The barriers to empowering niche-innovations in long-term care

Abstract

This thesis deals with innovative long-term care projects that aimed at changing long-term care delivery practices. Around the world, long-term care systems are pressured by an aging population, increasing costs and the scarcity of care professionals. Therefore, the concept of niches becomes ever more important as it can start a transition from our existing system to a new system that is able to deal with the aforementioned pressures. Niches are protected spaces that allow networks to experiment with radical innovations outside the rules of the system. To eventually change or replace an existing system requires the empowerment of niche-innovations. The empowerment is the increasing structuration and stability of niche-innovations. The problem, however, is that there are only limited empirical insights into how niches enable transitions from pressured systems to new systems. While there are many studies on the initiation of niche-innovations and the nurturing (e.g. planning, executing, supporting) of experiments, there are fewer studies on the empowerment of niche-innovations. In fact, many previous niche-innovations did not move beyond the nurturing phase. This thesis highlights the importance of understanding the barriers to empowering niche-innovations so that future programs can enable the change of the long-term care system. In particular, three niche-innovation projects were studied which were subsidized by a transition program for long-term care. During the years 2007 to 2011, the transition program itself was initiated and subsidized by the Healthcare Ministry. In total, the program governed 26 niche-innovation projects throughout the Netherlands. The vision was that the projects experiment with radical long-term care innovations to start a transition from the fragmented, supply-driven system to an integrated, demand-driven one. However, several barriers hindered the empowerment of the niche-innovations. This included the conflict of interests between niche and system actors, the subsidy focus of the care system, and the lack of engaging powerful actors into the niche. The findings significantly contribute to our understanding of today’s long-term care challenges. Barriers arose within the projects, the transition program and the ministry. The results can help care practitioners and policymakers alike to improve long-term care innovations and to advance the empowerment of future niche-innovations.