Jitse Schuurmans

Private investment in residential long-term care has surged around the world. Growing evidence shows that this is changing the institutional logic and the inner workings of the sector, prioritising the financial interests of asset holders above those of other stakeholders (eg. clients, care professionals and regulators). We know little about how policy makers and regulators are responding to private investment and profit-making in the long-term care sector. This paper addresses that gap by analysing policies prompting the growth of private investment and profit-making in residential long-term care, the emerging power struggles in some cases between asset holders and other stakeholders in long-term care, the controversies that have arisen and the concomitant responses of regulators and policy makers in Ontario (Canada), Lombardy (Italy), the Netherlands and England (United Kingdom). We show that the institutional context (eg. legal frameworks, policies and regulations) shapes controversies concerning quality, accessibility and affordability of care, and argue that regulators and policymakers in the constituencies we studied are responding reactively to such controversies rather than proactively anticipating and preventing unwanted effects. Our analysis provides policymakers with valuable insights regarding the regulation and governance of private investment and profit-making in the residential long-term care sector.

Fundamental to action research in healthcare is the co-production of knowledge by researchers and participants, including professionals, patients and policymakers. Despite high expectations of co-produced knowledge, few scholars have reflected critically on how researchers navigate situations in which different kinds of knowledge are articulated and potentially clash both at the front- and backstage of research projects. Drawing on our own experiences in various healthcare action research projects, we analyze the ways in which action researchers can relate to the ‘epistemological politics’ of action research, i.e., the negotiations and tactics that include and exclude certain types of knowledge and knowers in the production of scientific and societal insights. To understand this ‘relating of researchers’ and its implications for knowledge production, we draw on the concept ‘sorting attachments’, which we conceptualize as the practical work of figuring out how to relate to particular individuals, agenda’s, institutions and organizations, while at the same time acknowledging the wider political, economic and cultural relations that shape the normativities of stakeholders in action research projects. We distinguish different dimensions of sorting attachments; latching attachments , extending attachments, balancing attachments and foregrounding and backgrounding attachments. By teasing out these forms of sorting attachments, as well as their implications for knowledge productions, we provide researchers with heuristics to navigate contested knowledge claims in action research projects.

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.

Health care systems are facing soaring workforce shortages, challenging their ability to secure timely access to good-quality care. In this context, nurses make difficult decisions about which patients to deliver care to, transfer to other providers, or strategically ignore. Yet, we still know little about how nurses engage in situated practices of bedside rationing. Building on the work of Giorgio Agamben and Judith Butler, we have developed a research agenda that homes in on a politics of bedside rationing. We argue that this agenda is essential to better understand the implications of scarcity for nursing and to explore new ways to cope with challenges faced.

Task reallocation is increasingly foregrounded as a promising solution for capacity problems. Numerous studies show, however, that task reallocation between medical professionals is a highly contested issue and difficult to institutionalise. Conflicts are omnipresent and often arise from ‘intraprofessional competition’: Zero‐sum games between professionals from different disciplinary backgrounds where one party’s gains require another party’s losses. In this article, we build on calls to enrich the sociology of professions with new concepts and theories. We analyse a case of task reallocation between medical professionals in a nursing home using concepts from empirical ethics and valuation studies. We argue that modes of good care offer a valuable framework for analysing the reorganisation of professional work because they provide an empirically grounded and fine‐grained conceptual toolkit for understanding the dynamics among professionals and between professionals and managers. Enactment of different modes of good care inspires innovation in service provision but at the same time creates new tensions between those involved. We show how, in times of scarcity, a dynamic emerges between professionals attempting to stave off and reallocate work, thereby restricting their professional domains.

Purpose: The purpose of this paper is to explore the formation and composition of “regions” as places of care, both empirically and conceptually.Design/methodology/approach: This paper draws on action-oriented research involving experiments aimed at designing, implementing and evaluating promising solutions to the entwined problems of a burgeoning elderly population and an increasing shortage of medical staff. It draws on ethnographic research conducted in 14 administrative areas in the Netherlands, a total of 273 in-depth interviews and over 1,000 h of observations.Findings: This research challenges the understanding of a healthcare region as a clearly bounded topological area. It shows that organizations and professionals collaborate in a variety of different networks, some conterminous with the administrative region established by policymakers and others not. These networks are by nature unstable and dynamic. Attempts to form new regional collaborations with neighbouring organizations are complicated by existing healthcare governance and accountability structures that position organizations as competitors.Practical implications: Policymakers should take the pre-established partnerships of healthcare organizations into account before delineating the area in which regionalization is meant to take place. A better alignment of governance and accountability structures is also needed for regionalization to occur in healthcare.Originality/value: This paper combines insights from valuation studies with sociogeographical literature and provides a framework for understanding the assembling and disassembling of “regions”.