Roland Bal

Background and Objectives: Narrative approaches to quality improvement are increasingly adopted by long-term care organizations to gain insight into quality from the perspectives of older persons. However, it remains unclear how organizations experience the organizational challenges of embedding these approaches in new quality improvement routines and policies. This study aims to investigate what tensions arise when organizing and embedding narrative approaches and how organizations respond to these tensions. Research Design and Methods: An exploratory qualitative multiple-method design consisting of observations, semi-structured interviews, and document analysis was used. Data were collected in Dutch nursing homes between February 2024 and June 2025. To gain in-depth and broader insights, organizations were observed for a longer period (n = 2) and interviews were conducted with other organizations (n = 9) about organizing a narrative approach. Results: Four tensions were identified: (1) steering on predetermined themes vs. emergent themes from experiences; (2) abstracting narratives into broad quality terms vs. preserving the richness of narratives; (3) organizing quality top-down and in silos vs. as a collaborative and dynamic process; and (4) accounting for compliance vs. learning for improvement. Discussion and Implications: The tensions show that organizing a narrative process goes beyond organizational challenges but requires a paradigm shift in how organizations view and organize quality improvement. It requires a different way of data collection, analysis, and collaboration and emphasizes relationality and learning over individualized accounting. When organizations get stuck between two different quality paradigms, this can lead to several risks. The implications, risks, and potential of narrative approaches are discussed.

This study explores a new clustered social housing concept for older people through the lens of social citizenship for people living with dementia. For people living with dementia citizenship occurs most evidently in the ordinary domestic and community spheres. Based on ethnographic fieldwork, including observations and interviews, our analysis reveals how the design of this concept supports creating care-collectives outside of the often prevalent medical view. A structural interprofessional meeting acts as an institutionalized coordination body which pro-actively monitors, coordinates and shapes collectives for residents to receive care and support and remain engaged with the community. Initiating care-collectives from signals (early changes in residents’ functioning and wellbeing) has potential for enacting citizenship for people living with dementia, by situating them in a broader effort to engage with, and be part of a community. However, in the cross-domain collaboration new dilemmas and ethical considerations arise around boundaries of professionals responsibilities, information sharing, and their amount of agency to tailor services for residents.

In health care regulation, open outcome‐oriented standards are used to provide flexibility for care organizations to determine how to deal with complex issues. What remains understudied is how this works out in practice. This paper studies how inspectors use open standards to regulate the complex issue of person‐centered care. An exploratory qualitative multiple‐method design was used to study the work of inspectors who assess the quality of nursing homes within the Dutch Health and Youth Care Inspectorate. Five mechanisms were found that hamper the assessment of open outcome‐oriented standards for person‐centered care: difficulties in triangulating information, estimating the reliability of the information, deviating from the schedule of the inspection program, judging direct care provision negatively, and indicating a clear boundary between sufficient and insufficient. When using open outcome‐oriented standards, it is important to reflect on these mechanisms and evaluate whether outcomes still align with the societal values they attempt to regulate.

This article analyses how regional actors and national authorities shape and transform ‘the region’ from a geographical place into an object of governance for organising and delivering older person care. Drawing on an extensive ethnographic research project in the Netherlands, our findings show that these actors in interaction constitute the region through three practices: consistently creating urgency to foreground regional problems and solutions; renegotiating regulatory policies to facilitate regional care provision; and reconstructing care infrastructures to materialise regional care provision. Actors use and obtain power from co-existing and interacting institutional arrangements to develop new regional care arrangements. This evokes new interdependencies that reconfigure existing governance arrangements. Studying governance objects in-the-making reveals the required iterations, reconsiderations, and adjustments as processes within a given (ambiguous) institutional context, and which lead to institutional change. As regional organisation policies are increasingly scrutinised, this article provides an interesting and important contribution to this field.

Background: Tackling falsified and substandard medicines requires intersectoral collaboration, impact-oriented research and the effective application of research findings. However, the best way to organize research and involve stakeholders from different sectors to ensure that results are used, remains unclear. We aimed to assess how intersectoral stakeholder engagement in research on medicine quality in Indonesia evolved, influenced the research processes and participants, and affected the uptake of the results. Methods: For this prospective case study, we adopted an abductive approach inspired by contribution mapping and collaborative governance. We conducted 37 interviews with key informants, observed 24 meetings and analysed 121 documents to systematically map the engagement of stakeholders in a study on medicine quality, focusing on processes, influences and research-related contributions. Results: From the outset, it proved feasible, but challenging, to effectively engage stakeholders in research into falsified and substandard medicines in Indonesia. After a cautious start and persistent efforts, stakeholders, such as the national medicine regulatory authority, became increasingly involved and developed a shared understanding of the need for intersectoral collaboration to tackle problems with medicine quality. While the research findings did not lead to a different estimate of the magnitude of the problem, the involvement of stakeholders was beneficial. After formalizing the collaboration, stakeholders provided data needed to study potential risk factors, product varieties and sales volumes, and contributed to decisions during the research and interpretation of the findings. Owing to frequent personnel changes and diverging priorities, stakeholder engagement required more effort than anticipated, and necessitated a strategic and adaptive approach. This approach had to account for the varying priorities and interests of stakeholders, the evolving framing of the problem, the implications of the findings and the nature of the field, where regulators must operate cautiously, balance interests and respond to critical incidents. Conclusions: Intersectoral stakeholder engagement in medicine quality research is challenging but beneficial. Engagement contributed to building trust and relationships between researchers and stakeholders, helped forge an intersectoral network focused on medicine quality, exposed the medicine regulator to new methods, inspired stakeholders to take on new roles and make better use of existing data and furthered a research–policy partnership forum on pharmaceutical topics.