the issue of "governance" in Health Tourism
Konstantinos Konstantinidis, M.D., Ph.D.
Director - ExCtu - addressing the Health Tourism Sector "Builder Class" (a.k.a. the "growth makers" and “developers”) with originated T-shaped knowledge for thinking and doing.
…Economic Sector and Destination
This is an “ever-evolving” EMVIO document
See: EMVIO Entities - in Health Tourism - https://www.dhirubhai.net/pulse/emvio-entities-health-tourism-constantinides-m-d-ph-d-/ .
NOTE
For the “definition and scope” of Contemporary Health Tourism (a.k.a. Internet Century Health Tourism – with both terms now, represented by ht8) - in bullet point form - see: https://www.dhirubhai.net/pulse/health-tourism-few-bullet-points-constantinides-m-d-ph-d-/ .
Also included is a short reference to the “then” and “now”.
Some of the “unfamiliar” terms used in this article (“fuzzy” and “wicked problem”) are defined / explained towards the end (see: “the meaning of things”).
a term associated with “fuzziness” with regards to its meaning
…and the Wicked Problem
The issue of governance – in the context of Health Tourism - has been confounding me (as a Wicked Problem), not only because of the “fuzziness” of the term (with regards to its meaning), but because, under the Conventional Health Tourism “regime”, several “legal entities” (including industry representative bodies [associations, councils, confederations], cluster organizations, governmental organizations - and even inbound travel agents), claim to play the role of Destination Management Organization and provide governance.
This in turn led to the “dilemma” of “knowing who to call when you want to speak to a Health Tourism Destination” (something I have written about).
This dilemma (and uncertainty) is an example of Governance Failure (see: Effective and Democratic Governance).
As should be obvious, the issue of “governance” comes into play when considering Health Tourism at the “macro” level - i.e., Destination – and latterly, Economic Sector, as well.
BTW, the “economic sector” layer, was added on top of “destination”, as a consequence of “transformation” which resulted in Health Tourism, now, being regarded as an economic sector (sector of the economy).
The term “governance” takes on differing meanings – depending on the context it is used in.
As H.K. Colebatch comments (in his article titled “Making sense of governance”), governance is a term which is widely, but not always precisely, used (https://www.tandfonline.com/doi/full/10.1016/j.polsoc.2014.10.001).
I add that, the term is also, not clearly understood.
In this article, the term is used – and explained - in the context of Health Tourism Economic Sectors and Destinations.
In generic terms, “governance” means:
Governance is about:
In the context of Health Tourism, “governance” means overseeing the direction of Economic Sectors and Destinations, determining how decisions are made – and who has a voice in making these decisions - and ultimately, who is accountable – and generally, about the “nuts and bolts” of how economic sectors and destinations operate.
Governance through a Network
…guiding rather than “commanding”
In this modern age, governance should be “effective”, and at the same time, “democratic” – which means that it should be about guiding rather than “commanding”.
Even as far back as 1995, the Commission on Global Governance, composed of eminent public figures, in its report, saw the core defining characteristics of governance as:
Jacob Torfing and Eva S?rensen (who wrote an article titled “Making Governance Networks Effective and Democratic Through Metagovernance”) see governance as: “governing through networks” (May 2009 Public Administration 87(2):234 – 258).
I like - and subscribe to - the assertion that governance is rule by autonomous self-organizing networks.
And the reason I am championing the Decentralized Autonomous Organization (DAO) as the type of legal entity to opt for, in providing the governance of Economic Sectors and Destinations.
Today, Governance Networks are mushrooming, in response to the “steering ambitions” (i.e., ambitions to control) of Governmental Organizations and individuals – and the increasing fragmentation of social, political and business life.
Governance through the formation of networks aims to solve wicked problems and enhance democratic participation in policy-making – and combats “steering ambitions” and “fragmentation”.
And I reiterate that “governance” should be about guiding rather than “commanding”.
领英推荐
?Effective and Democratic Governance
…and the role of “Metagovernance” in overcoming governance failures
In order to ensure that governance networks (in the form of DAOs) contribute to the effective and democratic governing of Health Tourism Economic Sectors and Destinations, careful metagovernance by the “engaged stakeholders” involved, is necessary.
In their paper titled “Making Governance Networks Effective and Democratic Through Metagovernance”, Jacob Torfing and Eva S?rensen discuss how to assess the effective performance and democratic quality of governance networks.
They also describe how different metagovernance tools can be used in the pursuit of effective and democratic network governance.
Finally, they argue that “metagovernors” must develop their strategic and collaborative competences in order to become able to metagovern governance networks.
In order to keep this article short, the role of Metagovernance in the governance of Health Tourism Economic Sectors and Destinations will be addressed in a dedicated article on the subject.
BTW, Metagovernance is also part of Web3 – which Contemporary Health Tourism has embraced.
Governance exercised through a Decentralized Autonomous Organization (DAO)
…and the concept and practice of “flat organizational structure”
Contemporary Health Tourism is based on the concept and practice of Academic Libertarianism – which means the acceptance of rules – but rules which are not imposed by an institutional authority.
In Contemporary Health Tourism, the term “rules” is replaced by the terms “Accepted Practices” and “Protocol”.
Furthermore, Contemporary Health Tourism abhors “hierarchy” – and champions the “flat organizational structure”.
In the corporate world, the term “flat organizational structure” refers to a company with few or no hierarchical levels between employees, which means that all employees have essentially the same power and authority.
The lack of hierarchy can be seen as a positive attribute because it allows for more communication and collaboration between employees.
There are several reasons why a company might decide to implement a flat organizational structure, such as to reduce costs, eliminate the need for middle managers, or allow the company to become more agile and responsive to change.
In the context of Health Tourism Governance, the “flat” approach to organizational structure is reflected in the choice of the “DAO” – through which governance is to be exercised.
A DAO is an organization without a hierarchical structure.
DAOs have a “distributed structure”, where the stakeholders can interact with each other in accordance with the conditions specified in the “code” which is documented on the blockchain.
The DAO, with its flat organizational structure, allows for more communication and collaboration between stakeholders – and allows the “organization” to be more agile and responsive to change.
In fact, in Health Tourism, the DAO is designed as an EMVIO Entity (which has its evolution “designed-in” [Planned Evolution] – meaning it has been designed to be ever-evolving [probably containing flaws] and never definitive - aiming for perfection, but probably never achieving it).
The conditions are integrated with smart contracts through the “governance framework”.
BTW, the DAO does not depend completely on automation.
It does not use automated processes for operations - it depends on subjective coordination among a group of human participants.
Having said this, it needs to be pointed out that the DAO is not under the centralized control of a few people.
The autonomy for participants is determined by the DAO’s governance framework.
the meaning of things
…Fuzzy and Wicked Problem
Fuzzy
The term “fuzzy” refers to something which is:
Wicked Problem
A wicked problem is one that is resistant to resolution because of incomplete information, conflicting interests, complex interdependences and constantly shifting circumstances.
In the realm of Health Tourism, one usually encounters wicket problems in the context of fast-developing “Economic Sectors” and “Destinations” – which as a rule, are ever-evolving and have a diverse and fragmented stakeholder base - with “seemingly” conflicting interests.
See also LinkedIn article: the Wicked Problem dilemma in Health Tourism - the tools used in its prevention and resolution -?https://www.dhirubhai.net/pulse/wicked-problem-dilemma-health-tourism-constantinides-m-d-ph-d-/?.