‘Good Governance’ and Stakeholder Involvement: Why We Need a Context-Sensitive Approach

Assessments of health systems governance have shown that strengthening stakeholder involvement is a major policy lever for governance innovation and an important tool for improving performance. We argue the need for a more critical and context-sensitive approach on stakeholder involvement as an indicator of good governance. Health workforce governance in European countries serves as empirical example; the aim is to identify different models of stakeholder involvement and their capacity to drive integrated people-centred care. The analysis is explorative and draws on policy documents, public statistics and other secondary sources. Three models of involving stakeholders in health workforce governance can be identified: corporatist professional involvement either in a continental European model of conservative corporatism (e.g. Germany, Belgium) or in a Nordic model (e.g. Sweden, Denmark) of public corporatism; managerialist and market-centred involvement of professions as organisational agents; and a more inclusive, network-based involvement of plural professional experts at different levels of governance. The power relations embedded in these models of stakeholder involvement have different effects on capacity building for an integrated people-centred health workforce. Corporatist governance models embody risks, albeit in different ways, to remake professional silos rather than serving patient needs, while managerialist stakeholder involvement has some capacity for more integrated care but the effects are uncertain and shaped by market logics. Most promising is a bottom-up driven model, that connects diverse professional groups and care sectors through network-based governance and shared values of ‘good care for patients’. The results highlight that stakeholder involvement must be assed in the context of power relations embedded in health workforce governance.