How concepts guide policy: an ethnographic study of the meaning making of ‘appropriate care’ in Dutch healthcare

Concepts, such as value-based healthcare, patient-centered care and integrated care, are used to guide and govern healthcare structures and services. Although prior research has pointed us towards the multiplicity of interpretations of these concepts, there is little understanding of how a concept gets attributed a particular meaning from its various understandings. This paper describes how healthcare actors engage in the meaning-making of the concept of appropriate care in a policy process in Dutch healthcare by employing the discourse-analytical lens of Laclau & Mouffe. The policy process was studied from February 2022 to July 2022 by taking on an ethnographic approach, comprising fieldnotes (92 days of observation), drafts of the policy document (N = 77), interviews (N = 4), and documents (N = 88). Data analysis suggested that meaning was attributed to appropriate care through three strategies: hegemonizing (prevailing of discourses), compromising (merging of discourses), and co-existing (discourses put alongside each other). We argue that from the interplay between these three strategies appropriate care and similar concepts attain a meaning which might be able to productively guide and govern care proposing healthcare actors to actively engage with the ambiguity of concepts.