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Flexibility is essential for healthcare organizations to anticipate the increasing internal and external dynamics. Mental healthcare organizations in the Netherlands face major policy reforms made by the government, increasing involvement from municipalities and gradual replacement of clinical care with outpatient care. Top management plays an important strategic role in creating this flexibility because they make important choices, give direction and structure the organization. To create flexibility, managers have to deal with complexity and paradoxes. In this study, the authors aim to contribute to the knowledge on how healthcare managers can create flexibility in their organizations.

This is a qualitative empirical field study. In total, 21 managers of mental healthcare organizations participated in open in-depth interviews. The authors explored flexibility on three perspectives: organizational direction, structure and operations. The COVID-19 pandemic has provided an opportunity to explore flexibility. The authors asked participants to reflect on their organization's response to the pandemic.

Most mental healthcare organizations create flexibility in an implicit way. Flexibility and resilience are closely linked mechanisms. Flexibility ensures a quick response while resilience provides the counterforce and rebound needed to adapt. Adaption ensures that healthcare professionals learn from their experiences and do not return completely to the way things were done before. The primary urge to survive ensured rapid and adequate responses to the COVID-19 pandemic. Whether this is a manifestation of flexibility remains difficult to conclude.

The complexity theory offers some guidance in creating a flexible organization without losing consistency. Flexibility and resilience are closely linked mechanisms that antagonize and protect each other. With this insight, managers in mental healthcare can utilize the qualities and balance them without falling into the various pitfalls.

In this research, the authors are concerned with flexibility as a proactive attitude and capacity of organizations. By looking at the response of organizations to the COVID-19 crisis, the authors find out that responding to a disaster out of survival instinct is something else than flexibility. There is an interesting relationship between flexibility, resilience and adaptability, and they can balance each other.

Flexibility is necessary in a dynamic healthcare environment. However, balancing flexibility and consistency is difficult for healthcare teams, especially when working in threatening conditions. Methods are needed to help teams create, monitor and maintain flexibility.

This study evaluates a practice-based program –– the Flexmonitor – which aims to help teams develop and maintain flexibility. Here, realistic evaluation was used to refine the program and define building blocks for future programs.

The Flexmonitor can be used to monitor implicit criteria and differences in interpretation and beliefs among team members to promote flexibility. It also monitors team behavior and the effects of this behavior on self-defined indicators. Using the Flexmonitor, team members can discuss their beliefs and the definitions and criteria of flexibility. Strikingly, teams were not able to effectively self-manage their flexibility using the Flexmonitor.

This article contributes to our knowledge of self-managing teams, particularly the question of whether team members can take responsibility for team flexibility.

Background: The central issue of this paper is whether the intuitive relation between problematic drinking and seeking professional help holds. To shed light on this issue an ecological study is done in which the relation between different drinking patterns, alcohol‐related harm, and help‐seeking behaviour at the neighbourhood level of Rotterdam, The Netherlands is examined. Two questions are posed:1. Are there geographical differences in drinking patterns, alcohol problems, problem drinking, and number of alcohol clients within the city of Rotterdam?2. Is there a relation between drinking patterns, alcohol‐related harm, and help‐seeking behaviour at the neighbourhood level?Methods: Ecological analyses are conducted based on individual data originating from a survey and person‐based registers. Respondents to the survey were classified as abstainers, light, moderate or excessive drinkers, and were classified as having alcohol‐related problems and/or being a problem drinker. Person‐based registers were used to obtain data on the number of ambulatory and clinical alcohol clients in Rotterdam. The number of ambulatory and clinical clients measured help‐seeking behaviour.Results: The intuitive reasoning that the more problematic drinkers, the more professional help is sought does not stand. No association was found between the number of alcohol clients and the percentage of excessive drinkers and problem drinkers at the neighbourhood level. Large differences between neighbourhoods in prevalence of excessive drinking, alcohol‐related problems and problem drinking were found. The number of alcohol clients, however, varied much less between neighbourhoods. A notable result is that the higher the percentage of abstainers, the lower the number of alcohol clients in a neighbourhood.Discussion: It was concluded that in all neighbourhoods the number of problem drinkers outnumbers those seeking professional help, indicating a friction between need and supply of help with respect to problematic drinking. It is hypothesised that besides drinking behaviour and drinking‐related problems individual, as well as social and cultural factors, play a role in the process of help‐seeking behaviour.

Stakeholder management is not yet incorporated into the standard practice of most healthcare providers. The purpose of this paper is to assess the applicability of a comprehensive model for stakeholder management in mental healthcare organization for more evidence-based (stakeholder) management.

The assessment was performed in two research parts: the steps described in the model were executed in a single case study at a mental healthcare organization in the Netherlands; and a process and effect evaluation was done to find the supporting and impeding factors with regard to the applicability of the model. Interviews were held with managers and directors to evaluate the effectiveness of the model with a view to stakeholder management.

The stakeholder analysis resulted in the identification of eight stakeholder groups. Different expectations were identified for each of these groups. The analysis on performance gaps revealed that stakeholders generally find the collaboration with a mental healthcare provider “sufficient.” Finally a prioritization showed that five stakeholder groups were seen as “definite” stakeholders by the organization.

The assessment of the model showed that it generated useful knowledge for more evidence-based (stakeholder) management. Adaptation of the model is needed to increase its feasibility in practice.

Provided that the model is properly adapted for the specific field, the analysis can provide more knowledge on stakeholders and can help integrate stakeholder management as a comprehensive process in policy planning.

The article discusses how care programmes and integrated care pathways can be linked, finding ways to improve healthcare process professional and logistical quality from a supply chain and a network point‐of‐view.

The authors argue that owing to cost containment goals and increasing healthcare demand, healthcare services systems are challenged to improve service quality, whilst at the same time finding ways to improve delivery processes. It explores if the combination of two instruments, care programmes and integrated care pathways, can meet both goals. This combination is illustrated by an example from the Institute of Mental Health Care Eindhoven en de Kempen.

Analysis suggests that care programmes can be combined with integrated care pathways, leading to a situation where both quality and process improvement can be reached. These instruments are complementary.

The article is largely conceptual; ideas are presented to stimulate thinking rather than to prove an argument.

Combining care programmes and integrated care pathways has implications for the way we think about and organise healthcare processes.

There have been few publications on instruments combining both a network and a supply chain approach to describe and understand healthcare processes.