Johansen Françoise, Loorbach Derk, Stoopendaal Annemiek
Dutch Research Institute for Transitions (DRIFT), Erasmus University Rotterdam , Rotterdam, The Netherlands.
Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam , Rotterdam, The Netherlands.
J Health Organ Manag. 2018 Oct 8;32(7):875-890. doi: 10.1108/JHOM-07-2018-0185. Epub 2018 Nov 1.
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.
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.
医疗保健系统面临着持续的挑战，比如应对人口老龄化、慢性病相关增长以及技术进步推动下的医疗成本增加。作者认为，优化的边界已被触及，需要进行更根本性的变革或转型。本文旨在探讨荷兰这种转型的轮廓。作者从参与“可持续医疗保健探索之旅”的医疗保健组织的角度进行探讨：这是荷兰可持续医疗保健网络组织的一个学习项目，旨在培养这一转型中的领先者。
设计/方法/途径：本文将概念性工作与实验性实证工作相结合。作者运用转型研究框架来概念化医疗保健系统中的持续性问题和转型动态。在一项纵向研究中，作者分析了参与组织在探索之旅后的发展情况。
该过程验证了对持续性可持续发展挑战的初步理解。可持续医疗保健的整体方法被转化为文化、结构和实践的转变，以及跨越组织内外边界和领域的能力发展。为了促进和推动这一过程，作者发现对持续性问题以及医疗保健系统中的不可持续性进行问题构建和集体识别，是朝着支持变革的共同观点和话语迈出的关键一步。
原创性/价值：荷兰医疗保健系统的转型刚刚开始出现，几乎未成为研究对象。本文在此背景下提供了对转型管理过程的实证描述。作者希望为未来旨在从理论和实践上探索医疗保健转型的工作奠定基础。
