How ambiguity becomes productive: implementing the policy concept of ‘appropriate care’ in Dutch healthcare

Abstract

Ambiguity is ascribed both productive and unproductive effects on the implementation of policy. What we do not know, however, is how ambiguity operates in these contrasting ways. This paper examines the duality of ambiguity by studying the implementation of the concept of ‘appropriate care’ in Dutch healthcare. Drawing on an ethnographic approach, we analyze discussions on appropriate care based on fieldnotes of meetings (n = 51), interviews (n = 7), and documents (n = 73). We expected friction to arise as actors negotiated appropriate care pointing to different understandings to be made explicit and discussed. The analysis shows, however, four strategies – diverting, dissolving, swirling, and opening – which together constitute a politics of depoliticization that prevents friction between different understandings. We argue that this politics of depoliticization preserves policy unity while simultaneously directing policy action, thereby demonstrating how ambiguity becomes productive in implementation.