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Many Western countries have introduced market principles in health- care. The newly introduced financial instrument of ''care-intensity packages'' in the Dutch long-term care sector fit this development since they have some character- istics of a market device. However, policy makers and care providers positioned these instruments as explicitly not belonging to the general trend of marketisation in healthcare. Using a qualitative case study approach, we study the work that the two providers have done to fit these instruments to their organisations and how that enables and legitimatises market development. Both providers have done various types of work that could be classified as market development, including creating accounting systems suitable for markets, redefining public values in the context of markets, and starting commercial initiatives. Paradoxically, denying the existence of markets for long-term care and thus avoiding ideological debates on the marketi- sation of healthcare has made the use of market devices all the more likely. Making the market invisible seems to be an operative element in making the market work. Our findings suggest that Dutch long-term care reform points to the need to study the 'making' rather than the 'liberalising' of markets and that the study of healthcare markets should not be confined to those practices that explicitly label themselves as such. ; Funding agencies: Market, State and Society program of the Netherlands Scientific Council for Government Policy

In this paper we argue that performance measurement can be done better by general, less accurate measurements than by complex -- and possible more accurate -- ones. The conclusions of this study are drawn from a case study of the Dutch Foundation for Effective Use of Medication. While most studies about performance measurements focus on the management of public service organizations, this case study -- informed by the literature from Science and Technology Studies -- focuses on the active role of the measurements themselves. In the paper we show that indicators do not have to be as complex as the practices they represent -- as long as they are part of a chain of intermediary data that allow travelling from the general or simple indicators to detailed data in day-to-day practices and vice versa. Furthermore, general indicators enable stakeholders to obtain distance from each other. Rather than the involvement of stakeholders, it is this reflexive distancing that explains the degree of compliance to performance measurement and thereby the prospect for effective co-governance. Adapted from the source document.

Si l'on s'intéresse de plus en plus à la coproduction dans les soins de santé, on sait peu de choses sur le processus de coproduction. Dans le présent article, nous essayons de comprendre pourquoi les hôpitaux associent les patients et le personnel aux activités de coproduction et analysons les expériences des hôpitaux en matière de coproduction dans la pratique. Une étude qualitative, comprenant des entretiens semi-structurés (N=27), des observations (70 heures) et une analyse documentaire, a été réalisée auprès de cinq hôpitaux néerlandais qui mettaient à contribution les patients et le personnel en vue d'améliorer leurs services. Les résultats indiquent que les hôpitaux ont des raisons variables d'associer les patients et le personnel et qu'ils ont adapté les méthodes existantes pour mettre à contribution les patients. Il est intéressant de noter que les domaines d'amélioration présentés par les patients étaient bien souvent déjà connus. Le processus de coproduction a cependant bel et bien contribué à l'amélioration de la qualité à d'autres égards. Le processus de coproduction a amené les hôpitaux à réfléchir davantage à la manière de réaliser les améliorations de la qualité. Ce processus facilitait les améliorations de la qualité, le fait de voir les patients et d'entendre leurs expériences créant un sentiment d'urgence parmi le personnel, qui réagissait dès lors aux questions d'amélioration soulevées. De plus, les expériences ont eu pour effet de légitimer les améliorations auprès des organes de direction. Remarques à l'intention des praticiens Différentes méthodes de participation peuvent mettre en évidence les expériences des patients en matière de services de soins de santé, ce qui peut servir à améliorer la qualité. Notre étude démontre que le fait d'adapter les méthodes existantes aux ressources hospitalières locales peut être bénéfique pour les processus de coproduction dans un contexte donné. L'adaptation peut cependant aussi présenter des risques. Les activités d'adaptation, comme le recours à des critères pour sélectionner les patients, influencent ce que l'on considère comme la contribution légitime des patients. En outre, compte tenu de l'importance du processus de coproduction, la méthode doit se composer d'une trajectoire organisée, à laquelle les patients et le personnel sont associés et qui met en évidence les expériences personnelles. Les équipes de projet doivent par conséquent poser un regard critique sur les conséquences des adaptations et des actions d'adaptation, ainsi que sur leur opportunité, lors de la mise en œuvre de projets d'amélioration de la qualité.

Co-production in healthcare is receiving increasing attention; however, insight into the process of co-production is scarce. This article explores why hospitals involve patients and staff in co-production activities and hospitals' experiences with co-production in practice. A qualitative study with semi-structured interviews ( N = 27), observations (70 hours) and document analysis was conducted in five Dutch hospitals, which involved patients and staff in order to improve services. The results show that hospitals have different motives to involve patients and staff and have adapted existing methods to involve patients. Interestingly, areas of improvement proposed by patients were often already known. However, the process of co-production did contribute to quality improvement in other ways. The process of co-production stimulated hospitals' thinking about how to realize quality improvements. Quality improvements were facilitated by this process as seeing patients and hearing their experiences created a sense of urgency among staff to act on the improvement issues raised. Moreover, the experiences served to legitimatize improvements to higher management bodies. Points for practitioners Different participation methods can bring patients' experiences with healthcare services to the fore, which can be used for quality improvement. Our study shows that adapting existing methods to local hospital resources is likely to be beneficial for co-production processes within a given context. However, adapting and tailoring also poses risks. Tailoring activities, such as using criteria to select patients, influence what is considered to be legitimate patient input. In addition, as the co-production process is important, the method should consist of an organized trajectory in which patients and staff are involved and personal experiences are presented. Therefore, project teams need to critically reflect on the consequences of adaptations and tailoring actions, and their desirability, when carrying out quality improvement projects.