Abstract
This paper illuminates the way multiple narratives concerning urgency for change dynamically interact on different levels and influence change processes in healthcare organizations. It explores the processes of sensemaking and opposing urgency narratives during a period of implementation for new legislation within the Dutch healthcare sector. Building on recent debates on process theory, narratives, and temporality, a new perspective on change urgency is presented, which shows how urgency is not unilaterally created from one position but is produced and reproduced by different editors in a narrative struggle. A temporal framework for change urgency was developed to study these narrative dynamics. Three urgency narratives contested the dominant narrative in the public discourse. The article shows how directors of healthcare organizations, dominated by these narratives, also hold narrative power. Managing change processes implies managing discourse.
Highlights
Worldwide, healthcare faces challenges due to rising expenditure as populations grow and age, technologies advance, and chronic conditions increase [1] [2] [3]
The leading question in this paper is: which narratives can be conceptualized and how did they discursively create change urgency in the debate over Dutch long-term health care? Besides expanding knowledge on temporality in narratives, this study aims to establish how narratives on the urgency for health care changes dynamically interact with other narratives in public and local debates
This study explores processes of sensemaking and sensegiving and analyzes urgency narratives in a period before the implementation of new legislation within the Dutch healthcare sector
Summary
Healthcare faces challenges due to rising expenditure as populations grow and age, technologies advance, and chronic conditions increase [1] [2] [3]. In the Netherlands, the costs of long-term health care are soaring rapidly [4], and structural measures are developed to remedy this. In January 2015, the distribution and funding of long-term health care changed due to the implementation of a new law (the Wet Langdurige Zorg; WLZ), through which municipalities became responsible for social care while receiving a reduced budget. There are implications for patients, insurers, directors of healthcare organizations, and local governments. These changes are an example of New Public Management [2], and too often healthcare studies seem to support New Public Management developments, which, on the contrary, call for critical assessment via healthcare management papers [2] [7]
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