Practical wisdom in health care governance

When it comes to governance in health care, we rely far too much on general principles of good governance. In my dissertation I am looking for ways to understand supervisory practice from the perspective of practical wisdom 

When it comes to governance in health care, we rely far too much on general principles of good governance. In my dissertation I am looking for ways to understand supervisory practice from the perspective of practical wisdom (phronesis) as interpreted in the works of Hannah Arendt and Hans-Georg Gadamer, which offer an interpretation of governance as ‘knowing what is good (to do) in a concrete situation’.

I find myself to be a member of the research group Critical Ethics of Care. My field of work is that of boards and supervisory boards in health care. This can become quite abstract indeed. The research group, as it is so diverse in its research objects, often brings me back to earth, with examples of research in ordinary (health care and education) practices.  I partly work as a scientific consultant for a society of supervisory (or: non-executive) boards in health care (from hospitals to social care). Beside this, I am working on my PhD at the Vrije Universiteit Amsterdam, faculty of humanities, department of practical and social philosophy. My promotors are Prof. Dr. Govert Buijs, political and social philosophy at the Vrije Universiteit Amsterdam and Prof. Dr. Frans Vosman, ethics of care at the University of Humanistics Utrecht. At the Vrije Universiteit, I am also a teacher in Philosophy of Management&Organization. Recently, I also started my own office, called Phronèsis, and provides ‘philosophy in organizations’. Indeed, my working field is very much on the boundary lines between philosophy and organizational practices, with a focus on health care ((1)).

Basically, my dissertation focusses on the self-understanding of supervisory boards in long-term care organizations. The research is partly theoretical, working on the ideas of Hannah Arendt and Hans-Georg Gadamer in connection to (health care) governance theory and research, and partly empirical. In the empirical part we perform a so-called Dialogical Mediated Inquiry (DMI) with two or three supervisory boards and its near stakeholders ((2)). It is a non-representational method that looks for sense-making rather than for universal explanations. This method has not been used so often, and I am looking forward to contribute to the expansion of knowledge regarding this method, and am happy to hear if other researchers are familiar with it.

The discourse on supervisory boards is highly influenced by beliefs of how this kind of work should be done – as is the case in merely all practices. However, since many supervisory board members spend relatively little time on the job, they will be more likely to (unreflectively) adjust their doings and sayings to that practice than if they were in that practice on a day-to-day basis. For example, anyone entering the practice of supervisory boards in The Netherlands will soon be likely to confess the dogma of: “Thou shalt not sit on the chair of the executive”. Supervisory boards appear to rely heavily on general principles of good governance – something which is more widely shared in corporate and public governance settings. Our argument is that in concrete situations, general principles are of minor relevance ((3)). Rather, in specific situations, one needs practical wisdom or the ability to judge (reflectively) – as Arendt would say it ((4)). Most specific situations cannot be resolved by applying some general principles, as the concrete context is often edgy, highly complex and politically contested. Hence, one might expect that in concrete situations, dilemmas arise in which a supervisory board must decide-in-action what the good thing is to do; something which cannot be derived from general principles or values.   Hence, I contest a narrow focus of boards on (quality) measures and general techniques (such as tick-boxes), as they tend to suppress the moral and political embedded nature of supervisory board practice, and hence the need for the acknowledgement of supervisory work as practical wisdom. In this line, I will further work out the idea of common sense and dialogue. Both of these concepts are mentioned quite often in for example roundtables for supervisory boards, however, I argue, it often remains quite shallow, while a really important source of inspiration can be found there.

For me, ethics of care has provided an approach to the organization and governance of health care which does far more justice to the actual practice of care than contemporary management and governance approaches do. To understand care as relational, ordinary practice; to acknowledge that care is politically and morally embedded; to account for – instead of polishing away – vulnerability, power and conflict, are all highly important notions. Moreover, ethics of care has taught me the relevance of thick descriptions and narrative identities of singular or specific care practices in understanding health care.

Literature:

  1. Cf. Den Uijl, H. & Van Zonneveld, T. (2015) Zorg voor Toezicht. De Maatschappelijke Betekenis van Governance in de Zorg. Amsterdam: Mediawerf
  2. Lorino, P., Tricard, B. & Clot, Y. (2011) Research Methods for Non-representational Approaches to Organizational Complexity: The Dialogical Mediated Inquiry, in: Organization Studies, 32(6), pp. 769-800
  3. Gadamer, H-G. (1975) Wahreit und Methode: Grundzüge einer philosophischen Hermeneutik, Tübingen: Mohr
  4. Arendt, H. (1989) Lectures on Kant’s Political Philosophy. Chicago: University of Chicago Press

 

 

About the author: Henk Den Uijl

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