Healthcare executives as binding outsiders in fragmented and politicised organisations

Healthcare executives govern large, complex and often fragmented organisations in which the distance between policy and practices is often huge. An important effect is that — in some way — healthcare executives have become remote from their own organisations. They have to fulfil a dual role of maintaining a distance while at the same time continuing to be involved. In addition, they have to cope with the fragmented order of healthcare organisations in which departments and locations can be experienced as islands and where layers can turn out to be barriers. This study investigates the strategies that executives develop to deal with these complexities, while remaining detached outsiders. The empirical data are based on three ethnographic case studies in different sectors of Dutch healthcare. The study makes clear that distance and involvement are constantly constructed and reconstructed by context, structures and symbols and also by the various parties in daily operations; that executives make use of four specific methods to govern distance; and that executives play a special role because of their detached position. As processes of distance and involvement freeze, there is a special task for executives. In fragmented and politicised healthcare organisations, they can be of importance as ‘binding outsiders’.