Projects in the spotlight
Background project
Public regulation and supervision face growing challenges due to the increasing complexity and horizontalization of society, particularly in the provision of services to vulnerable groups. Traditional top-down regulatory models based on fixed standards often fail to account for the dynamic, person-centred needs of service users. This project responds to the need for innovative, reflexive regulatory arrangements that are more adaptive, inclusive, and legitimate. We aim to enhance regulatory practices by incorporating narrative approaches that foreground the lived experiences of users, especially those in vulnerable positions.
The research project focuses on three vulnerable groups – people with dementia, unemployed individuals, and children with mental health challenges – to explore how user narratives can inform more integrated, person-centred service provision. Using a reflexive governance approach, the project implements regulatory interventions to study the use of narrative approaches, develop new regulatory arrangements, and translate findings into a practical regulatory toolkit.
In terms of societal impact, the project works to enhance trust and collaboration between regulators, service users, and service providers, and supports a shift toward more responsive, networked regulation. Scientifically, the project contributes to theoretical and empirical insights on reflexive regulation, the role of narratives in governance and regulation, and accountability structures in complex service environments.
Ultimately, the project seeks to co-produce reflexive regulatory practices that better align with the complex realities of service users, promoting sustainable, person-centred care across policy and regulatory domains.
Research team
Erasmus University, Erasmus School of Health Policy & Management (ESHPM)
- Prof. dr. Anne Margriet Pot
- Dr. Josje Kok
- Prof. dr. Roland Bal
- Prof. dr. Iris Wallenburg
- Prof. dr. Hester van de Bovenkamp
- Milan van Keulen, PhD candidate
- Mirjam Kalisvaart, PhD candidate
University of Groningen, Groningen Centre for Law and Governance (GCLG)
- Prof. dr. Marc Hertogh
- Dr. Paulien de Winter
- Marilie Odding, PhD candidate
Radboud University, Institute for Management Research (IMR)
- Prof. dr. Jan-Kees Helderman
- Dr. Dorian Schaap
- Eline Verheijen, PhD candidate
Partners
Organisations representing service user interests
- Zorgbelang Inclusief
- Alzheimer Netherlands
- MIND
Regulatory organisations and policy actors
- Health and Youth Care Inspectorate
- Inspectorate of Education
- Justice and Security Inspectorate
- Netherlands Labour Authority
- Joint Inspectorate Social Domain
- Netherlands Institute for Social Research
- Association of Dutch Municipalities
- Divosa
- GGD GHOR Netherlands
- Nationale Ombudsman
Funder
NWO, grant number: NWA.1334.19.010
Duration
2022 - 2026
Background project
In the realm of healthcare, incidents and errors persist, raising concerns about patient safety. Despite extensive efforts to analyze adverse events, the prevalence of medical errors remains unsettling. This research aims to investigate the effectiveness of traditional Root Cause Analysis (RCA) compared to alternative approaches, particularly those emphasizing human factors and systemic perspectives. Root Cause Analysis (RCA) is a common method for investigating adverse events. However, its limitation lies in the tendency to stop the analysis at the level of "preventable causes." Incorporating an external expert from another sector could add value by providing an outsider's perspective. Shifting from a linear cause-and-effect analysis conducted solely by healthcare professionals to a systemic analysis carried out in collaboration with non-healthcare safety specialists might provide a more holistic understanding of contributing factors, offering added insights for designing interventions and systemic improvements.
In this project, three safety experts from the petrochemical industry will be involved in the analysis of adverse events in a university medical hospital. The project aims, first, to research how alternative approaches that involve safety experts from outside healthcare contribute to a more comprehensive understanding of the underlying factors that lead to medical incidents. Secondly, it aims to analyze whether external safety experts suggest other potential improvements for enhancing the impact of patient safety measures.
The project is highly relevant for the regulation of adverse events in healthcare, as the Dutch Inspectorate provides guidelines on how healthcare organizations should analyze adverse events and evaluates their submitted reports on adverse events. In the follow-up to this project, we aim to research whether the current Dutch regulation of adverse events poses a possible barrier to a better understanding of adverse events and the development of systemic improvements.
Research team
Erasmus University, Erasmus School of Health Policy & Management (ESHPM)
- Dr. Kor Grit
- Prof. Ian Leistikow
University Medical Center Groningen (UMCG)
- Jurjen Oosterhuis
- Dr. Margriet de Jong
Technical University Delft
- Dr. Irene Grossman
Funder
Dutch Health and Youth Care Inspectorate
Duration
2024-2025
Background project
During the COVID-19 pandemic, the organization of healthcare in the Netherlands showed remarkable adaptability, as did the supervision of healthcare. Existing field standards and quality of care frameworks were discussed, and professionals and organizations were given space and confidence to respond to the pandemic. As a result of the pandemic, there is growing attention to the preparedness and resilience of healthcare systems. However, it is not yet sufficiently clear how—and whether—the (pandemic) preparedness and resilience of the organization of healthcare can be regulated and monitored. Existing literature on the COVID-19 pandemic, for example, emphasizes the need for a dynamic view of pandemic preparedness and resilience: not (only) as measurable properties or outcomes of a system, but as a resilient practice.
Using this perspective, we engage in a) a scoping review of relevant literature, b) a retrospective analysis of the work of the Dutch Health and Youth Care Inspectorate (IGJ) during and after the pandemic in regulating preparedness, and c) a qualitative formative analysis of current practices of the IGJ in developing such regulation, specifically in relation to the thematic regulation of laboratories and European regulatory developments.
Our analysis emphasizes the concrete work required from a regulator to arrive at a regulatory object. That is, regulators such as the IGJ must work to translate the social appreciation and political discussion of—in this case—pandemic preparedness into concrete practices of supervision. The work involves, for example, identifying the risk, formulating (and encouraging) relevant field standards, and defining relevant addressees. We discuss how such work is not an unambiguous task, particularly in cases of high uncertainty and amidst a healthcare system already facing many creeping crises.
Research team
- Dr. Bert de Graaff
- Bertien Winkel
Funder
Dutch Health and Youth Care Inspectorate
Duration
2024-2025, with possible extension
- The involvement of citizens and service users in regulation
- Safety-II in complex care environments for people with learning disabilities
- Room for resilience: embedding Safety-II approaches in hospital care
- Regulation of sexual misconduct in healthcare
PhD-studies in the spotlight
Background project
The Youth Care division of the Dutch Health and Youth Care Inspectorate aims to contribute to high-quality care for young people by regulating youth care providers. One of three areas of focus is organizational leadership. In recent years, the theme of “Leadership” has been included in the “Youth in Youth care-framework” (JIJ-kader), which serves as the assessment framework for this division. However, it remains unclear whether this framework adequately supports inspectors in evaluating leadership practices and whether these behaviours are adequately captured. This is relevant, as both research and international practice show that leadership behaviour has a significant impact on the quality of care. As such, leadership behaviour constitutes an important focus area for regulatory practices. This study aims to make leadership behaviour inspectable, ultimately improving the quality of child and youth care.
The study began with a scoping review, which showed that specific leadership behaviours positively affect employee well-being and organizational commitment. Both factors were associated with positive influences on quality of care. This underscores the importance of leadership as a regulatory focus.
Next, a multi-case analysis was conducted for which we observed inspections in both the Netherlands and Scotland and conducted interviews with inspectors from the Netherlands, Scotland, and England. In addition, we analysed inspection reports, policy documents, and regulatory frameworks. This phase included two key studies: a discourse analysis of the term "leadership", as leadership can be defined both broadly and narrowly, and thus may carry different meanings for different individuals, and an analysis based on theories on regulation, specifically Value Driven Regulation. These analyses contributed to identify both strengths and areas for improvement in current regulatory approaches to leadership.
The final phase of the study involves action-oriented research with inspectors to develop regulatory objects for leadership, including quality indicators that meet the criteria for effectiveness. The goal is to embed these in a regulatory framework that supports inspectors in assessing and addressing leadership behaviours where needed.
PhD-candidate
Janet Ressang-Wildschut
Supervisory team
- Prof Ian Leistikow
- Dr Lieke Oldenhof
Duration
2022 - 2026
Background project
The Dutch Health and Youth Care Inspectorate carries a dual mandate under the Dutch Health Act (Gezondheidswet) and the Dutch Code of Criminal Procedure (Wetboek van Strafvordering). On one hand, it serves as the regulatory authority responsible for monitoring and promoting the quality and safety of public health and healthcare in the Netherlands. On the other, it includes a criminal investigations unit tasked with investigating criminal offences within the healthcare domain, under the authority of the Public Prosecutor.
In practice, aligning these two functions presents certain challenges. Within the organization, collaboration between the regulatory departments and the criminal investigations unit as well as the public prosecution service is often experienced as complex. There can be uncertainty about roles, differing professional cultures, and a sense that these functions serve fundamentally different objectives. This can result in limited mutual understanding and occasional inefficiencies in daily operations.
These observations have led to the central research question: What can be done to improve collaboration between regulatory oversight and criminal law enforcement in support of healthcare quality and safety?
To explore this question, the project investigates several key areas. It begins by examining the legal framework that defines and guides the Inspectorate’s dual responsibilities. This includes an analysis of how the combination of regulatory and criminal enforcement functions is structured in law, and how this influences collaboration in practice. The study also explores the challenges that may emerge at the intersection of these roles, such as the practical and legal complexities that arise during cooperation between departments. Finally, the study explores what values and considerations play a role in the decision-making of both the regulator and criminal law enforcement regarding an appropriate response after incidents in healthcare.
Building on these findings, the project identifies possible approaches to strengthen collaboration, foster shared understanding, and improve internal coordination. Finally, it considers how better integration of these functions might support the overarching goal: ensuring that healthcare in the Netherlands remains safe, transparent, and of high quality.
PhD-candidate
Quirine Amelink
Supervisory team
- Prof Ian Leistikow
- Dr Jan-Willem Weenink
Duration
2022 - 2026
Background project
Traditionally, linear causality thinking still plays a dominant role in serious adverse event (SAE) investigations. This research, aiming to enhance the safety of healthcare, begins with an analysis of the ontologies presented in SAE reports submitted to the Dutch Health and Youth Care Inspectorate. We will examine whether these reports—and thus the SAEs—are constructed using traditional linear reasoning or reflect more diverse approaches.
To do so, and in line with insights from contemporary safety science, we will formulate trigger questions that help reveal how investigation teams reconstruct the course of events in SAEs. By gaining insight into the underlying ontologies used in these reconstructions, we aim to identify new opportunities to improve learning after SAEs.
In addition, we will assess whether SAE reports address a set of essential psychological goals. These include: 1) providing a clear and understandable explanation of what happened, 2) outlining the measures taken to prevent recurrence, 3) making ethical or moral judgments when appropriate, and 4) offering meaning and recognition to those affected and harmed by the SAE.
We will evaluate the extent to which these goals are addressed in current SAE reports and use these findings to offer recommendations that may enhance feelings of satisfaction, justice, and closure for all parties involved in an SAE.
In the second phase of our research, we aim to uncover the assumptions guiding SAE investigators while analysing and reporting SAEs and proposing improvement measures. What beliefs and perspectives shape their understanding of safety in healthcare?
Based on these insights, when introducing alternative and contemporary ontological safety perspectives during future SAE investigations, we will explore whether the learning capacity after SAEs can be expanded and examine the experiences of all individuals involved in this alternative method. How does this enriched approach to investigating SAEs affect the level of learning and the satisfaction of those involved?
PhD-candidate
Oliver Beckmann
Supervisory team
- Prof Ian Leistikow
- Dr Jan-Willem Weenink
- Dr Johan Bergström (Lund University, Sweden)
Duration
2024 - 2029
- Regulating organizational learning and improvement capability | Kees de Kok | 2019-2027
- Sustainable employability of healthcare workers | Iris van de Voort | 2020-2025
- Appreciation of healthcare workers | Jooske Leenders | 2020-2026
- Geographical context of healthcare quality and consequences for regulation | Annet Winter | 2021-2026
- Narrative approaches in person-centered care | Mirjam Kalisvaart | 2022-2026
- Experiments with reflexive regulation of dementia care networks | Milan van Keulen | 2022-2026