“Tja… meestal verliest de dementerende, die moet dan naar een verpleeghuis.” : frontline werkers in interactie met dementerenden en hun naasten; een kwalitatieve studie naar rolconflicten en copingmechanismes

Abstract

It has now been well established that research on frontline workers is relevant to understand public policy implementation, as these workers “make public policy on the spot”. Frontline workers are public service employees working in direct contact with the public. Frontline workers are the people that eventually implement public policies. For example; A Policeman decides which person gets a fine, a Social Worker decides what support is provided, a Nurse decides what care is given and a Teacher decides whether a pupil will be moved from the forth to the fifth form. Central to literature on policy implementation, is that frontline workers often implement policies differently than intended, and deviate from policy rules. Frontline workers start to deviate from policy rules when expected behaviours by other actors are incompatible with expected behaviour based on policy rules. Conflicting role expectations are often referred to as role conflicts, behaviours to cope with role conflicts are described as coping mechanisms in policy implementation literature (Keiser, 2010; Lipsky, 1980,2010; Tummers, 2015; Hill & Hupe, Lipsky, 1980; Maynard-Moody & Musheno, 2000). Despite the overwhelming amount of literature on frontline workers which has confirmed the critical role they play in policy implementation, it appears to have an important limitation. It has been conceptualised and assumed that frontline workers interact with one client instead of two or more clients (e.g. Tummers et al., 2015; Hupe & Hill, 2007:280,283; Scott, 1997:36; Brodkin, 2011; Nelson, 2006; Lipksy, 1980;2010). The reality of healthcare frontline workers is that they interact with patients and their relatives, and moreover they have to serve both. This observation indicates a gap in current policy implementation literature (Alzheimer Nederland & Vilans, 2013:23-24). The aim of this study is to improve the policy implementation literature via conceptualising the client as plural. In addition, frontline workers provide an excellent opportunity to reflect on implemented public policies, therefore this paper reflects centrally on implemented policy. This study will reflect on Dutch Long-term care, more specifically the Dutch dementia policy. This thesis aims to provide insight into the following research questions: 1) What insights do the conceptualisations of the client as plural add to current policy implementation literature? 2) How do the discovered role conflicts and coping mechanisms in this study reflect on the Dutch long-term care policy for people with dementia? In order to be able to answer the research questions, interviews were held with frontline workers and house calls made to patients and their relatives. The findings in this study enhanced the relevance to conceptualise the client as plural. It appeared to provide an important contribution to the understanding of role conflicts and coping mechanisms. In addition, the discovered role conflicts and coping mechanisms provided a fruitful base for critical reflections on Dutch long-term care policies for people with dementia.