‘It's about the connections we've made with each other’: resilience and risk translation in governing healthcare during the COVID-19 pandemic

Abstract

In this paper we focus on risk translation in the governing of healthcare during the COVID-19 pandemic. We do so to explore crisis resilience in healthcare systems as a concrete practice. We build 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). Our analysis underscores how the COVID-19 pandemic in healthcare is enacted through a multitude of relations of risk. These relations are translated between institutional 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 specific objects and infrastructures of governance such as care (acute/‘non-COVID’), geographies (‘the region’) and materials (‘an ICU-bed’). Risk translation appears as a crucial practice for resilient healthcare systems; emphasizing 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 inherently political, leading to the in- or exclusion of (alternative) concerns and their representatives in governing healthcare during crisis.