Despite all improvement initiatives such as the national action plan [De-]Regulate Healthcare by the Dutch Ministry of Health, Welfare and Sport in 2018 to create more time for care within the Netherlands, the administrative burden for care workers is still increasing. Managers of healthcare institutes struggle with efficiently implementing government legislations in day-to-day operations. They indicate that the time spent on administrative tasks demanded by municipalities and national authorities is too much. In addition, they also indicate that there is a lack of consistency and uniformity when it comes to the way care workers handle administrative tasks. This way of working causes additional, and often ad hoc, work in the run-up to an audit. It seems that before laws and regulations are effectively implemented, new laws or regulations again demand attention. This looks like a vicious circle, but research to confirm this is not found yet. Therefore, the following research question is formulated: "What is the impact of laws and regulations on the administrative burden with regard to the primary and supportive processes of Dutch long-term care?" An explanatory multiple case study was conducted to answer the research question. Three case studies were carried out during September 2019 to January 2020. Based on these studies, we have concluded that between 29% and 62% of the total perceived administrative burden by long-term care professionals can be related to legislation.
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English Abstract:Administrative turbulence in social work: the challenge of pluralist coalition-formation As elsewhere in Europe, social work in the Netherlands is facing ever more administrative changes. This article analyzes the administrative changes that local social work institutions are currently facing and how representatives of these institutions are reacting to these changes. The article is divided into three sections. The first section describes four administrative changes that organizations in the field of social work are currently facing. The second section is based on the results of four studies in local social work, and analyzes how social workers and managers from these organizations are experiencing and handling these administrative changes. We group the reactions into four different clusters: the confused reaction, the introvert reaction, the extravert reaction and the binding reaction. The third section zooms in on what we see as the most beneficial strategy: the binding reaction. We argue that these turbulent times call for organizations that are able to create strong coalitions, both internally and externally. These are necessary to guarantee service provision as well as innovation in a meaningful way.--Dutch Abstract:Bestuurlijk turbulentie in het sociaal werk: de uitdaging van meervoudige coalitievorming Net als elders in Europa wordt het sociaal werk in Nederland geconfronteerd met indringende bestuurlijke veranderingen. In dit artikel analyseren wij met welke bestuurlijke veranderingen instellingen in het lokaal sociaal werk te maken hebben en hoe representanten van deze instellingen op deze veranderingen reageren. Het artikel bestaat uit drie delen. In het eerste deel beschrijven we vier in het oog springende bestuurlijke veranderingen waarmee organisaties in dit veld geconfronteerd worden. In het tweede deel analyseren we op basis van verschillende onderzoeken in het lokaal sociaal werk hoe representanten van deze organisaties – sociaal werkers en managers – deze veranderingen ervaren en hoe zij hiermee omgaan. We onderscheiden vier clusters reacties: de verwarde reactie, de introverte reactie, de extraverte reactie en de verbindende reactie. In het derde deel zoomen we in op de ons inziens meest vruchtbare reactiewijze: de verbindende reactie. We betogen dat deze turbulente tijd vraagt om organisaties die erin slagen om zowel sterke interne als krachtige externe coalities te creëren, nodig om de kwaliteit van de dienstverlening te waarborgen en betekenisvol te innoveren.
Background: To be accountable to laws and regulations, healthcare professionals spend more than 40% of their time on administrative tasks. The Compulsory Mental Healthcare Act (CMHA) was introduced in Dutch mental healthcare in 2020. It was hypothesized that this legislative amendment would raise the administrative burden for some care professionals. Pilot studies in 2020 and 2021 visualized the exponentially rise of the administrative burden for care professionals, especially psychiatrists due to the transition. However the total response was too small and not generalizable. Aim: gain more nationwide insight in the hypothesized raise of administrative burden of psychiatrists due to the implementation of the CMHA. Method: Under the leadership of an advisory board of three medical director psychiatrists, a Likert scale questionnaire was further developed to investigate the administrative burden of psychiatrists in the Netherlands before and after transition. Open-ended questions provided the opportunity for feedback from the psychiatrists. The study was supported by the Department of Medical Directors (DMD) of The Netherlands Psychiatric Association (NPA). Results: all mental health institutions members of the DMD of the NPA received an invitation to participate. 14 institutions (total N=158) responded. The data show a significant change in the time spent on administrative tasks, the usefulness of the administrative actions, the fit for use and ease of use of supporting systems. The forementioned all decreased significantly after the implementation. Conclusion and discussion: Psychiatrists spend more time on administration than before the legislative amendment instead of helping vulnerable patients. None of the institutions has been able to use the transition to its advantage given the time spent on administrative tasks and the usefulness of these tasks. This is an unacceptable development in the field of mental health in the Netherlands and should be addressed to those who are responsible for the decision making, especially policy makers. These results show that the introduction of the CMHA have made the field of Dutch mental health an impossible area to work for. , Administrative burden, Legislative amendment, Public governance, Information Management
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