Tilburg University Modular Care Provision



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Tilburg University
Modular Care Provision
de Blok, S.A.
Publication date:
2010
Link to publication
Citation for published version (APA):
de Blok, C. (2010). Modular Care Provision: A qualitative study to advance theory and practice Utrecht: Labor
Grafimedia BV
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Modular Care Provision
M
odular C
ar
e P
ro
vision
  
A qualita
tiv
e study t
o adv
anc
e theor
y and pr
ac
tic

 
  
 
Car
olien de Blok
A qualitative study to advance
 theory and practice
Carolien de Blok


Modular Care Provision
A qualitative study 
to advance theory and practice
Carolien de Blok


The research for this thesis was performed at the Department of Tranzo, Faculty of Social 
and Behavioural Sciences, Tilburg University, Tilburg, the Netherlands.
The research was performed with the financial support of CZ-Zorgkantoor, VGZ (UVIT) 
Zorgkantoor and the Science Shop, Centre for Knowledge Transfer, Tilburg University. The 
printing of this thesis was financially supported by the Oldendorff Research Institute, Tilburg 
University and the Science Shop, Centre for Knowledge Transfer, Tilburg University.
Cover design   Kitty van der Veer, Proefschrift.nu
Layout    
Renate Siebes, Proefschrift.nu
Printed by     Labor Grafimedia BV, Utrecht
ISBN    
978-94-90791-03-2
©  S.A. de Blok, Tilburg, the Netherlands 2010
All rights reserved. No part of this publication may be reproduced, stored in a retrieval 
system or transmitted, in any form or by any means, electronic, mechanical, photocopying, 
recording or otherwise, except in case of brief quotations with reference embodied in critical 
articles and reviews, without the prior written permission of the author.


Modular Care Provision
A qualitative study 
to advance theory and practice
Proefschrift
ter verkrijging van de graad van doctor
aan de Universiteit van Tilburg,
op gezag van de rector magnificus,
prof. dr. Ph. Eijlander,
in het openbaar te verdedigen ten overstaan van een 
door het college voor promoties aangewezen commissie
in de aula van de Universiteit
op vrijdag 10 september 2010 om 14.15 uur
door
Stoffelina Adriana de Blok
geboren op 12 juni 1981 te Goes


Promotor: 
 
Prof. dr. J.M.G.A. Schols
Copromotores:   
Dr. K.G. Luijkx
 
 
 
Dr. ir. B.R. Meijboom
Promotiecommissie: 
Prof. dr. P. Gemmel
 
 
 
Prof. dr. A.A. de Roo 
 
 
 
Prof. dr. C.A. Voss
 
 
 
Prof. dr. H.J.M. Vrijhoef
 
 
 
Dr. J. Hsuan


Introduction_7_Chapter_2'>Chapter 1
Introduction
7
Chapter  2
Demand-based provision of housing, welfare and care 
services to elderly clients: from policy to daily practice 
through operations management
25
Chapter  3
Improving client-centered care and services: the role of 
front/back-office configurations
47
Chapter  4
Research design and methods
65
Chapter  5
Modular care and service packages for independently 
living elderly
89
Chapter  6
Exploring interfaces in the reconfiguration of modular 
services
119
Chapter  7
Personalization in modular long-term care provision
153
Chapter  8
Improving long-term care provision: towards demand-
based care by means of modularity
181
Chapter  9
Discussion and conclusions
209
Summary
239
Samenvatting (Summary in Dutch)
249
Dankwoord (Acknowledgements)
261
Curriculum vitae
265
List of publications
269
Contents



1
Introduction


8
1.1  Background 
In most Western countries, aging societies result in a growing number of elderly 
people. In the Netherlands, for example, fifteen percent of the population is sixty-five 
years or older, and it is expected that in 2040, twenty-six percent of the population will 
belong to this age group (De Jong and Van Duin, 2010). The same trend can be seen 
in other countries of the European Union, Sweden and Italy having the largest aged 
populations (Schols, 2004). The increasing size of the older population and longer life 
expectancies imply that there will be significant numbers of older persons in need of 
long-term care and assistance in the decades to come (Van Bilsen, 2008). 
Due to their aging populations, governments all over the developed world face 
financial and capacity related challenges in the field of care. To cope with these 
issues, care systems for the elderly are reformed and efforts are taken to introduce 
more business risks and promote efficiency in care provision (Breedveld et al., 2006, 
De Gooijer, 2007). Along with changes due to the size of elderly populations, we are 
also witnessing changes in the political and societal orientation towards care for the 
elderly. Governments are creating environments that move away from the supply-
oriented approach to care provision and its accompanying lack of transparency, 
towards accessibility, complementarity, and continuity in service provision (Schols, 
2004). Nowadays, health policies put the elderly client at the center of processes and 
structures (e.g. Mead and Bower, 2000, McLaughlin and Kaluzny, 2000, Herzlinger, 
2004, Rijckmans, 2005). More specifically, these policies are aimed at facilitating greater 
and longer-lasting autonomy for older clients in their own homes, backed by a coherent 
supply of necessary support services (WHO, 2000, Van Campen and Woittiez, 2003). 
Various terms are used to describe this increasing consideration for older health care 
clients; here, we define this as a trend towards demand-based care. 
The developments identified put challenges to organizations providing care and services 
to elderly clients (Brodsky et al., 2002, Fortin et al., 2007). Fed by the government-
induced stimuli concerning efficiency and demand-based care, providers are puzzling 
over the question of how to develop a care delivery system that provides responsiveness 
to client demand at the lowest possible costs (Van Bilsen, 2008). Currently, the notion 
of demand-based care is used largely at a strategic level to express long-term goals, 
mission statements, and organizational visions only, and its implementation seems 
far from straightforward (Rijckmans, 2005). In this respect, providers are in urgent 
need of appropriate methods and approaches that enable them to tune the day-to-
day supply of care and services to the needs and requirements of their elderly clients 
(Hofmarcher et al., 2007).
Over the last century, thorough thinking about the design of industrial processes 
and systems has greatly improved the responsiveness, flexibility, and efficiency of 
Modular Care Provision




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