Learn to dance. Governing healthcare in times of a pandemic (Learning to dance. Governing healthcare in pandemic times)

In this project we conducted ethnographic research into decision-making in healthcare during the corona pandemic. We were particularly interested in the question of whether and how decision-making can be adaptive; that is, can adapt to changing circumstances and uncertainties-and to what extent decision-making contributes to the resilience of healthcare. To this end, we made observations at three regional consultations for acute care and we also conducted interviews with nurses, doctors, patient representatives, administrators, policy makers and supervisors. We also collected and analyzed many documents. We find that governance has been only partially adaptive. Lessons have been learned during the pandemic-for example with regard to non-COVID care-but problems in long-term care, for example, have only been addressed to a limited extent. Representation of patients and 'the work floor' has only gradually taken shape. We make several recommendations to make healthcare more resilient. Goal This project focuses on the organization of decision-making. Looking back, we want to learn from the first and second waves of the pandemic. Looking ahead, we are trying to learn lessons with the actors involved. The starting point is that a form of 'adaptive governance' is needed; a board that can adapt to unexpected and uncertain circumstances. Background The virus will be with us for a long time and that means we have to learn to live with it. We use the metaphor of dance to give substance to this adaptive handling of the virus. How can we learn to dance (better)? We hope to contribute to this by following decision-making processes and reflecting on them together with those involved. Research design The questions this project answers are: Looking back, what can we learn from the administrative response to the Corona crisis about the management of care in times of pandemic crises? How can the dance of local, regional and national administrative arrangements be effectively shaped in the 'chronic' phase of the crisis and which parties can positively influence this? What effects does this dance and the resulting decisions have on the organization and implementation of healthcare? The project is designed as an action research in which data is collected through interviews, observations and document analysis, which is reflected on in regularly held sessions with partners. We build on data that has already been collected in recent months. The project results in recommendations for the organization of decision-making for healthcare in pandemic times, as well as in scientific publications.