Objectives There is a broad call for change towards € new era' quality systems in healthcare, in which the focus lies on learning and improving. A promising way to establish this in general practice care is to combine audit and feedback with peer group discussion. However, it is not known what different stakeholders think of this type of quality improvement. The aim of this research was to explore the opinions of different stakeholders in general practice on peer discussion of audit and feedback and on its opportunities and risks. Second, their thoughts on transparency versus accountability, regarding this system, were studied. Design An exploratory qualitative study within a constructivist paradigm. Semistructured interviews and focus group discussions were held and coded using thematic analysis. Included stakeholders were general practitioners (GP), patients, professional organisations and insurance companies. Setting General practice in the Netherlands. Participants 22 participants were purposively sampled for eight interviews and two focus group discussions. Results Three main opportunities of peer discussion of audit and feedback were identified: deeper levels of reflection on data, adding context to numbers and more ownership; and three main risks: handling of unwilling colleagues, lacking a safe group and the necessity of patient involvement. An additional theme concerned disagreement on the amount of transparency to be offered: insurance companies and patients advocated for complete transparency on data and improvement of outcomes, while GPs and professional organisations urged to restrict transparency to giving insight into the process. Conclusions Peer discussion of audit and feedback could be part of a change movement, towards a quality system based on learning and trust, that is initiated by the profession. Creating a safe learning environment and involving patients is key herein. Caution is needed when complete transparency is asked, since it could jeopardise practitioners' reflection and learning in safety.
Background: In 2009, the Steering Committee for Pregnancy and Childbirth in the Netherlands recommended the implementation of continuous care during labor in order to improve perinatal outcomes. However, in current care, routine maternity caregivers are unable to provide this type of care, resulting in an implementation rate of less than 30%. Maternity care assistants (MCAs), who already play a nursing role in low risk births in the second stage of labor and in homecare during the postnatal period, might be able to fill this gap. In this study, we aim to explore the (cost) effectiveness of adding MCAs to routine first- and second-line maternity care, with the idea that these MCAs would offer continuous care to women during labor. Methods: A randomized controlled trial (RCT) will be performed comparing continuous care (CC) with care-as-usual (CAU). All women intending to have a vaginal birth, who have an understanding of the Dutch language and are > 18 years of age, will be eligible for inclusion. The intervention consists of the provision of continuous care by a trained MCA from the moment the supervising maternity caregiver establishes that labor has started. The primary outcome will be use of epidural analgesia (EA). Our secondary outcomes will be referrals from primary care to secondary care, caesarean delivery, instrumental delivery, adverse outcomes associated with epidural (fever, augmentation of labor, prolonged labor, postpartum hemorrhage, duration of postpartum stay in hospital for mother and/or newborn), women’s satisfaction with the birth experience, cost-effectiveness, and a budget impact analysis. Cost effectiveness will be calculated by QALY per prevented EA based on the utility index from the EQ-5D and the usage of healthcare services. A standardized sensitivity analysis will be carried out to quantify the outcome in addition to a budget impact analysis. In order to show a reduction from 25 to 17% in the primary outcome (alpha 0.05 and bèta 0.20), taking into account an extra 10% sample size for multi-level analysis and an attrition rate of 10%, 2 × 496 women will be needed (n = 992). Discussion: We expect that adding MCAs to the routine maternity care team will result in a decrease in the use of epidural analgesia and subsequent costs without a reduction in patient satisfaction. It will therefore be a costeffective intervention. Trial registration: Trial Registration: Netherlands Trial Register, NL8065. Registered 3 October 2019 - Retrospectively registered.
In dit project wordt gekeken naar de validatie van een procesverbeteringstool.Doel De belastingdienst heeft een tool ontwikkeld met als doel de samenhang tussen Business en IT te verbeteren en een proces van continu verbeteren op te starten. Deze tool wil de belastingdienst objectief te evalueren. Resultaten Dit project leidt tot de volgende resultaten: Een validatierapport Een verbeterplan Een wetenschappelijk artikel Looptijd 01 oktober 2021 - 31 december 2022 Aanpak Binnen dit onderzoek wordt gebruik gemaakt van de volgende onderzoeksmethoden: Focusgroepen Literatuuronderzoek Workshops Meedoen in dit onderzoek? Als je onderzoek wil doen naar tools in het werkveld van Agile werken, Business IT alignement of continu verbeteren, neem dan contact op met Paul Morsch.
Social enterprises (SEs) can play an important role in addressing societal problems. SEs are businesses whose primary objective is to generate social impact (e.g. well-being, social wealth and cohesion, and ecology) through a market-based model. SEs achieve this through a hybrid business model, trading-off financial and social value creation objectives. SEs typically face higher costs, for example because of ethical sourcing principles and/or production processes centering around the needs of workers who are vulnerable or hard-to-employ. This results in SEs’ struggling to scale-up due to their relatively costly operating model. Traditional management techniques are not always appropriate, as they do not take into account the tensions between financial and social value creation objectives of SEs. Our project examines how continuous improvement, and in particular the philosophy and tools of Lean can be harnessed to improve SEs competitiveness. Lean organizations share many values with SEs, such as respect for people, suggesting a good fit between the values and principles of Lean and those of SEs. The consortium for this project is a cooperation between the research groups Improving Business and New Marketing of the Center of Expertise Well-Being Economy and New Entrepreneurship and the minor Continuous Improvement of AVANS Hogeschool, and the SME companies Elliz in Company and Ons Label. The project consists of two phases, an exploratory phase during which the question “in what ways can the philosophy and tools of Lean be used by Social Enterprises?” will be addressed. Interviews and focus groups will be conducted with multiple SEs (not only partners). Participant observation will be conducted by the students of the minor Continuous Improvement at the partner SEs. During the second phase, the implementation of the identified principles and tools will be operationalized through a roadmap. Action research will be conducted in cooperation with the partner SEs.
