Table 3 Governance structures and roles: expectations, intended Population Health Management strategies and prior experiences as reported by stakeholders

Stakeholder groups’ intended strategies (short (5-), middle (10-), long (20 years) term)

Short

B, H, HCI, M, PCG, PM, PRO: Decreased role of individual local and regional organizations, a regional governance structure is increasingly seen as the right scale for regional responsibility. Increasingly other regional stakeholders will enter. Governance structures will continuously change. Structures will range from informal to formal collaborative networks (on specific subjects).

H, HCI, PCG, PRO: Different ideas on who will play a lead role.

B, H, M, PM. Citizens solve local problems (e.g. loneliness) as co-creators with support of professionals.

H, HCI, PCG, PM, PRO: Increased citizens’ awareness of responsibility for their own health via big data-technologies. The role of ‘co-creative citizens’ is increasingly anchored in the regional healthcare policy (H, HCI, PCG, PM, PRO) (strategic, tactical, operational) (PRO).

H, HCI.: Invest in hospital learning networks.

H, HCI, PCG: Invest in the bundling of high complex care in hospital networks and low complex care in multidisciplinary centres. Invest in the development of regional governance structures.

B, H, HCI, M, PCG, PM, PRO: Develop meaningful engagement of citizens.

HCI, M, PCG, PRO: Inventory of citizens’- patient’s wishes and needs regarding regional health and wellbeing

H, M, PCG, PM, PRO: Establish a citizens’ cooperative.

B, HCI, M, PCG, PM, PRO: Activate community building so citizens can self-manage.

Middle

HCI, PCG: The beginning of ACO Dutch style.

H, HCI, PM, PCG: PHM networks are responsible for regional PHM

H, HCI, PM, PCG: The community is more in the lead.

B, M, PCG, PM, PRO: A bigger role for municipalities in directing regional health care, while the role of the healthcare insurers is expected to decrease as it insufficiently fits the transformation movement. Citizens are co-creators in the regional healthcare policy.

H, HCI: Idem short term.

H, HCI, PCG: Idem short term.

B, H, HCI, M, PCG, PM, PRO: Idem short term.

HCI, M, PCG, PRO: Ensure citizens-patients are co-creators.

B, HCI, M, PCG, PM, PRO: Idem short-term.

Long

HCI, PCG, PM: Accountable Care Organisation – Health Management Organisations.

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contextual factors-mechanisms

HCI, H: Technological developments will build organizational power for hospital networks. H: primary care groups might be marginalized as they lack professional capacity and knowledge. Hospitals are capable of taking the integrator role.

PCG: Agendas have become increasingly ambitious by engaging local, regional influential stakeholders and national policymakers. Integrator role is seen as a powerful strategy to influence future governance structure.

B, H, HCI, M, PCG, PM, PRO: -Stakeholders were in doubt if this organizational representation equalized the representation of citizens. Also, questions remained with regard to what governance structures would be appropriate for patient-citizens engagement.

-The political-social relations between the government, the market and the community are changing. Engagement of citizens is necessary to ensure that services are being arranged according to their needs.

B, M, PCG, PM, PRO: Municipalities are obliged by law to support that more people participate and find work (also people with an occupational disability in collaboration with regional businesses), and to support citizens to arrange matters themselves in the public domain (‘Do-democracy’). Democratization and decentralization will erode healthcare insurers’ role in time.