Short abstract:

In this paper we argue that risk translation practices are a crucial mechanism for resilient health care systems as they enact and value objects and infrastructures of governance. We explore this by analyzing Dutch healthcare governance during the COVID-19 pandemic through a multi-sited ethnography.

Long abstract:

In this paper we focus on risk translation in the governing of Dutch healthcare during the COVID-19 pandemic. We do so to explore crisis resilience in healthcare governance as a concrete practice. We built in this paper on a multi-sited ethnography of the Dutch crisis-organization in healthcare between March 2020 and August 2022. We zoom-in on regional networks of acute care delivery (ROAZ) during the second year of the pandemic in the Netherlands (from August 2021 to August 2022). During this period our participants sought to learn from previous experiences during the first ‘waves’ of the pandemic and started to look forward to a post-pandemic situation.

Our analysis underscores how the COVID-19 pandemic in healthcare is enacted through a multitude of relations of risk. These relations are translated between layers of crisis-governance through relation-building, data-infrastructures, modelling and scenario-building, (re)writing guidelines and protocols next to formal political practices. We argue that risk translation during crises allows for creating time-spaces and infrastructures, enacting crucial objects of governance such as care (acute/’non-COVID’), geographies (‘the region’) and beds (‘an ICU-bed’). Risk translation appears as a crucial practice for resilient health care systems; showing the ad hoc, informal and manual risk work that mediates knowledge and values about how to act during crisis between layers of healthcare governance and emerging collective(s) (in) action. These practices are also inherently political, leading to the in- or exclusion of (alternative) concerns and their representatives in governing healthcare during crisis.