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Reading: Interorganizational Care needs Horizontal Governance


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Interorganizational Care needs Horizontal Governance


Monique Spierenburg ,

Rian van de Schoot


Interorganizational Governance isn’t a theme for research yet. Because of the complexity of problems of (new) clients there is an urgent need to cooperate in networks of welfare, care, initiatives of citizens, general practitioners and others. And because of the policy of the (local) government, the transition of the healthcare systems, with the vision to help people close by. In these practice we see new ideas and forms of governance.

What’s the problem? Decentralization, integration and personalizing in care and welfare are trending topics of the big changes in the long term care in the Netherlands. These trending topics includes issues of integrated care and welfare, over domains and boundaries of regulations. Connections between those worlds is needed. In practice we see local and regional new initiatives of cooperation between citizens-initiatives in daily life, welfare and care. We want to investigate what it means to work in such new networks for forms and performance of governance. We define interorganizational governance in four themes: control, purchase, accountability and supervisory. Hierarchic management is not the right answer anymore, trust and dialogue is what’s needed and transformational leadership of the directors between organizations, we call it horizontal governance.

“You have to release the hierarchic structure and downsize the responsibility to professionals in the working units. Freedom is not the word. You need to trust the professional … the boundaries do you notice together”.

There is a lack of interorganizational Governance code

- innovation is needed to operate according to the four themes of governance: control, purchase, accountability and supervisory.

Research that’s done last year

- Qualitative research: interviews with eight directors, reflection on these interviews with a assistant professor of the university, two do-design sessions with ten directors and supervisors;

- Quantitative research: making a map for all the networks in the Netherlands with new ideas about horizontal governance; survey directors social care and welfare municipalities;

- Two articles to start discussion.

Figure 1 visual of the process in one of the do-design-thinking sessions

Results: New types of interorganizational teamwork is needed to respond on the demand of vulnerable citizens.

Focus of Interorganizational Governance in four themes:

- Organizing: the art of release;

- Circularize: horizontal, integrated, reciprocally and transparent;

- Self-direction: staging and teamwork starts in the environment of citizens;

- Financing: short lines between those who have the money and who need support.

What’s needed to discuss

- Need to learn from experiences in cooperation practice;

- Search for a new language in a new world of networks and quick digital knowledge exchange;

- Learn to reform old habits and attitudes of all involved practitioners;

- The need to change and reshape the governance code of directors between organizations, it’s also called the art of boundary spanning: the approach of complex needs over domains of services.

First conclusions: The time is there to change and shape new forms of governance, horizontal governance, experimental governance. Not only the executive boards of the big care organizations, also the supervisory boards and inspectors of quality of care are willing to and in need for change. From Bottom-up the initiatives of citizens are also looking what’s needed to pinpoint their focus on the needs of the clients, instead of working on a compromise.

Lessons learned: Engaging board members and powerful members of supervisory boards are important to involve in new ways to perform. The partnerships in innovations in thinking and doing in interorganizational governance is hopeful. Together we could make new language for new methods and attitude to perform. New models of supervisory, accountability, control and purchase are needed to promote horizontal governance.

Collaboration with different people on different playing fields: executive boards, supervisory boards, universities, initiatives of citizens and management are searching for the new ways. It is important to connect these innovations to become reality in practice.

Limitations: The study was conducted with a limited number of boards. The awareness of consciousness of getting things changed in governance is the first step. The first step in a long process of changing the culture from hierarchic and control to trust and dialogue.

Suggestions for future research: Next year Vilans follows initiatives in new forms of governance in four regions on one topic theme of governance. To address new behavior and discuss dilemma’s, do action research and built together with partners in the field. For example one of the themes will Vilans explore in co-creation with Movisie (Netherlands centre of social development) and five initiatives of citizens. This is the theme financing and how they will succeed in purchase their care at the insurance company without loose the focus on their ambitions for the client.

How to Cite: Spierenburg M, van de Schoot R. Interorganizational Care needs Horizontal Governance. International Journal of Integrated Care. 2016;16(6):A120. DOI:
Published on 16 Dec 2016.


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