Introduction: There are good reasons to study urban innovation from a systemic perspective. A key finding in innovation research is that organizations rarely innovate in isolation, but in interaction with clients, competitors, suppliers, and other organizations. A system perspective is useful in understanding and analyzing these interactions. Cities and urban regions are increasingly recognized as key milieus in which these interactions occur. The urban innovation system approach conceptualizes the city or urban region as a context in which innovations emerge from complex interactions between urban actors—firms, citizens, governments, knowledge institutes— in a particular institutional setting. The systemic view of innovation departs from traditional linear models that depict innovation as a staged process that starts with (basic) scientific research and ends with commercialization by companies. Innovation processes are much more complex and diverse, influenced by multiple actors that interact in networks with feedback loops, and involving many types of knowledge beyond scientific knowledge. Urban innovation systems are nested in innovation systems on other spatial levels—regional, national, international. Studies on urban innovation systems seek to explain how innovations emerge in an urban context, why urban regions differ in their innovative performance, and also address questions on the governance and management of such systems. Studies in this field draw from a variety of disciplines including economic geography, urban and regional economics, political sciences, innovation studies, social sciences, and urban planning.
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This report describes the Utrecht regio with regard to sustainability and circular business models.
Background Variations in childbirth interventions may indicate inappropriate use. Most variation studies are limited by the lack of adjustments for maternal characteristics and do not investigate variations in adverse outcomes. This study aims to explore regional variations in the Netherlands and their correlations with referral rates, birthplace, interventions, and adverse outcomes, adjusted for maternal characteristics. Methods In this nationwide retrospective cohort study, using a national data register, intervention rates were analysed between twelve regions among single childbirths after 37 weeks’ gestation in 2010–2013 (n = 614,730). These were adjusted for maternal characteristics using multivariable logistic regression. Primary outcomes were intrapartum referral, birthplace, and interventions used in midwife- and obstetrician-led care. Correlations both between primary outcomes and between adverse outcomes were calculated with Spearman’s rank correlations. Findings Intrapartum referral rates varied between 55–68% (nulliparous) and 20–32% (multiparous women), with a negative correlation with receiving midwife-led care at the onset of labour in two-thirds of the regions. Regions with higher referral rates had higher rates of severe postpartum haemorrhages. Rates of home birth varied between 6–16% (nulliparous) and 16–31% (multiparous), and was negatively correlated with episiotomy and postpartum oxytocin rates. Among midwife-led births, episiotomy rates varied between 14–42% (nulliparous) and 3–13% (multiparous) and in obstetrician-led births from 46–67% and 14–28% respectively. Rates of postpartum oxytocin varied between 59–88% (nulliparous) and 50–85% (multiparous) and artificial rupture of membranes between 43–52% and 54–61% respectively. A north-south gradient was visible with regard to birthplace, episiotomy, and oxytocin. Conclusions Our study suggests that attitudes towards interventions vary, independent of maternal characteristics. Care providers and policy makers need to be aware of reducing unwarranted variation in birthplace, episiotomy and the postpartum use of oxytocin. Further research is needed to identify explanations and explore ways to reduce unwarranted intervention rates.
