‘It is difficult to do the right thing’: resilience and institutional work during and after the COVID-19 pandemic in Dutch healthcare governance

Abstract After the COVID-19 pandemic the resilience of healthcare systems has been put firmly on the agenda. Systemic approaches to healthcare systems are limited in explaining the institutional reactions to the pandemic, making the case to study resilience in healthcare systems as a more mundane and ongoing practice of organizing healthcare. In this paper we take up this call and focus on the institutional work done by a crucial systemic actor in Dutch healthcare during and after the COVID-19 pandemic. We focus on how this actor, the Dutch National Health Care Institute, worked to manage the pandemic and its aftermath through qualitative in-depth interviews (N=16) and document-analysis of policy. We analyze this robust empirical material abductively building on literature of resilience and institutional work. This allows us to foreground the actual practices of governing healthcare and reflect with our participants on this. Our results underscore how a specific framing of resilience in policy-practice influences the (lack of) institutional work in and by the Institute. This framing is established and constantly influenced by the role of personal leadership, institutional history and the affective and informal alliances in which the Dutch National Health Care Institute as well as associated independent regulatory agencies were engaged during and after COVID-19. We show, for instance, the interactions and interdependencies of such actors in the public arena and stress the vulnerabilities of informal alliances in dealing with crises. Ultimately, we argue that understanding resilience as institutional work helps to grasp the mundane and lived realities of adaptive capacities of actors in healthcare systems.