Runtime: 2024-2028
Project description
Workforce shortages challenge the ability of welfare states to secure timely access to good-quality healthcare. In this context, policymakers and healthcare professionals have called for a more efficient organisation of healthcare services and have coined digitalisation, interdisciplinary collaboration, and leadership practices, as important strategies to funnel the transition. In a similar vein, ‘care provided in the comfort of one’s own home’, and an increased reliance on ‘informal networks of support’, are foregrounded as important value-orientations in a transforming welfare state. Meanwhile, on the shopfloor, healthcare organizations struggle with an erratic fall-out of personnel. Additionally, their healthcare workers are confronted with more vulnerable patients and complex caseloads. This situation often prompts frontline healthcare professionals to make difficult decisions about who to provide care to, transfer to other providers, or strategically ignore.
Although the organisation of timely and equal access to healthcare and welfare services – and its challenges – is widely discussed amongst academics, professionals, and policymakers, these discussions are often descriptive in nature or focus on manageable criteria such as integrated services, personnel turnover, sick leave percentages, and waiting lists. Meanwhile, less attention is paid to the different ways in which capacity issues affect the situated and daily organisation and delivery of care and social services; and how this leads to new dependencies between patients, formal and informal caregivers, and to new vulnerabilities in access to healthcare and welfare services. We argue that more attention to the daily organisation and delivery of healthcare services and (in)formal networks of support is therefore particularly relevant now that more stringent rationing decisions are being made in everyday professional healthcare and welfare practice.
This project focusses on foregrounding and conceptualising the social consequences of structural workforce shortages. The project comprises two doctoral studies that explore precariousness from the perspective of clients and healthcare providers. The first study looks at what happens to people who need long-term care and support, who live at home, and who depend on an ever-changing and precarious configuration of professional and informal care providers for their healthcare and support. The aim is to understand the new vulnerabilities that emerge in the face of burgeoning capacity problems. The second study focusses on the daily considerations and choices made by professionals when they are confronted with limited time and resources, and an increasingly vulnerable patient population with complex caseloads. Together, these studies aim to identify and scrutinise the (fundamental) political dimensions inherent in the everyday organisation and provision of healthcare services, especially as the interactions – and interdependencies – between formal and informal networks of care and support are under pressure and in transition.
Both projects utilise ethnographic methods and are situated in a medium-sized town in the Netherlands. Over a considerable period, researchers will follow inhabitants and healthcare providers to highlight the impact that emerging vulnerabilities and networks of formal and informal support have in shaping timely access to healthcare and support services. A key objective of the project is to develop new empirical and theoretical insights that facilitate a deeper understanding and scrutiny of the consequences of limited access to welfare services. In doing so, this project also supports and interacts with more practice-oriented research projects of the department of Health Care Governance that study and engage with contemporary professional-, community-, and policy responses.
Team
Charlotte Tiebosch, Nando Katoele, Jitse Schuurmans, Martijn Felder, Roland Bal, and Iris Wallenburg.
Publications
- Felder, M., Schuurmans, J., van Pijkeren, N., Kuijper, S., Bal, R., & Wallenburg, I. (2023). Bedside Politics and Precarious Care: New Directions of Inquiry in Critical Nursing Studies. Advances in Nursing Science, 10-1097. https://doi.org/10.1097/ANS.0000000000000518 
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- Huizenga, Sabrina, Lieke Oldenhof, Hester van de Bovenkamp, and Roland Bal. 2023. “Governing the resilient city: An empirical analysis of governing techniques." Cities 135: 104237. https://doi.org/https://doi.org/10.1016/j.cities.2023.104237. 
- Van Pijkeren, N., Schuurmans, J., Wallenburg, I., & Bal, R. (2024). The night is for sleeping: how nurses care for conflicting temporal orders in older person care. Health Sociology Review, 1–14. https://doi.org/10.1080/14461242.2024.2316737
- Opens external
- Van Pijkeren, Nienke, Iris Wallenburg, Hester van de Bovenkamp, Siri Wiig, and Roland Bal. 2024. Caring peripheries: How care practitioners respond to processes of peripheralisation. Sociologia Ruralis 64 (1): 64-81. https://doi.org/https://doi.org/10.1111/soru.12459.