This dissertation concerns the adaptive ability by which workers meet new expertise needs throughout their careers. We aimed to increase our understanding of this adaptive ability through a series of four studies building upon the concept of flexpertise (Van der Heijden, 1998, 2000). These studies were designed to advance theorizing, specifically in scholarly research on expertise and expert performance (Ericsson et al., 2006) and sustainable careers (Van der Heijden & De Vos, 2015), and to increase our understanding of how flexpertise may be fostered among workers across expertise domains and working contexts.In this introduction chapter, we outline the key theoretical concepts regarding the flexpertise phenomenon that we will use throughout this dissertation, a description of the knowledge gap in the scholarly literature, and our research focus. This is followed by a summary of this PhD project that outlines the overall research objective, the research questions and research methods that we deployed, as well as an overview of the four flexpertise studies conducted (see Table 1.1). The subsequent chapters include the four (submitted) scientific publications on this matter. We conclude by reflecting on the theoretical, methodological and practical value of our research, and on the limitations of our research approach. We finish with recommendations for future research, ethical considerations on the usage of the flexpertise concept in labor market debates, and a personal reflection on this PhD program.Before explaining the key concept of flexpertise and related core concepts, we first outline what we mean by new expertise needs. These needs shaped the background of the four studies conducted.
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Adaptive governance describes the purposeful collective actions to resist, adapt, or transform when faced with shocks. As governments are reluctant to intervene in informal settlements, community based organisations (CBOs) self-organize and take he lead. This study explores under what conditions CBOs in Mathare informal settlement, Nairobi initiate and sustain resilience activities during Covid-19. Study findings show that CBOs engage in multiple resilience activities, varying from maladaptive and unsustainable to adaptive, and transformative. Two conditions enable CBOs to initiate resilience activities: bonding within the community and coordination with other actors. To sustain these activities over 2.5 years of Covid-19, CBOs also require leadership, resources, organisational capacity, and network capacity. The same conditions appear to enable CBOs to engage in transformative activities. How-ever, CBOs cannot transform urban systems on their own. An additional condition, not met in Mathare, is that governments, NGOs, and donor agencies facilitate, support, and build community capacities. This is the peer reviewed version of the following article: Adaptive governance by community-based organisations: Community resilience initiatives during Covid‐19 in Mathare, Nairobi. which has been published in final form at doi/10.1002/sd.2682. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions
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Voor toekomstige professionals is het belangrijk om Adaptieve Expertise (AE) te ontwikkelen. Dit geldt in het bijzonder voor studenten die gaan werken in de IT, waar technieken zich in een razend tempo ontwikkelen. In de Digital Society Hub (DSH) van de Hanzehogeschool Groningen werken studenten, docent-onderzoekers en bedrijven uit de regio samen aan het oplossen van complexe vraagstukken. Deze vraagstukken vragen om innovatieve toepassingen van relatief onbekende technieken; zonder AE van betrokkenen kunnen de vraagstukken niet opgelost worden. Hiermee lijkt de DSH de ideale omgeving om AE te ontwikkelen. Daarom hebben we onderzocht hoe de DSH AE-ontwikkeling bij studenten stimuleert. De resultaten van dat onderzoek illustreren we graag aan de hand van een praktijkvoorbeeld.
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In het Adaptieve Expertise World café geven we deelnemers inzicht in de manieren waarop studenten in het hoger onderwijs middels werkplekleren adaptieve expertise ontwikkelen. Adaptieve expertise (AE) is het vermogen van professionals om om te kunnen gaan met veranderingen en vernieuwingen. Het is een uitdaging voor het hoger onderwijsinstellingen en de beroepspraktijk het onderwijs te (her-)ontwerpen met het oog op AE. In een groot project over adaptieve expertise hebben we een initiële programma theorie ontwikkeld dat gaat over: (1) de relatie tussen studentkenmerken en AE, (2) de invloed van de authenticiteit en complexiteit van taken en AE, (3) interactie met anderen en AE en (4) het leerwerkklimaat en AE. Onze volgende stap is het aanscherpen van de initiële programma theorie middels informatie uit case studies. In het Wold café stellen we een selectie van vier cases centraal en gaan we in twee rondes de cases middels een dialoog uitdiepen. Vervolgens scherpen we in een gezamenlijk gesprek onder leiding van een referent de initiële programma theorie aan. Dit vormt input voor verdere synthese en geeft deelnemers inspiratie over de ontwikkeling van AE tijdens werkplekleren en de verschillende factoren die daarin een rol spelen.
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The generalist-plus-specialist palliative care model is endorsed worldwide. In the Netherlands, the competencies and profile of the generalist provider of palliative care has been described on all professional levels in nursing and medicine. However, there is no clear description of what specialized expertise in palliative care entails, whereas this is important in order for generalists to know who they can consult in complex palliative care situations and for timely referral of patients to palliative care specialists. Objective: To gain insight in the roles and competencies attributed to palliative care specialists as opposed to generalists. Methods: A scoping review was completed based on PRISMA-ScR guidelines to explore the international literature on the role and competence description of specialist and expert care professionals in palliative care. Databases Embase.com, Medline (Ovid), CINAHL (Ebsco) and Web of Science Core Collection were consulted. The thirty-nine included articles were independently screened, reviewed and charted. Thematic codes were attached based on two main outcomes roles and competencies. Results: Five roles were identified for the palliative care specialist: care provider, care consultant, educator, researcher and advocate. Leadership qualities are found to be pivotal for every role. The roles were further specified with competencies that emerged from the analysis. The title, roles and competencies attributed to the palliative care specialist can mostly be applied to both medical and nursing professionals. Discussion: The roles and competencies derived from this scoping review correspond well with the seven fields of competence for medical/nursing professionals in health care of the CanMEDS guide. A specialist is not only distinguished from a generalist on patient-related care activities but also on an encompassing level. Clarity on what it entails to be a specialist is important for improving education and training for specialists. Conclusion: This scoping review adds to our understanding of what roles and competencies define the palliative care specialist. This is important to strengthen the position of the specialist and their added value to generalists in a generalist-plus-specialist model
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Due to the variegated nature of the teaching profession system, different actors operating in this system (teachers, school leaders, policy makers) are inevitably intertwined and assumably influence each other’s sensemaking processes, especially when system-wide educational change occurs. Gaining insight into how different actors in the teacher profession system make sense of educational change is important, as it might hamper or enable the system's adaptive capacity. That is why we stretched Coburn’s model of collective sensemaking from a teacher-team lens to include different actors and focus on their interpersonal dynamics during sensemaking processes. Performing a conceptual review, we synthesized 87 articles which focus on collective sensemaking of the following actor groups: (1) teachers (micro), (2) school leaders (meso), and/or (3) district/state/national leaders, policy makers, professional development providers, curriculum developers, researchers, community members, and parents (macro). In the results we describe how actors’ involvement varied due to different role distributions and role perceptions of actors. In addition, four contextual factors influencing the interpersonal dynamics were distinguished that were closely related to leadership practices that enable actors to compare the change with their own beliefs and (organizational) practices. We describe three mechanisms which explain how actors valuate a change (valuating), how they are owning this change (owning), and which is shaped by gatekeeping of sensegivers in their social context (gatekeeping).
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Background: Follow-up of stroke survivors is important to objectify activity limitations and/or participations restrictions. Responsive measurement tools are needed with a low burden for professional and patient. Aim: To examine the concurrent validity, floor and ceiling effects and responsiveness of both domains of the Late-Life Function and Disability Index Computerized Adaptive Test (LLFDI-CAT) in first-ever stroke survivors discharged to their home setting. Design: Longitudinal study. Setting: Community. Population: First ever stroke survivors. Methods: Participants were visited within three weeks after discharge and six months later. Stroke Impact Scale (SIS 3.0) and Five-Meter Walk Test (5MWT) outcomes were used to investigate concurrent validity of both domains, activity limitations, and participation restriction, of the LLFDI-CAT. Scores at three weeks and six months were used to examine floor and ceiling effects and change scores were used for responsiveness. Responsiveness was assessed using predefined hypotheses. Hypotheses regarding the correlations with change scores of related measures, unrelated measures, and differences between groups were formulated. Results: The study included 105 participants. Concurrent validity (R) of the LLFDI-CAT activity limitations domain compared with the physical function domain of the SIS 3.0 and with the 5MWT was 0.79 and -0.46 respectively. R of the LLFDI-CAT participation restriction domain compared with the participation domain of the SIS 3.0 and with the 5MWT was 0.79 and -0.41 respectively. A ceiling effect (15%) for the participation restriction domain was found at six months. Both domains, activity limitations and participation restrictions, of the LLFDI-CAT, scored well on responsiveness: 100% (12/12) and 91% (12/11) respectively of the predefined hypotheses were confirmed. Conclusions: The LLFDI-CAT seems to be a valid instrument and both domains are able to detect change over time. Therefore, the LLFDI-CAT is a promising tool to use both in practice and in research. Clinical rehabilitation impact: The LLFDI-CAT can be used in research and clinical practice.
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Current research on data in policy has primarily focused on street-level bureaucrats, neglecting the changes in the work of policy advisors. This research fills this gap by presenting an explorative theoretical understanding of the integration of data, local knowledge and professional expertise in the work of policy advisors. The theoretical perspective we develop builds upon Vickers’s (1995, The Art of Judgment: A Study of Policy Making, Centenary Edition, SAGE) judgments in policymaking. Empirically, we present a case study of a Dutch law enforcement network for preventing and reducing organized crime. Based on interviews, observations, and documents collected in a 13-month ethnographic fieldwork period, we study how policy advisors within this network make their judgments. In contrast with the idea of data as a rationalizing force, our study reveals that how data sources are selected and analyzed for judgments is very much shaped by the existing local and expert knowledge of policy advisors. The weight given to data is highly situational: we found that policy advisors welcome data in scoping the policy issue, but for judgments more closely connected to actual policy interventions, data are given limited value.
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Wheelchair mobility skills (WMS) training is regarded by children using a manual wheelchair and their parents as an important factor to improve participation and daily physical activity. Currently, there is no outcome measure available for the evaluation of WMS in children. Several wheelchair mobility outcome measures have been developed for adults, but none of these have been validated in children. Therefore the objective of this study is to develop a WMS outcome measure for children using the current knowledge from literature in combination with the clinical expertise of health care professionals, children and their parents. Methods Mixed methods approach. Phase 1: Item identification of WMS items through a systematic review using the ‘COnsensus-based Standards for the selection of health Measurement Instruments’ (COSMIN) recommendations. Phase 2: Item selection and validation of relevant WMS items for children, using a focus group and interviews with children using a manual wheelchair, their parents and health care professionals. Phase 3: Feasibility of the newly developed Utrecht Pediatric Wheelchair Mobility Skills Test (UP-WMST) through pilot testing. Results Phase 1: Data analysis and synthesis of nine WMS related outcome measures showed there is no widely used outcome measure with levels of evidence across all measurement properties. However, four outcome measures showed some levels of evidence on reliability and validity for adults. Twenty-two WMS items with the best clinimetric properties were selected for further analysis in phase 2. Phase 2: Fifteen items were deemed as relevant for children, one item needed adaptation and six items were considered not relevant for assessing WMS in children. Phase 3: Two health care professionals administered the UP-WMST in eight children. The instructions of the UP-WMST were clear, but the scoring method of the height difference items needed adaptation. The outdoor items for rolling over soft surface and the side slope item were excluded in the final version of the UP-WMST due to logistic reasons. Conclusions The newly developed 15 item UP-WMST is a validated outcome measure which is easy to administer in children using a manual wheelchair. More research regarding reliability, construct validity and responsiveness is warranted before the UP-WMST can be used in practice.
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In the Netherlands, palliative care is provided by generalist healthcare professionals (HCPs) if possible and by palliative care specialists if necessary. However, it still needs to be clarifed what specialist expertise entails, what specialized care consists of, and which training or work experience is needed to become a palliative care special‑ist. In addition to generalists and specialists, ‘experts’ in palliative care are recognized within the nursing and medical professions, but it is unclear how these three roles relate. This study aims to explore how HCPs working in palliative care describe themselves in terms of generalist, specialist, and expert and how this self-description is related to their work experience and education. Methods A cross-sectional open online survey with both pre-structured and open-ended questions among HCPs who provide palliative care. Analyses were done using descriptive statistics and by deductive thematic coding of open-ended questions. Results Eight hundred ffty-four HCPs flled out the survey; 74% received additional training, and 79% had more than fve years of working experience in palliative care. Based on working experience, 17% describe themselves as a generalist, 34% as a specialist, and 44% as an expert. Almost three out of four HCPs attributed their level of expertise on both their education and their working experience. Self-described specialists/experts had more working experience in palliative care, often had additional training, attended to more patients with palliative care needs, and were more often physicians as compared to generalists. A deductive analysis of the open questions revealed the similarities and dis‑ tinctions between the roles of a specialist and an expert. Seventy-six percent of the respondents mentioned the impor‑tance of having both specialists and experts and wished more clarity about what defnes a specialist or an expert, how to become one, and when you need them. In practice, both roles were used interchangeably. Competencies for the specialist/expert role consist of consulting, leadership, and understanding the importance of collaboration. Conclusions Although the grounds on which HCPs describe themselves as generalist, specialist, or experts difer, HCPs who describe themselves as specialists or experts mostly do so based on both their post-graduate education and their work experience. HCPs fnd it important to have specialists and experts in palliative care in addition to gen‑eralists and indicate more clarity about (the requirements for) these three roles is needed.
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