottom-up) (see Avelino and Rotmans, 2009;Brown, 2016;Johansen and van den Bosch, 2017). These changes manifest in revised institutions, which in turn serve as leverage points to facilitate and stabilize further change processes (top-down) (Beunen et al., 2017;Biggs et al., 2015;Brown, 2016). ...
... (1) Deepening and Building Resistance: This first step of challenging the status-quo aims at deepening the alternative by initiating continuous processes of learning and experimentation that create robustness to withstand external incumbent forces, create and expand spaces for decision-making and secure long-term institutionalization and funding (Brown, 2016;Johansen and van den Bosch, 2017). The central goal is to make visible that robust, viable alternatives to the status quo are possible. ...
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A fundamental transformation towards sustainability in face of complex social-ecological challenges needs to initiate deep changes of those incumbent system structures that support unsustainable trajectories, while at the same time encouraging a diversity of alternative practices. A review of transformation approaches towards sustainability shows that these do not (sufficiently) link processes of change at the micro level to deep leverages of change in wider system structures. Addressing this research gap, we develop a conceptual framework for a social-ecological transformation that connects the macro and the micro level and helps to bridge process-oriented and structural approaches to transformation. At the macro level, the objectives of inter-and intragenerational justice need to be pursued by challenging the central paradigms that constitute unsustainable trajectories. To make the framework concrete and applicable in practice, we propose a preliminary set of evaluation principles for the micro and meso level that reflect these normative objectives and help to measure the transformative character and transformative impact of change processes. The example of the European Organic Breeding Network illustrates the application of the framework. An Ecological Economics research that is reflective of its transformative quality in light of the incumbent paradigms can make important contributions to transformation research.
... Regimes are considered as having the dominant position and reproducing incumbent structures, including institutions, while niches attempt to challenge and change these structures. The normative-strategic perspective of Transition Management looks into the upscaling of niche innovations with the purpose of increasing their societal impact (Elzen et al., 2012;Ingram, 2015;Johansen and van den Bosch, 2017;Schot and Geels, 2008). For instance, Johansen and van den Bosch (2017) have proposed the framework of deepening, broadening and scaling-up as effective strategies for niche movements to increase the impact of their engagement. ...
... The meso level serves to connect the micro and macro dimension of the SET-conception by highlighting the transformative impact of change processes. It evaluates how change processes with a transformative character can take effect beyond the scope of their niche, scaleup their efforts and challenge larger societal structures and incumbent paradigms (bottom-up) (see Avelino and Rotmans, 2009;Brown, 2016;Johansen and van den Bosch, 2017). These changes manifest in revised institutions, which in turn serve as leverage points to facilitate and stabilize further change processes (top-down) (Beunen et al., 2017;Biggs et al., 2015;Brown, 2016). ...
... (1) Deepening and Building Resistance: This first step of challenging the status-quo aims at deepening the alternative by initiating continuous processes of learning and experimentation that create robustness to withstand external incumbent forces, create and expand spaces for decision-making and secure long-term institutionalization and funding (Brown, 2016;Johansen and van den Bosch, 2017). The central goal is to make visible that robust, viable alternatives to the status quo are possible. ...
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This cumulative dissertation (status: submitted) analyzes the transformative potential of Commons approaches in plant breeding, seed production or conservation (so-called Seed Commons) as alternative Governance approaches to tendencies of privatization and enclosure in the seed sector and the wider agri-food system. For this purpose, on the basis of a literature review, first a conceptualization of a social-ecological transformation (SET) is developed that allows to assess the contribution of small initiatives to a wider transformation. The proposed conceptual SET framework also contributes to connecting the strengths of diverse transformation literatures. In a comprehensive transdisciplinary process, a concept for 'Seed Commons' is developed that highlights shared characteristics of diverse Seed Commons initiatives. Seed Commons can be characterized by four criteria: by recognizing a collective responsibility for the conservation and further development of cultivated plants and genetic diversity, by protecting seeds and varieties from legal or (bio-)technological enclosure, through collective, polycentric management and by sharing formal and practical knowledge within and/or beyond the initiative. These criteria are suitable for a stringent analysis of the shared challenges and opportunities of Seed Commons initiatives. In the next step, I apply these Seed Commons criteria in a systematic document analysis to examine how the complexity of the multi-level governance regime around seeds, biodiversity and intellectual property rights impacts Seed Commons initiatives in Germany and the Philippines. The results show that especially the patent and variety protection regime as well as strict requirements for marketing of seeds can threaten central practices such as the sharing of seeds or their on-field adaptation and further development. Yet the impact of norms such as the conservation of biodiversity and farmers' rights of the biodiversity convention and the international Seed Treaty also contribute to exceptions that widen the scope of action of Seed Commons. Finally, this thesis highlights the very creative, differentiated and conscious ways in which Seed Commons initiatives deal with these incumbent institutional frame conditions, i.e. by resisting them or using gray areas. Through their alternative, everyday practices, they contribute to institutional and political change. Hence Seed Commons initiatives challenge dominant structures by disputing incumbent practices, rules and norms and creating a real and viable alternative on the ground. Overall this thesis shows, taking the example of Seed Commons initiatives, that even small initiatives can contribute to a social-ecological transformation, when they confront incumbent structures, institutions and paradigms, and create just and resilient alternatives. If you are interested in reading the introductory chapter to my cumulative dissertation, feel free to get in touch! (problem statement, main results and contributions, discussion of transdisciplinary methodology, future research avenues etc.) Three of the four papers of the cumulative thesis have (so far) been published, all open access. See below (also on my RG profile): - Tschersich, J. (2021). Norm conflicts as governance challenges for Seed Commons: Comparing cases from Germany and the Philippines. Earth System Governance, 7, 100097. https://doi.org/10.1016/j.esg.2021.100097 - Sievers-Glotzbach, S., Tschersich, J., Gmeiner, N., Kliem, L., & Ficiciyan, A. (2020). Diverse Seeds – Shared Practices: Conceptualizing Seed Commons. International Journal of the Commons, 14(1), 418–438. DOI: http://doi.org/10.5334/ijc.1043 - Sievers-Glotzbach, S. and J. Tschersich (2019): Overcoming the process-structure divide in conceptions of social-ecological transformation: Assessing the transformative character and impact of change processes. Ecological Economics 164. https://doi.org/10.1016/j.ecolecon.2019.106361
... The characteristics of Buurtzorg's model have been discussed elsewhere (Cristofalo et al., 2018;Johansen, van den Bosch, 2017) and its major landmarks can be found in Appendix 1. The particular context in which the founder, Jos de Blok [JdB], launched Buurtzorg was the inefficiency of large homecare institutions and the resulting frustration among nurses, thus contributing to its fast growth. ...
... The article lists ten main characteristics of the Buurtzorg model that are described as reflecting a process of social progress. A seminal study examining Buurtzorg's rapid development over ten years is presented as an example of "Transitional Management" (Johansen, van den Bosch, 2017). "Transition" initiatives are defined as small-scale experimentations that solve existing challenges through radical transformation. ...
... Funding from the MoH in 2006 through the Transition Programme in Long Term Care (van den Bosch, 2010) gave Buurtzorg a protected space for JdB to mature his vision of nursing teams developing "entrepreneurship and ownership" (Johansen, van den Bosch, 2017, p. 66 Outside its national borders, it appears that interest has arisen less from Buurtzorg's deliberate intention to diffuse internationally and seems more the result of local initiatives wishing to 'replicate' the model, having heard of its success. Yet assessing Buurtzorg's international adaptation requires further research to investigate how the model is being diffused across borders (Johansen, van den Bosch, 2017). As previously mentioned, detailed academic analyses of the process of cross-border initiatives remain scarce. ...
Article
The aim of this paper is to present initial findings from an exploratory case study analyzing the process of emergence and diffusion of a new homecare service in France. In healthcare delivery, innovations aiming to tackle structural aspects of the system can take the form of social innovation. Social innovation is generally defined as a process, rather than an outcome, creating strategies that reconfigure social relations to meet a social goal. Buurtzorg Nederland is an example of such innovation. Launched twelve years ago in the Netherlands by a small team of four, this innovative homecare organization now includes over 10,000 self-managed nurses providing efficient value- and team-based care to patients in their homes, empowering both staff and patients. Today Buurtzorg Nederland has grown and been transposed to other countries, but few studies describe the process of adoption. This paper explores how Buurtzorg has been adapted in France since 2017. JEL Codes: O35, I18, I1, O0
... Currently, a better understanding of the creative uses of discretion is especially relevant, as street-level practitioners across domains and countries are increasingly granted more formal latitude and encouraged to find novel solutions and novel ways of working (Durose 2011;Johansen and van den Bosch 2017;Kruyen and van Genugten 2017;Raaphorst and Loyens 2020;Rutz et al. 2017;Sabel et al. 2011;Sabel, Zeitlin, and Quack 2017;van Berkel, van Der Aa, and van Gestel 2010). This trend begs for further research into how discretion is used in practice. ...
... We consider the concept of creative discretion to be relevant beyond our case study, as it provides insight into a larger trend. Street-level practitioners are increasingly expected to find creative solutions in the provision and regulation of social services across Europe such as elderly care, social work, activation, and education (Durose 2011;Johansen and van den Bosch 2017;Kruyen and van Genugten 2017;Raaphorst and Loyens 2020;Rutz et al. 2017;Sabel et al. 2011;Sabel, Zeitlin, and Quack 2017;van Berkel, van Der Aa, and van Gestel 2010). Yet, a single case study comes with its limitations. ...
Article
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Although scholars and practitioners promote creative uses of discretion in the delivery of public services, there is limited empirical research that explains through which activities street‐level practitioners develop creative solutions. Based on over 300 hours of ethnographic observations of child and family practitioners, we demonstrate the pattern of collective and deliberate experimenting that encompasses creative discretion. The development of this subtype of discretion helps to better analyze and perform it, while simultaneously nuancing the potential positive outcomes of creative uses of discretion for public service provision. Additionally, we explain the collective nature of creative discretion, which has important implications for both research and practice of creativity at the street‐level. Finally, we show that street‐level practitioners become architects of the political and organizational system in which they work by changing the rules and provision, the organization of work, and the development of policy through their performance of creative discretion. This article is protected by copyright. All rights reserved.
... However, the stability of dominant constellations prevents successful integration of innovations that entail a practice, culture and structure that is considerably different from mainstream practices, culture and structure. To facilitate this integration process van den Bosch & Rotmans (2008, p. 42) have developed three types of mechanisms: deepening involves learning processes which take place in a relatively protected space at local level; broadening entails linking and repeating experiments in different contexts and scaling up is the process in which innovative experiments become mainstream (Johansen & van den Bosch, 2017;van der Ham et al., 2013). ...
... deepening, broadening and scaling up). Identifying the (systemic) barriers and facilitators is considered important for scaling up experiments in the system innovation literature (Johansen & van den Bosch, 2017;van den Bosch & Rotmans, 2008) and mental health literature alike (Eaton et al., 2011;Murray et al., 2014;WHO, 2008). Factors influencing scaling up may occur at landscape, constellation and niche level. ...
Article
In recent years, a range of brief protocolised psychological interventions like Problem Management Plus have been developed. Such "scalable psychological interventions" are meant to be delivered by nonspecialists which can greatly increase access to psychological therapies for people affected by adversity, including forced displacement. However, embedding new interventions into mainstream practices is challenging. Novel interventions can remain in the research phase for a long time or stop altogether, which minimises their intended impact and reach. In this conceptual paper we propose a "system innovation perspec-tive" on scaling up new psychological interventions for refugees and argue that existing mental health systems often need to change to integrate new interventions in a sustainable way. We present a conceptual framework, which includes ideas on cycles of deepening (learning by doing), broadening (repeating and linking), and scaling up (embedding) and the multilevel and constellation perspective. This framework has been operational-ised in our scalability research as part of the STRENGTHS study in which we increase our understanding of the opportunities for scaling up four new psychological interventions in eight countries hosting Syrian refugees, including in Europe (Germany, Netherlands, Sweden and Switzerland) and the Middle East (Egypt, Jordan, Turkey and Lebanon).
... To analyse this transition process, we adopted Geels' (Geels, 2002) multilevel perspective on transitions. This perspective is increasingly used to analyse transitions in social, public health and healthcare systems (Johansen and van den Bosch, 2017;Hassink et al., 2018;Frantzeskaki and Wittmayer, 2019;Kö hler et al., 2019) as it offers a valuable perspective on how social innovations are dynamically shaped and permeate existing policies and ways of doing. The multilevel perspective on transitions goes beyond current perspectives on intersectoral action by offering more in-depth understanding of the dynamics of evolving systems, by seeing transition as a long-term process with co-evolving changes at multiple levels and as a political processes in which actors utilize specific strategies to change the system. ...
... Following earlier studies on social transitions (e.g. Johansen and van den Bosch, 2017;Hassink et al., 2018), we adopted a timelining method to distinguish the processes and events in the evolution of intersectoral action between youth-care organizations and sports clubs in Rotterdam and its embedding in Rotterdam social policies. ...
Article
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Intersectoral action is advocated as a social practice that can effectively address health inequalities and related social issues. Existing knowledge provides insight into factors that may facilitate or hinder successful intersectoral action, but not much is known about how intersectoral action evolves and becomes embedded in local health policies. This is where this study aims to make its contribution, by adopting the multilevel perspective on transitions, which is increasingly used to study social innovation in sustainability transitions but has not yet been applied to public health and health promotion. Through this perspective, it was unravelled how intersectoral action between youth-care organizations and community sports clubs became embedded in local health policies of Rotterdam, a large city in the Netherlands. A single explorative case study was conducted based on content analysis of policy documents and 15 in-depth interviews with policy officers, managers and field workers operating in the fields of youth and sports in Rotterdam. The findings showed that intersectoral action between community organizations and policymakers evolves through congruent processes at different levels that changed institutional logics. Moreover, it emerged that policymakers and other actors that advocate novel social practices and act as boundary spanners can adopt multiple strategies to embed these practices in local health policy. The multi-level perspective adds value to earlier approaches to research intersectoral collaboration for health promotion as it allows to better capture the politics involved in the social innovation processes. However, further sharpening and more comprehensive application of transition concepts to study transitions in public health and health promotion is needed.
... Currently, street-level practitioners like Chengguan across domains and countries have been increasingly brought into focus. Their dismal public image and poor job performance need to be solved by novel ways of working and unique solutions (Johansen and van den Bosch, 2017;Kruyen and van Genugten, 2017;Rutz et al., 2017;Sabel et al., 2017;Raaphorst and Loyens, 2020). This can be achieved by improvement of leadership under the principle that the "success or failure of every human endeavor depends solely on the kind of leadership available for such endeavor" (Youth Heritage Development Centre, 2009). ...
Article
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Chengguan, the Urban Administrative Law Enforcement Bureau, has been criticized for its dismal public image and poor job performance. Based on an ethnographic case study in Z City, we analyzed the type of leadership that results in passive work performance in Chengguan, and we examined whether any leadership style can be used to improve Chengguan's image and performance. We developed a new leadership ontology of CNP (Cognition–Normalization–Performance) on this foundation, and ethnographic research was conducted in three phases: leader's cognition, followers' normalization, and organization performance. Several implications were drawn. Leader selection should be cautious and can be improved by studying the leader's traits and behavior. This is done by investigating candidates' leadership career paths, trait characteristics, motive profiles, and other qualities. It is useful to change leaders by strengthening followers' unity and cohesion by setting up a labor union, youth federation, women's federation, and other groups. A leader should be selected among individuals who have completed leadership training as opposed to appointing one from outside the organization. On the one hand, the superior should help to improve the leadership environment (context), supervise problems in the organization's operation and performance, and track changes over time. On the other hand, the leader can also provide the followers with a flexible and adaptive place of work.
... In various other organizations, there is a trend towards self-steering teams in the social welfare and health sector and also in education. Self-steering teams make joint decisions on the provision of care in neighbourhoods, for instance (Johansen and van den Bosch 2017). Hence, the collective aspects of discretionary room are relevant in a variety of organizational contexts. ...
Chapter
Discretionary judgement—defined as the freedom to decide how to act within controlled limits—is increasingly being exercised in teams and networks. We introduce the notion of collective discretionary room to emphasize this relational nature of discretionary judgement. Collective discretionary room is the freedom granted to a team or a network to reach judgements to take action. In this chapter we describe the main differences between discretion as an individual asset of a worker versus discretion as collective resource of a team or network. The first difference is the aim which changes from being responsive in individual situations to improving policy designs and outcomes. The second difference entails control. Collective discretionary room merges using and controlling freedom. In addition, collective discretionary room offers mechanisms to control and enhance the quality of the working methods.
... Exploring the diffusion process of an alternative homecare service in France", Petit dit Dariel, Durand and Cristofalo study a well-known model of homecare services (originally located in Buurtzorg, Holland). This model is based on the principled assumption that humanity should prevail over bureaucracy (Johansen, van den Bosch, 2017), and on the empowerment of nurses and patients. This organization was launched in 2006 and constitutes "a bottom-up response that aimed to empower nurses and patients and offer a counter-revolution to the supply-chain management approach to delivering homecare in Holland". ...
Article
The healthcare ecosystem faces complex and multiple challenges: increase in chronic diseases, population ageing, emergence of new issues (health promotion, ageing disability, social isolation, etc.), increase in social and territorial health inequalities, failing to seek medical treatment, increase in the cost of certain treatments, expectations for personalized approaches to care, etc., as well as the obvious financial constraints on the healthcare ecosystem...
... Mit Prekarisierung sollen in diesem Beitrag primär unsichere Arbeitsbedingungen bezeichnet werden, die in der Folge zu verschlechterten Lebensund Teilhabechancen in der Gesellschaft führen, wie befristete Teilzeitarbeit, diskontinuierliche und entgrenzte Arbeitszeiten, Isolation bzw. Entsolidarisierung der Arbeitskräfte.Am Fallbeispiel des mobilen Pflegedienstanbieters Buurtzorg wird nun ausgeleuchtet, wie der Einsatz digitaler Technologie die Arbeitsorganisation und geschlechtliche Zuweisungsprozesse in der Pflege verändern kann.Das niederländische Unternehmen Buurtzorg (übersetzt: Nachbarschaftshilfe) wurde vor zehn Jahren gegründet(Hauer 2016, S. 178-179;Johansen und van den Bosch 2017;Kreitzer et al. 2015;Monsen und Blok 2013;Nandram 2015) 4 , mittlerweile sind etwa 10.000 Pflegekräfte bei diesem Unternehmen angestellt. 5 Buurtzorg kann als virtuelle Organisation(Child 2015, S. 241 ff.) beschrieben werden, die sich dadurch auszeichnen, dass es eine geringe Erwartung an physische Präsenz der MitarbeiterInnen an einem festen Arbeitsort gibt(Child 2015, S. 241 ff.). ...
Chapter
Seit einigen Jahren wird international an der Schnittstelle von Ingenieur- und Pflegewissenschaften diskutiert und erforscht, inwiefern durch Technik und smarte Anwendungen Sorgetätigkeiten von Angehörigen und (bezahlten) Pflegekräften ersetzt und/oder unterstützt werden können (Bräutigam et al. 2017; Hielscher et al. 2015a, b). Der Beitrag nimmt dies zum Ausgangspunkt, die Debatte der Arbeitssoziologie zum Thema „Arbeit 4.0“, der Geschlechterforschung um die Rationalisierung von Care-Arbeit und Erkenntnisse aus den Pflegewissenschaften zur Digitalisierung zusammen zu führen. Diese werden dann u. a. mit Überlegungen von Angelika Wetterer (2002) zum Thema Professionalisierung und Geschlecht verknüpft.
... Furthermore the future of this sector and the innovation in that industry is strictly connected with the evaluation of healthcare in the same geographical areas, which we consider in the analysis. For example in Netherland new ideas are transforming the Dutch long-term care system (Johansen & Van den Bosch, 2017). As suggested by Van Reedt Dortland et al. (2014), it is necessary to expand the borders of rationality of decision makers by expanding the context in which they think about the consequences for the organization and the need for flexibility beyond financial models in order to improve the healthcare system. ...
Article
The purpose of this paper is to investigate the role of knowledge spillovers on productivity returns pharmaceutical leading firms. The analysis is based upon a dataset (sourced from the EU R&D investment scoreboards) made of R&D-intensive pharmaceuticals firms. In particular, we quantify the impact of R&D spillovers on the total factor productivity (TFP) between 2002 and 2010 on the basis of technological proximity. Thus, we elaborate more future scenarios to know what will happen, what can happen and how a predefined target may be obtained. Indeed, a numerical analysis for prediction of scenarios was conducted using the Method of Least Squares. The technological relatedness between the firms is computed through an original Mahalanobis industry weight matrix, based on the construction of technological vectors for each firm (Aldieri, 2013; Jaffe, 1986). The results confirmed the leadership of Europe and the USA in the pharmaceutical sector, highlighting the innovative capacity of Pfizer. The results might be interpreted to provide some useful implications for pharmaceutical policy strategy given that mainly in the pharmaceutical industry the private sector innovations derive from public-sector research investments.
... It is the institutional proximity, the close connections and interactions of actors and, occasionally, the overlapping institutional settings (recently also captured by the concept of a nexus of sectoral institutions, e.g. the nexus of energy-water-food) that configure a fruitful ground for innovations to emerge and even to spread (Frantzeskaki et al. 2016b;Wolfram, 2018;Johansen & van den Bosch, 2017). Wolfram (2018, p. 12) supports this by referring to the "importance of intermediaries as actors that connect different agents of change and that share, transfer and translate lessons across urban spheres" (not only in the same locality but across geographies). ...
Chapter
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This Handbook shows the enormous impetus given to the scientific debate by linking planning as a science of purposeful interventions and complexity as a science of spontaneous change and non-linear development. Emphasising the importance of merging planning and complexity, this comprehensive Handbook also clarifies key concepts and theories, presents examples on planning and complexity and proposes new ideas and methods which emerge from synthesising the discipline of spatial planning with complexity sciences.
... The transition from a supplydriven to a demand-driven approach increases the resilience of long-term care systems: on the one hand, the patient acquires awareness and becomes more autonomous in the management of his chronic conditions and necessary therapies. On the other hand, medical treatments move towards the domestic dimension, shifting from a hospital-centred to a distributed healthcare approach, as evidenced by the spread of new models of Neighbourhood Care (Johansen & van den Bosch, 2017) as well as the Health Homes and Accountable Care Organization models introduced by the US Affordable Care Act (Shields, Patel, Manning, & Sacks, 2011). Although depending on the specific socio-economic context, patient-centred medical home models are leading to restructuring primary care to provide high-quality care tailored to different individuals' needs (Jackson et al., 2013), shifting the focus to enhanced interaction between users and care services in a home care context (Rajkomar, Mayer, & Blandford, 2015). ...
Article
Over the past years, the interest in sustainable healthcare has been growing globally and the transition toward environmentally, economically and socially viable health systems is perceived as inevitable and necessary. All the approaches to this emerging field are mainly focusing on short-term specific issues and involving a limited number of stakeholders. This study aimed to address the topic of the possible futures of sustainable healthcare from a multi-stakeholder perspective, in order to define a long-term scenario and the key strategies to enhance this transition. A series of workshops have involved a representative selection of stakeholders based in Nordic countries and concerned with sustainable healthcare (health industries, health providers, managing authorities, universities and research centres, clusters, NGOs and healthcare networks, professional consortia) through a collaborative foresight process. A design-based approach has been adopted to investigate the current scenario and deepen foresight outcomes. The results highlighted three different horizons and the drivers to reshape the roles of individual stakeholders, enhancing the socio-technical transition towards a desirable scenario based on collaboration between distributed dynamic networks. The identified transition strategies move from the local to the international level, focusing on innovation, information and collaboration between stakeholders. This study provides the framework for future studies to deepen the transition process towards sustainable healthcare and its implications at Nordics, European and international levels.
... From a psychological perspective, the principle of the importance of older adults being nursed in their living places is predominant in European countries (UN, 2020). Buurtzorg, translatable as 'neighbourhood care', was first created in the Netherlands, offering a good example (Johansen & Bosch, 2017) Indeed, the eldercare services' provision is country-, culture-, and context-specific. The different types of care provisions and platforms reflect and reshape the desires and wishes of older adults and their families. ...
Article
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Ageing population is one of the most fundamental socio-economic transformations of the twenty-first century, with significant policy implications. China, the world’s most populous nation, is no exception. The necessity for cost-effective, culture-appropriate and sustainable eldercare services is one of the Government’s priorities, in both present and future. This research uses a focus-group interviews methodology to explore sustainable models of eldercare services through an in-depth comparative analysis of care demands and service provision in two Chinese cities. The study reflects a prevailing trend of the integrated-care service mix in line with the United Nations’ five most relevant Sustainable Development Goals (SDGs 1, 3, 5, 10, 11) for older adults. In addition to the 7Ps of the service marketing mix, this article highlights the particular importance of ‘Partnership’ in sustainable care delivery in China. The past-present-future scenario and the thematic analysis of older adults’ pattern-matching add two unique dimensions to population ageing and eldercare studies: ‘People’ and ‘Partnership’.
... Finally, we reflect on the parallel shifts being experienced in other parts of society as part of a broader paradigm change. According to recent literature, most sectors-like energy (Geels et al., 2017;Verbong & Geels, 2010), health (Johansen & van den Bosch, 2017), and education (Yarime et al., 2012)-are experiencing similar transitions toward more sustainable modes of production and consumption (Loorbach et al., 2017). These transitions reflect the same underlying changes in society that drive the transformation of the water sector, and share multiple aspects with the new urban water paradigm-like promotion of diversity, learning approaches, distributed structures, or greater citizen participation. ...
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Urban water systems in industrialized countries have underpinned unprecedented improvements in urban living standards through effective drinking water supply, sanitation and drainage. However, conventional urban water systems are increasingly regarded as too rigid and not sufficiently resilient to confront growing social, technological and environmental complexity and uncertainty, manifested, for example, in the maladaptation to climate change, depletion of nonrenewable resources, and degrading urban livability. In response, a new urban water paradigm has emerged in the last two decades within the context of a broader societal change that promotes a more organic worldview over the classical mechanistic and technocratic understanding of reality. This article develops and applies an analytical framework to coherently describe the new paradigm and contrast it with the old urban water paradigm. The framework includes a philosophical foundation and set of methodological principles that shape the new paradigm’s approach to governance, management, and infrastructure.
... However, the use of eHealth is not very well developed and its potential has been little exploited (Gjestsen, Wiig, & Testad, 2017). Demographic changes resulting in a mismatch between the numbers of people in need of healthcare and the resources available to meet those needs, more people living with chronic diseases and growing healthcare costs are some of the challenges necessitating transformation in healthcare (Johansen & van den Bosch, 2017;Kroezen, van Hoegaerden, & Batenburg, 2018). Factors such as experience, skills, training and knowledge, expectations of the technology and its use, power relations and existing technology are other elements that may limit the use of eHealth (Cresswell & Sheik, 2013;Orlikowski, 2000). ...
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eHealth is considered a solution to current challenges in healthcare. However, its use is not very well developed, and its potential has been little exploited. There are many reasons for the limited diffusion of eHealth. Knowledge, opportunities for training and collaborative activities are examples of factors that influence diffusion. Managerial responsibility is decisive in transforming healthcare. This paper aims at exploring middle management strategies that can facilitate workplace learning when introducing eHealth and new ways of providing healthcare. Introduction of eHealth will imply new and innovative working processes, where both employees and managers need to be aware that their work will change fundamentally, from routine work to work that involves learning, skills development and continuous changes in work practice. This study takes a qualitative approach by analysing data collected through focus group interviews. The findings indicate a necessity for a shift towards learning-oriented leadership and adaptive management that emphasizes employee involvement and opportunities for learning. Helping employees make sense of the complexities associated with continuously changing work practices is another identified middle management strategy. Scenario planning and backcasting stand out as suitable tools for sensemaking in complex organizations and as techniques that can promote workplace learning.
... Noin kymmenessä vuodessa yhtiö on kasvanut 850 tiimiin ja 10 000 työntekijään, ja se toimii 25 maassa. Buurtzorg-tiimit palvelevat noin kymmentä prosenttia hollantilaisista kotihoidon asiakkaista (Johansen & van den Bosch 2017). ...
... Recently, several studies have been published that are focusing on transitions in the health care system. These studies discuss and explain phenomena like persistent problems [55], transition governance [36], and transition experiments [56] in relation to health outcomes and the health care system. Yet, so far there is no research that applies a transition perspective to the Dutch obstetric care system and ways to address (perinatal) health inequities. ...
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We apply a transition research perspective to the Dutch obstetric care system to analyze historic, current, and future shifts and find ways to overcome persistent health inequities. We present social obstetrics as an emerging niche that addresses perinatal health inequities by acknowledging their multifaceted origins and fostering collaborations across the medical, social, and public health sectors. We conducted desk research, in-depth semi-structured expert interviews, and interactive group sessions with change-inclined professionals that are relevant for the implementation of social obstetrics in six Dutch municipalities. The outcomes are synthesized in a historical narrative and perspectives on current obstacles and future systemic shifts. We argue that social obstetrics can be considered a sustainable addition to what is already present, instead of a disruptive transformation of the current system. Social obstetrics is innovative as it connects various societal systems and offers a framework for cross-sectoral collaboration. These collaborations, in turn, can be the starting point for the transformation of the obstetric care system as well as other relevant societal systems.
Purpose This paper aims to understand the specific role of value chain flexibility (VCF) in the strategies of green service production (GSP) in healthcare. The study explores the key dimensions of VCF and their linkages with the current GSP strategies in healthcare firms. Design/methodology/approach The study uses an exploratory case study with three representative national-level healthcare firms in India. A multiple case study methodology was utilized to explore the relationships between GSP and VCF. Findings The findings of the study suggest that several strategies for GSP require the support of multiple dimensions of VCF. More importantly, the role of each dimension of VCF depends upon the innovativeness of green service design, green procurement and green service practices. Research limitations/implications The study was conducted in the emerging healthcare market of India. Thus, the generalizability of the framework needs to be tested in another context. The study reports the employee's perception, and the patients’ (customers) views were not included. Originality/value The study is a first step to understand the theoretical perspectives of the relationships between GSP and VCF by exploring the underlying concepts. Furthermore, the study explicates the dynamics of their interplay in a systematic way and contributes to a framework of GSP and VCF in the healthcare context.
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This thesis explores the solar production potential of Stavangerregionen Havn and Risavika and its possible contribution to the local energy challenges within the Elnett21 projects, that arises with the transport electrification strategy from the Norwegian government. The aim of this study is first to show the solar electricity generation potential for the given buildings and then investigate an economic long-term performance of those projects. Furthermore, will be explored how the integration of local produced electricity can be supported by battery storage systems. The thesis uses a Mixed-Method approach which gives the option to explore qualitatively the possibilists and challenges of the concept of system decentralization, decentral solar production and battery storage. Additionally, is through the utilisation of the K2 and PVsyst software the simulated electricity generation potential explored on which bases the quantitative analysis and economic evaluation is executed. Our analysis shows that Stavangerregionen Havn and Risavika have great electricity production potential which could be utilised. Furthermore, gives the economic long-term evaluation a positive output for the Ferry-Terminal as main case study object. We concluded that through the development of local generated solar electricity and the utilisation of battery storage significant contribution towards Elnett21 and the challenges are possible. Dependent on the size of future solar production and battery storage capacity can the contribution be bigger or smaller.
Article
European countries strive to provide people with a timely and appropriate access to care. Different models and approaches are implemented for this purpose. Whilst scholars have proposed various taxonomies to point out the peculiarities of health system types, little is known about patients’ satisfaction with the health services provided by such systems. This prevents a vision of the future of health care. The article intends to fill this gap through an empirical analysis of secondary data collected from the Eurofound’s database. Adhering to the taxonomy developed by Reibling and colleagues (2019), we investigated the performances of health systems types in terms of: 1) perceived quality of health services; 2) affordability of health care; 3) satisfaction with primary care; 4) satisfaction with secondary care; and 5) equity in the provision of care. Findings suggested that countries characterized by a thin access regulation and imposing a cost-sharing mechanism outperformed other health system types. Countries adopting a national health service scheme implying a strict access regulation and limited cost sharing were considered to be unfair. Health systems’ economic and social sustainability relies on the policy makers’ ability to stress the strengths of existing health system types, overcoming their weaknesses in terms of equitable and timely access to care. The future of health care will benefit from a contamination of existing health system types, which may lead to hybrid models able to merge fairness with financial sustainability.
Article
Purpose This study aims to identify the constituents of internal flexibility in health-care organizations for achieving sustainability. The study incorporates resources-based theory and resource-dependence theory to illustrate how health-care organizations exhibit internal flexibility to redress environmental uncertainties and maximize organizational responsiveness. Design/methodology/approach This paper conducts a case study in a health-care organization to explore how health-care organizations acquire several resources for attaining internal flexibility. A survey of health-care professionals was conducted to assess the relationships using partial least squares-structural equation modeling. Findings In the present study, the dimensions of internal flexibility in health-care organizations are identified. This study also established internal flexibility as a higher-order factor and explained its underlying aspects as a value-laden perspective on sustainability. Research limitations/implications The study was conducted in the public health-care context in India. The framework needs to be tested in another context. The sample size for the study was limited to health-care experts, which could be extended to include the customer’s perspective. Originality/value The study contributes to the body of knowledge by identifying the specific dimensions of internal flexibility and explains as a higher-order factor. It enhances the understanding of sustainability from a flexibility perspective of the firm.
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The Dutch home care provider Buurtzorg Nederland has attracted widespread interest for its innovative approach for caring elderly at home. Buurtzorg – meaning ‘neighbourhood care’ – empowers nurses to help their home care clients retain independence and autonomy. Buurzorg has earned high level of client and employee satisfaction and appears to provide high-quality home care at lower cost than other organizations. The model is spread worldwide, including Sweden, Japan, and United States. Currently this model will be tested and evaluated in Finland.
Chapter
This chapter discusses the work of Gunnar Myrdal, the Swedish economist who was as one of the founders of the Swedish welfare state. His work centres around discrimination and resilience. His insights are important for understanding why disadvantaged groups show the least resilience during a crisis, but also why well-meaning government policies may make matters worse. For that reason, he sees not only a solution in the state, but also within households, through labour unions and more political space for disadvantaged groups to express their voices. His theory of cumulative causation reflects insights from systems theory and emphasizes feedback effects of discrimination in labour markets, education and informal institutions (such as social norms). The remedy is, according to Myrdal, resilient institutions at the aggregate level of the economy instead of micro-level policies.
Article
November 2019 saw the release of A Blueprint for Children's Social Care (hereafter the Blueprint) in England. The Blueprint proposes introducing the Buurtzorg model of community nursing into the child protection social work in England, and received widespread interest and publicity. Buurtzorg is a Dutch community nursing agency that is based on a specific model of small self-managing and non-hierarchal teams. The authors of the Blueprint suggest that rapid and large-scale introduction of Buurtzorg into child protection social work would overcome many of the longstanding issues facing the profession in England. However, there are serious limitations to the suggestions outlined in the Blueprint and the Buurtzorg model does not translate well to child protection social work in England. Drawing on the work of Mark Fisher, this article examines the Blueprint under three core themes: consent and consensus, links with other neoliberal projects and failing forward. Ultimately, it is shown that the Blueprint can be considered part of a wider project of implementing neoliberal policies and market solutions to children's social care in England, a process that is increasingly being led by large, profit-driven global consultancy firms.
Chapter
Activation of people with disabilities in the labor market is an important issue for both social and economic reasons, but it is subject to a number of restrictions that sometimes result in such negative phenomena as disability hiding. The publication presents the results of a study in which researchers tried to find out the reasons for this situation based on semi-structured interviews with a group of over dozen people whose fate dictated the need of conceal their health restrictions by potential employers as well as at work. The research emerges a stigmatizing image of the Polish labor market as well as the imperfection of current support systems, which stigmatize and intensify discrimination processes in many places instead of counteracting them. Number of recommendations aimed at developing entrepreneurship for people with disabilities based on both interlocutors’ as well as and literature studies has been included.
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see: www.situatednovelty.com for a full text version of the book. Healthcare innovation is a hot topic among policy makers, researchers and professionals, attracted to the longstanding public debate by high expectations of the potential benefits. Putting innovation into practice, however, is often more complex than expected, and the results are sometimes even disappointing. This book delivers in-depth insights into healthcare innovation processes, based on the lessons learned in five case studies of innovation practices. The book introduces a multidisciplinary approach to the governance of healthcare innovation: ‘Situated Novelty’. In the Situated Novelty approach, innovation is not just about novelty. It emerges from contextualized, interactional and time-dependent processes and has different meanings in practice. Situated Novelty emphasizes the importance of never-ending processes that construct innovations and their value. In this view, the governance of innovation consist of attempts made to influence emergent, temporary and fluid processes of change. Situated Novelty has major implications for innovation practice, management and policy as it has the potential to change current attitudes to innovation and opens up new possibilities to act. Overall, the Situated Novelty approach argues for deeper practical and theoretical reflection on the essence and meaning of innovation. This book will interest all concerned with the management, organization and governance of innovation in healthcare practice and beyond.
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This chapter articulates a comprehensive definition of the notion of ‘experimentation’ in the context of urban sustainability transitions. Highlighting a number of key dimensions, we argue that experiments can be analysed according to the degree to which they are (1) inclusive, (2) systemic, (3) practice-based, (4) challenge-led and (5) adaptive in the face of uncertainty and ambiguity in fostering socio-technical change. We point out a number of urban governance challenges related to coordination, commitment and negotiation, and we highlight a number of promising avenues for future research on experimenting in the city.
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Our society faces a number of persistent problems whose symptoms are becoming more and more apparent. Persistent problems are complex because they are: deeply embedded in our societal structures; uncertain because of the hardly reducible structural uncertainty they include; difficult to manage with a variety of actors with diverse interests involved; and hard to grasp, in the sense that they are difficult to interpret and ill-structured (Dirven et al. 2002). Persistent problems are the superlative form of what Rittel and Webber (1973) refer to as ‘wicked’ problems. Examples of persistent problems are: the energy problem with anthropogenic climate change as manifestation; the agricultural problem with symptoms such as animal diseases such as bird flu, mad cow disease and foot-and-mouth disease; the water problem illustrated by major floods and periods of drought; and the mobility problem with traffic congestion and air pollution due to increased mobility. Persistent problems could generally be considered to be symptoms of an unsustainable society. These persistent problems cannot be solved using only current policies (SER 2001). Persistent problems are related to the system failures that have crept into our societal systems which, contrary to market failures, cannot be corrected by the market or current policies. Existing policies are necessary but not sufficient; much more is needed. In order to combat system failures a restructuring of our societal systems is required: transitions. A transition is a structural change in a societal (sub)system that is the result of a co-evolution of economic, cultural, technological, ecological and institutional developments at different scale levels (Rotmans et al. 2000). Transitions cannot be steered in command and control terms, because they are too complex phenomena with many uncertainties and surprises. However, transitions can be influenced and guided, in terms of influencing the speed and direction of these processes. The latter we call transition management, which will be described below.
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This PhD thesis presents the outcome of exploratory research on how transition experiments can be used as instruments to further sustainable development. A transition experiment is a specific type of innovation project that is aimed at exploring radically new ways to meet societal needs, such as the need for energy, mobility and health care. Transition experiments are a key instrument of the governance approach Transition Management (TM), which has recently been developed and applied to influence and direct transitions towards sustainability. This book presents a conceptual framework for analysing and managing transition experiments and their potential contribution to sustainability transitions. Central concepts in this framework are the mechanisms deepening (learning in a specific context), broadening (linking and repeating in different contexts) and scaling-up (embedding in established ways of thinking, doing and organising). The framework was developed in interaction with practitioners in three Dutch sustainability programmes: Learning for Sustainable Development, Transumo (TRANsition to SUstainable MObility) and the Transition Programme in Long-term Care. The practice-oriented concepts and examples that are described in this book could provide researchers, policy makers, programme managers and project leaders with a new way of looking at the role of innovation projects in transitions to sustainable development.
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This essay presents a conceptual framework for analyzing and influencing the contribution of small-scale experiments to transitions towards a more sustainable society. This framework is aimed at providing academics and practitioners with a theoretical and practice oriented perspective to both understand and ‘steer’ the contribution of experiments to transitions. The central instrument in this framework are ‘transition experiments’, which provide an alternative approach to classical innovation projects that are aimed at realizing short-term solutions. A transition experiment is an innovation project with a societal challenge as a starting point for learning aimed at contributing to a transition.
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Why do nations and industrial sectors cease to be pioneers? This question is discussed for the case of The Netherlands. Why was innovation in The Netherlands in the nineteenth century virtually limited to elaborating on developments in other countries whereas before it had been a technological paradise? It is argued here that no single reason can account for this loss of technological leadership. A complex of — often mutually reinforcing — factors was at work, some more important than others depending on the sector. The core of the explanation is that the Dutch had developed their own technological regime which was perfected before the nineteenth century. When a new regime emerged elsewhere it was difficult for the Dutch to adjust because of a complex set of barriers embedded in the existing technological regime. The inclination was to revitalise the old merchant capitalist regime and with success — albeit limited in the long run —, as some of the cases in the article show. This conclusion leads to a further question: How do regime shifts occur? Drawing on an evolutionary model, it is argued that new technologies emerge in technological niches, which after a process of branching can lead to a regime shift. Such a shift happens when successful niche formation coincides with a number of favourable external developments. Successful niche formation depends on the articulation of expectations, the coupling of new markets and new technologies, the development of new networks and the emergence of new competences.
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Structural problems in modern societies, such as climate change and congestion problems, require 'transitions' towards a more sustainable fulfilment of social needs. Recent research shows that experimenting in niches is crucial for learning about social challenges and stimulating transitions. Through a series of 'transition experiments' in different niches, social innovations can be improved and eventually replace dominant practice. This article reviews the literature on transitions and strategic niche management and argues that it has a strong analytical core, but less effort has been made to develop a managerial perspective. The authors aim to contribute to such perspective by developing a 'competence kit': a learning module that provides practitioners (e.g., policy makers, companies, intermediary organisations and NGO's) that are involved in transition experiments with an analytical framework, guidelines and tools and recognisable examples. The results from the first workshop with practitioners to explore potential applications of the competence kit are promising.
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A bounded socio-technical experiment (BSTE) attempts to introduce a new technology, service, or a social arrangement on a small scale. Many such experiments in personal mobility are ongoing worldwide. They are carried out by coalitions of diverse actors, and are driven by long term and large scale visions of advancing society’s sustainability agenda. This paper focuses on the processes of higher-order learning that occur through BSTEs. Based on the conceptual frameworks from theories of organizational learning, policy-oriented learning, and diffusion of innovation, we identify two types of learning: the first type occurs among the participants in the experiment and their immediate professional networks; the second type occurs in the society at large. Both types play a key role in the societal transition towards sustainable mobility systems. Two case studies, in which the Design for Sustainability Group at Technical University of Delft has participated, provide empirical data for the analysis. One case consists of development of a three-wheeled bike-plus vehicle (Mitka); the second case seeks to solve mobility problems on the Dutch island of Texel. We find that higher order learning of the first type occurs among the BSTE participants and beyond. Learning can be facilitated by deployment of structured visioning exercises, by diffusion of ideas among related BSTEs, by innovative couplings of problems and solutions, and by creating links among related experiments. Government agencies, universities and other intellectual entrepreneurs have key roles to play in making that happen. The cases provide much less insights about the second type of learning. Research on the latter is necessary.
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Societal embedding of new products – that is, their integration in relevant industries and markets, their admissibility with regard to regulation and standards, and their acceptance by the public – is a challenge. A management approach is developed based on our case studies in the biotechnology sector and on recent innovation literature. Tools are presented to map internal and external alignments. Learning processes, in interaction with societal actors, overcome the dilemmas or at least make them manageable.
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Over the past few decades, there has been a growing concern about the social and environmental risks which have come along with the progress achieved through a variety of mutually intertwined modernization processes. In recent years these concerns are transformed into a widely-shared sense of urgency, partly due to events such as the various pandemics threatening livestock, and increasing awareness of the risks and realities of climate change, and the energy and food crises. This sense of urgency includes an awareness that our entire social system is in need of fundamental transformation. But like the earlier transition between the 1750's and 1890's from a pre-modern to a modern industrial society, this second transition is also a contested one. Sustainable development is only one of many options. This book addresses the issue on how to understand the dynamics and governance of the second transition dynamics in order to ensure sustainable development. It will be necessary reading for students and scholars with an interest in sustainable development and long-term transformative change.
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Retrospective studies have shown the non-linear and situated character of technological developments; the importance of articulation of demand and of acceptability, and how these are part of large socio-technical transformations; and how technical nd socio-technical alogment activities occur and are consciously shaped by ‘macro-actors’. These insights are transformed into thirteen suggestions for successful introduction of new technology.
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Persistent problems in society require structural societal transformation. In recent research the concept of transitions is developed that gives a new perspective on these urgent transformation processes. Innovation projects play an important role in transition management as part of on over-all innovation strategy and portfolio. These innovation projects or 'transition experiments' are characterized by a focus on learning, high risks and uncertainty and involvement of multiple actors and networks. This paper aims to make a contribution to the theory on the relation between strategic innovation projects and structural societal change or transitions; a central question is "Through which mechanisms and patterns can innovation projects contribute to structural societal change?". Departing from complex adaptive systems theory, a literature study is conducted incorporating insights from innovation studies, learning and transitions. This leads to the development of a heuristic of patterns and mechanisms through which transition experiments might shape the wider societal system. Central are three mechanisms, deepening, broadening and scaling up that explain the pattern of broad scale societal change emerging from small-scale innovations.
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In this article we present four different cases of transition management in which we were involved over the past 10 years. Transition management was developed in the course of this period in theoretical and practical sense, mainly in the Netherlands, as novel mode of governance for sustainable development. The theoretical debate about transition management is being increasingly published, but so far only few empirical examples were. In this article we present four cases that combined give a representative illustration of both the advantages and the difficulties of actually trying to manage transitions. The article ends by drawing lessons and formulating research questions for the future.
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Proefschrift Erasmus Universiteit. Lit. opg.: p. 301-314. - Met een samenvatting in het Engels.
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In this article, the use of the niche concept for explaining radical technical change is explored. Contributions of various strands of literatures are elaborated and systematized in a taxonomy. Radical change or technological discontinuity is defined as the establishment of a new sociotechnical regime. Sociotechnical regimes carry and store rules for how to produce, use and regulate specific technologies. They perform the task of genes and define the boundary between technological species. It is proposed that radical change is generated by four different evolutionary mechanisms and patterns: natural selection, punctuated equilibrium, market niche selection, and technological niche selection. In each pattern, a different type of niche is implicated in the change process. The difference between niches results from differentiating between two dimensions: (1) whether niches are internal or external to the prevailing sociotechnical regime; (2) whether rules for design and use of a specific technology are stable or unstable within the niche.
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Discussions of technological change have offered sharply contrasting perspectives of technological change as gradual or incremental and the image of technological change as being rapid, even discontinuous. These alternative perspectives are bridged using the punctuated equilibrium framework of evolutionary biology. Using this framework, it is argued that the critical event is not a transformation of the technology, but speciation--the application of existing technology to a new domain of application. As a result of the distinct selection criteria and the degree of resource abundance in the new domain, a new technological form may emerge. The new technological form may be able to penetrate other niches and, in particular, may precipitate a process of 'creative destruction' and out-compete prior technologies. This framework is applied to an historical study of wireless communication from the early experimental efforts of Hertz to the modern development of wireless telephony. Copyright 1998 by Oxford University Press.
Book
Explains a client-focus approach to be easily applied in different contexts Provides evidence-based theory and applicable model Provides a detailed description of the case to inspire a context specific application This book presents the theory of integrating implification and it provides a profound evidence based study of Buurtzorg Nederland. The case itself, forming the building block of the theory, has received tremendous interest in the Netherlands and abroad. This is the first international book on Buurtzorg Nederland and the first one departing from a management multidisciplinary perspective. The book demonstrates theory building by using the Grounded Theory Methodology as a way to contribute to management theory. Integrating simplification gives room for context specific implementation of organizational innovation to different industries. One of the most talked about and innovative cases in community care: the successful and award winning practice of Buurtzorg. There is only one simple focus: the wellbeing of the client. Prof. Dr. Mathieu Weggeman, the Netherlands All grounded theories are asymptotic, that is as close to perfection as possible. Sharda has come very close to achieving a perfect Grounded Theory. Read well and enjoy the conceptual level and integration of concepts! Barney G. Glaser, PhD, Hon. PhD, USA Integrating Simplification Theory shows in a lucid and convincing way, how constructing reality based on different sources and processes of knowledge results in new organization creation. Prof. Ikujiro Nonaka, Japan Sharda has seamlessly combined the Eastern and Western philosophies to explain human principles of organizing the reality around us. The book has truly brought out the "art of management". Dr. Madhumita Chatterji, India The humanistic leadership of Buurtzorg demonstrates the Yoga philosophy which transcends the duality of matter and spirit as well as the duality of self and others, leading to radical simplicity. Sharda has provided a fascinating analysis of a fascinating case. Prof. Laszlo Zsolnai, Hungary Content Level » Professional/practitioner Keywords » Buurtzorg Nederland - Craftsmanship - Entrepreneurial space - Healthcare management - Organizational innovation - Self-managed teams Related subjects » Innovation - Technology Management - Organization - Human Resource Management - Public Health - Social Sciences TABLE OF CONTENTS Towards a New Way of Organizing.- Buurtzorg Nederland: Start-up Process and Organizational Design.- Theory of Integrating Simplification.- Attuning to Clients.- Subtle Craftsmanship in Communities.- Intrapreneurial Team Freedom.- Pragmatic Will with ICT.- Leading Higher Purpose.- Scientific Contribution of IST in the Domain of Organizational Innovation.- Implications and Discussion.- Reflections and Conclusion. http://www.springer.com/business+%26+management/organization/book/978-3-319-11724-9
Article
If we are to improve the health of the population and reduce the inequalities in health that plague our communities and our planet, we will have to give greater attention to the determinants of health. The reform of the health care system, necessary though it is, will never be sufficient; we need to reform our whole society and in particular to focus on human rather than economic development. At the community level we need to create healthy communities that are “health-creating systems” of environmental, social and human development, as well as health care systems that focus first on improving and maintaining health. Such a “bottom-down” health care system would see the hospital become once again the place of last resort (but still a potentially important partner in creating healthier communities) and would focus instead on how to provide health promotion and health care from the household level up.
Article
This article argues that a lack of a consistent agency-based approach in theory on sustainability transitions makes it difficult to describe processes of change. To overcome this problem, elements from transition theory will be rearticulated in terms of ‘discursive fields’, which are the bodies of meanings with which actors engage in social action. With that an agency-based conceptual framework is developed with which processes of change related to sustainability transitions can be researched. Discursive fields are subjected to a different degree of ‘fixation’—some discursive fields are more susceptible to change than others. The notion of discursive fixation helps us to develop new insights about the some of the elementary elements of sustainability transitions, such as the establishment of a so-called socio-technological niche, as well as the scaling up of the outcomes of such a niche. Moreover, the approach developed will be used to explore how individual agents can contribute to change processes. These insights give rise to an array of new empirical research in relation to sustainability transitions.
Article
Sustainability is increasingly becoming a core focus of geography, linking subfields such as urban, economic, and political ecology, yet strategies for achieving this goal remain illusive. Socio-technical transition theorists have made important contributions to our knowledge of the challenges and possibilities for achieving more sustainable societies, but this body of work generally lacks consideration of the influences of geography and power relations as forces shaping sustainability initiatives in practice. This paper assesses the significance for geographers interested in understanding the space, time, and scalar characteristics of sustainable development of one major strand of socio-technical transition theory, the multi-level perspective on socio-technical regime transitions. We describe the socio-technical transition approach, identify four major limitations facing it, show how insights from geographers – particularly political ecologists – can help address these challenges, and briefly examine a case study (GMO and food production) showing how a refined transition framework can improve our understanding of the social, political, and spatial dynamics that shape the prospects for more just and environmentally sustainable forms of development.
Article
Within the environmental social sciences, theories of practices are used by an increasing number of authors to analyze the greening of consumption in the new, global order of reflexive modernity. The use of practices as key methodological units for research and governance is suggested as a way to avoid the pitfalls of the individualist and systemic paradigms that dominated the field of sustainable consumption studies for some decades. With the help of practice theory, environmental governance can be renewed in three particular ways: First, the role and responsibilities (not) to be assigned to individual citizen-consumers in environmental change can be specified. Secondly, objects, technologies and infrastructures can be recognized for their crucial contribution to climate governance without lapsing into technological determinism. Third, the cultural framing of sustainability can be enriched by looking into the forms of excitement generated in shared practices of sustainable consumption. We conclude by discussing the need to investigate the globalization of practices from a post-national perspective in both science and policy.
Article
Although knowledge flows are a popular concept, the underlying dynamics are not well understood. This article develops a perspective that conceptualises the social and cognitive activities that make knowledge flows possible. Dynamics involve interactions between local and global levels, and dedicated aggregation activities by intermediary actors. An idealtypical four-phased pattern is developed to understand the creation of global knowledge. The socio-cognitive perspective is illustrated with a historical case study, the emergence of reinforced concrete (1850–1940). The concluding section formulates policy implications for nurturing the emergence of radically new technologies. Copyright , Beech Tree Publishing.
Article
In this paper, it is argued that outsiders play an important role in the dynamics of technical change and that, for this reason, outsider involvement is also an important entry if one wants to 'improve' or democratize technical development. Outsiders are defined as people not involved in technical development and not sharing the rules that guide the design and development of a technology. The totality of these rules makes up the technological regime of a technology. Technological regimes are characterized by certain trajectories of technical development. The focus in this paper is on outsiders who may trigger (radical) technical change that transform current technological regimes. Three different types of such outsiders are distinguished and their role in technical development is discussed: professional scientists and engineers, outsider firms and societal pressure groups.
Article
The unsustainability of the present trajctories of technical change in sectors such as transport and agriculture is widely recognized. It is far from clear, however, how a transition to more sustainable modes of development may be achieved. Sustainable technologies that fulful important user requirements in terms of performance and price are most often not available on the market. Ideas of what might be more sustainable technologies exist, but the long development times, uncertainty about market demand and social gains, and the need for change at different levels in organization, technology, infastructure and the wider social and institutional context-provide a great barrier. This raises the question of how the potential of more sustainable technologies and modes of development may be exploited. In this article we describe how technical change is locked into dominant technological regimes, and present a perspective, called strategic niche management, on how to expedite a transition into a new regime. The perspective consists of the creation and/or management of nichesfor promising technologies.
Article
In 1978 the Swedish Secretariat for Future Studies—a government advisory body for long-term issues of broad societal significance—began its project “Care in Society”. The final project report was published in May 1982. The original purpose of the project was to study how conditions in society affect needs for care in different forms and how these needs are met—informally or through formal institutions. More broadly, the study came to be a general assessment of the welfare state and its growing problems. This article examines findings and proposals from the Swedish report.
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Attention is drawn to the dynamic interaction between what different kinds of actors do and what can be observed at the system level. It aims to provide a closer look at how strategies, resources and capabilities of individuals, firms and other organizations impact the overall system and trigger transformation processes, and how these changes at the system level feed-back into the observed strategies at the actor level. This is important, not in the least because the particularity of sustainability transitions is that they are often purposefully initiated (or supported) and directed in the sense that long-term future visions are supposed to guide these transitions.While guidance of distributed actors is essential, it has been acknowledged that future visions as well as the means to achieve these visions are contested, with different actor groups claiming and advocating different interests. As we improve our understanding of the dynamic interplay of different actors involved in innovation and transition processes, we will be able to untangle some of the complexities of transitions unfolding at the system level. To contribute to this general line of reasoning, our special issue calls particular attention to the strategies and resources of actors in sustainability transitions. In this introduction we will concentrate on the following questions knowing that these can only shed light on some of the complex issues at hand: – What strategies do actors adopt to shape sustainability transitions and what resources do they mobilize and deploy in the realization of these strategies? – What kinds of different actors play a role in these transformation processes and how can and do they align their strategies (and resources) to achieve common goals?
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Sustainability oriented innovation and technology studies have received increasing attention over the past 10-15 years. In particular, a new field dealing with "sustainability transitions" has gained ground and reached an output of 60-100 academic papers per year. In this article, we aim to identify the intellectual contours of this emerging field by conducting a review of basic conceptual frameworks, together with bibliographical analysis of 540 journal articles in the field. It is against this background that we position the six papers assembled in a special section in Research Policy. These papers pave the way for new conceptual developments and serve as stepping-stones in the maturation of sustainability transition studies, by linking with the scholarly literatures of management studies, sociology, policy studies, economic geography, and modeling.
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Non-linearity and changes in the direction of technological trajectories, are related to changes in cognitive rules and expectations that guide technical search and development activities. To explain such changes, the article uses the literature on niche development, which highlights interactions between learning processes, network building and expectations. A long-term case study on Dutch biogas development illustrates how these interactions explain non-linearity, but the case study also shows the importance of external regime dynamics. It is concluded that non-linearity and changes in niche expectations are related to both internal learning processes and external developments.
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Transitions are transformation processes in which society changes in a fundamental way over a generation or more. Although the goals of a transition are ultimately chosen by society, governments can play a role in bringing about structural change in a stepwise manner. Their management involves sensitivity to existing dynamics and regular adjustment of goals to overcome the conflict between long-term ambition and short-term concerns. This article uses the example of a transition to a low emission energy supply in the Netherlands to argue that transition management provides a basis for coherence and consistency in public policy and can be the spur to sustainable development.
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The sustainability of current healthcare systems is threatened by several societal developments, including an aging population, an increase of unmet medical needs and rising healthcare costs. A transition is needed in rder to meet these threats and to achieve a proper balance between the demand for care and the capacity to supply it. Entrepreneurs play a crucial role in developing the required sustainable innovations for this structural change. They are able to develop innovations in close interaction within the healthcare context. This paper studies entrepreneurial strategies for the successful development of sustainable innovations in Dutch healthcare. Data comes from semistructured interviews with healthcare entrepreneurs. Results show that entrepreneurs experience the interaction with the healthcare systemcontext in various ways and act accordingly. Four types of sustainable healthcare entrepreneurs could be identified: isolated, innovative, evolutionary and revolutionary. These entrepreneurial types differ in terms of their beliefs as to whether and how individual entrepreneurs can contribute to achieving structural change in healthcare.
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This article presents a multi-pattern approach for the description and understanding of the dynamics of societal transitions. The central idea is that any transition path can be considered a concatenation of patterns. Although theorising on transitions has advanced greatly, a coherent and integral approach was still lacking. Therefore, the current conceptual language of transitions is reframed and expanded from a complexity view on societal systems. The resulting theoretical framework straightforwardly leads to the identification of the patterns presented. The Dutch healthcare system is used to demonstrate how this multi-pattern approach could be used to describe transitions and make storylines. Furthermore a typology of transition paths derived from this approach is presented as another way in which these patterns may be used.
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A role for green niches has risen to prominence in the environment and innovation literature. The role of idealistic enthusiasts in the creation of sustainability initiatives in niches is widely recognized. The importance of tensions in incumbent socio-technical regimes is acknowledged to provide niches with development opportunities. However, the literature currently gives insufficient consideration to the processes by which niches and regimes interact and are interdependent. This paper addresses this by considering socio-technical translations between niches and regimes. It does so by analysing niche-regime interactions in the areas of food and housing and the development of eco-housing and organic food in the UK. Three kinds of translations are identified that affect the sustainabilities practiced in niches and regimes, and which do not all flow from green niche to incumbent regime.
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The literature on sociotechnical transitions and their governance tends to concentrate on the introduction of new technologies and systems of supply. In this paper we seek to extend the scope of debate, introducing aspects of practice theory as a means of also conceptualising the dynamics of demand. Rather than treating ‘human need’ or ‘societal functions’ as given, we consider how variously sustainable practices come into existence, how they disappear and how interventions of different forms may be implicated in these dynamics. We use the two cases of daily showering and the congestion charging scheme in London to consider the distinctive challenges of understanding transitions in practice and of governing these so as to engender more sustainable ways of life.
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This paper addresses the question of how technological transitions (TT) come about? Are there particular patterns and mechanisms in transition processes? TT are defined as major, long-term technological changes in the way societal functions are fulfilled. TT do not only involve changes in technology, but also changes in user practices, regulation, industrial networks, infrastructure, and symbolic meaning or culture. This paper practices ‘appreciative theory’ [R.R. Nelson, S.G. Winter, An Evolutionary Theory of Economic Change, Bellknap Press, Cambridge, MA, 1982] and brings together insights from evolutionary economics and technology studies. This results in a multi-level perspective on TT where two views of the evolution are combined: (i) evolution as a process of variation, selection and retention, (ii) evolution as a process of unfolding and reconfiguration. The perspective is empirically illustrated with a qualitative longitudinal case-study, the transition from sailing ships to steamships, 1780–1900. Three particular mechanisms in TT are described: niche-cumulation, technological add-on and hybridisation, riding along with market growth.
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Large-scale shifts in dominant technologies are the necessary components of a transition toward sustainability. Such shifts are difficult because, in addition to technological innovation, they require changes in the existing institutions, professional norms, belief systems and, in some cases, also lifestyles. In the languages of cognitive and policy sciences, higher order learning on a scale ranging from individuals to professional and business communities, to the society at large, is needed. Higher order learning is especially crucial in the types of innovations that depend mainly on synthesis of existing technologies and know-how to achieve radical reductions in energy and material consumption, as is the case with high performance buildings. One way to facilitate this type of learning is through experimentation with new technologies and services.Drawing on our earlier concept of a Bounded Socio-Technical Experiment, in this paper we propose a four-level conceptual framework for mapping and monitoring the learning processes taking place in a BSTE, and apply it to an empirical case study of a zero-fossil-fuel residential building in Boston. Three major conclusions are that: learning took place both on the individual and team level, that individual learning primarily (but not exclusively) involved changes in problem definitions; and that team learning consisted of participant turnover until congruence in worldviews and interpretive frames was achieved. This case study also shows that we must think of innovating in building design as both a process and a product, and that both must be considered in the future efforts to replicate this building.This study highlights that technological innovation about technology as much as about people, their perceptions, and their interactions with each other and with the material world. Sustainability will not be reached by technology alone, but by deep learning by individuals, groups, professional societies and other institutions.
This paper aims to critically examine the notion of entrepreneurship in the UK National Health Service (NHS), promoted by government ministers and senior civil servants as part of the rhetoric of the modernisation agenda. The paper explores literature on entrepreneurship in the private and public sector and qualitative case study evidence on the emergence (and non-emergence) of "entrepreneurs" who led the improving working lives (IWL) initiative in the UK National Health Service and discusses the issues involved. The rhetoric serves an essentially ideological function, obscuring the real difficulty of securing effective and sustainable change, in organisations with deeply engrained power structures and as complex and intransient as the NHS in particular and health services more generally. A "new breed of entrepreneurial leaders" may eventually appear but they face the challenge of surviving in the hierarchical NHS culture and in a climate of turbulent change created by the volatility of government policy. The paper shows that efforts to pursue entrepreneurship in the UK NHS have to overcome obstacles involving the interplay of power, gender and language.