Work

How concepts guide policy: an ethnographic study of the meaning making of ‘appropriate care’ in Dutch healthcare

Year: 2025

Type: article

Abstract: Concepts, such as value-based healthcare, patient-centered care and integrated care, are used to guide and govern healthcare structures and services. Although prior research has pointed us towards the multiplicity of interpretations of these concepts, there is little understanding of how a concept gets attributed a particular meaning from its various understandings. This paper describes how healthcare actors engage in the meaning-making of the concept of appropriate care in a policy process in Dutch healthcare by employing the discourse-analytical lens of Laclau & Mouffe. The policy process was studied from February 2022 to July 2022 by taking on an ethnographic approach, comprising fieldnotes (92 days of observation), drafts of the policy document (N = 77), interviews (N = 4), and documents (N = 88). Data analysis suggested that meaning was attributed to appropriate care through three strategies: hegemonizing (prevailing of discourses), compromising (merging of discourses), and co-existing (discourses put alongside each other). We argue that from the interplay between these three strategies appropriate care and similar concepts attain a meaning which might be able to productively guide and govern care proposing healthcare actors to actively engage with the ambiguity of concepts.

Source: Social Science & Medicine

DOI: 10.1016/j.socscimed.2025.118152

Authors: Britt Kraaijeveld, Sietse Wieringa, Eivind Engebretsen, Jet Bussemaker

Institutions: Leiden University Medical Center, University of Oslo, University of Oxford, Leiden University

Language: English

Topic: Healthcare Systems and Practices

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

Open Access status: hybrid

Estimated APC paid: $3,800

Funders: Zorginstituut Nederland, HORIZON EUROPE Marie Sklodowska-Curie Actions