Exploring sustainability in the Dutch Healthcare system: a discourse analysis of the effect of COVID-19 on sustainability perspectives

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This research is an exploration of the effects of COVID-19 on discursive positions in the Dutch healthcare system. Discursive positions employed in this research originate from Cultural Theory, in which the individualist, hierarchist and egalitarian perspective are distinguished. The multiple level perspective (de Haan & Geels 2018) was used in to provide for the context of the discourse analysis and provided for three levels of analysis, namely the macro, meso and micro level. The macro level was analysed by the employment of a media content analysis of Dutch news articles. Data for a first discursive sketch of the meso level originated from interviews with healthcare experts. Moreover, the micro level of niches was analysed using data retrieved from interviews with employees of the case studies of the hospitals the Sint Maartenskliniek and Isala. The three parts of the analysis were combined in order to answer the research question. On the macro level, a discrepancy between the individualist and egalitarian perspective was visible. The individualist perspective was visible in the finding that companies try to use the crisis as an excuse to bypass environmental legislations and agreements; the egalitarian perspective was visible in the finding that companies try to plea for a sustainable recovery of the economy after the situation has calmed down a bit. On the meso level, the helicopter interviews with healthcare experts employed the concepts of metaphors, narratives and story line (Hajer, 2006). The discursive perspective that was mostly visible in the helicopter interviews is the hierarchist discourse in which experts create knowledge and provide with an action perspective on how to work more sustainably in the healthcare system. On the micro level, the interviews with key players of the two cases the SMK and Isala showed that actors are willing to work more sustainably, yet do not put sustainability into practice. The data from the three different levels showed a dispersion of structuration and institutionalisation of discursive position in the healthcare system. This might be a reason why the healthcare system is lagging behind in terms of sustainability, compared to other systems. Moreover, this might explain the difference in level of sustainability between hospitals. To create a more sustainable healthcare system, knowledge has to be developed and shared throughout the entire system in order to offer employees an action perspective on how to work more sustainably.
Faculteit der Managementwetenschappen