Ondanks de in de managementliteratuur beloofde voordelen leidt het concentreren van ondersteunende processen in shared service centers (SSC’s) in de praktijk vaak tot problemen, vooral op het terrein van de coördinatie. Dit heeft grote gevolgen voor de effectiviteit van SSC’s. Een strategie die steeds vaker toegepast wordt om deze problemen op te lossen, is de vorming van een regieorganisatie die verantwoordelijk is voor het afstemmen van de vraag naar en het aanbod van ondersteunende diensten. Deze strategie blijft gericht op het realiseren van efficiencyvoordelen door ‘economies of scale’. Maar is de regieorganisatie wel effectief? In dit artikel analyseren we de regieorganisatie vanuit het systeemtheoretisch perspectief op organisatieontwerp en evalueren we de effectiviteit ervan in een recent, diepgaand onderzoek in een grote Nederlandse organisatie. We concluderen dat de regieorganisatie de problemen niet oplost. Integendeel: de problemen nemen toe en de kosten stijgen. Wij pleiten daarom voor de ontwikkeling van een andere, meer effectieve strategie, gericht op het realiseren van ‘economies of flow’ in de ondersteunende processen.
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Organisaties vertrouwen erop goedkopere diensten te kunnen leveren met een betere service door onderdelen van bestaande bedrijfsfuncties te concentreren in een Shared Service Center. Die projecten zijn echter zeer complex en vaak mislukken ze, omdat (tegen)krachten ontstaan als gevolg van een verschuiving in de machtsbalans.
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In service design projects, collaboration between design consultant and service provider can be problematic. The nature of these projects requires a high level of shared understanding and commitment, which providers may not be used to. We studied designer-provider collaboration in multiple real-life cases, in order to uncover determinants for successful collaboration. The case studies involved six service innovation projects, performed by Dutch design agencies. Independent researchers closely monitored the projects. Additional interviews with designers and providers gave insights in how both parties experienced their collaboration in the innovation projects. During data analysis, a coding scheme was created inductively. The scheme supported us in formulating 12 themes for designer-provider collaboration, amongst them four contextual determinants of shared understanding and stakeholder commitment in SD-projects. The insights from this study were then grounded in literature. Knowledge gaps were identified on themes about agreements of responsibilities, the open-endedness of an SD-process, an opportunitysearching approach, and organizational change that is required for the successful implementation of innovative service concepts.
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Objective: To construct the underlying value structure of shared decision making (SDM) models. Method: We included previously identified SDM models (n = 40) and 15 additional ones. Using a thematic analysis, we coded the data using Schwartz’s value theory to define values in SDM and to investigate value relations. Results: We identified and defined eight values and developed three themes based on their relations: shared control, a safe and supportive environment, and decisions tailored to patients. We constructed a value structure based on the value relations and themes: the interplay of healthcare professionals’ (HCPs) and patients’ skills [Achievement], support for a patient [Benevolence], and a good relationship between HCP and patient [Security] all facilitate patients’ autonomy [Self-Direction]. These values enable a more balanced relationship between HCP and patient and tailored decision making [Universalism]. Conclusion: SDM can be realized by an interplay of values. The values Benevolence and Security deserve more explicit attention, and may especially increase vulnerable patients’ Self-Direction. Practice implications: This value structure enables a comparison of values underlying SDM with those of specific populations, facilitating the incorporation of patients’ values into treatment decision making. It may also inform the development of SDM measures, interventions, education programs, and HCPs when practicing.
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Background: This study investigates patients’ use of eHealth services, their awareness of the availability of these services, and their intention to use them in primary care. It also examines patient characteristics and factors that influence the use of these services. Methods: A cross-sectional design using questionnaires was conducted. Based on the unified theory of acceptance and use of technology (UTAUT), the participants rated the two most common services. Descriptive analyses and linear correlation analyses were performed. A simple linear regression was conducted to identify factors influencing the participants’ intention to use eHealth services. Results: In total, 1203 participants with an average age of 43.7 years were surveyed. The participants’ usage rates varied, with the lowest at 2.4%, for measuring vital signs, and the highest at 47.4%, for booking appointments. The intentions to use the services ranged from 22.5%, for video consultations, to 46.6%, for prescription refill requests. Approximately 20% of the respondents were unaware of each service’s availability. Positive associations were found between all the constructs and the intention to use online services, with a younger age being the most significant factor. Conclusions: The use of and intention to use eHealth services varied greatly. The participants were often unaware of the availability of these services. Promoting the availability and benefits of eHealth services could enhance patient engagement in primary care settings.
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In the decision-making environment of evidence-based practice, the following three sources of information must be integrated: research evidence of the intervention, clinical expertise, and the patient’s values. In reality, evidence-based practice usually focuses on research evidence (which may be translated into clinical practice guidelines) and clinical expertise without considering the individual patient’s values. The shared decision-making model seems to be helpful in the integration of the individual patient’s values in evidence-based practice. We aim to discuss the relevance of shared decision making in chronic care and to suggest how it can be integrated with evidence-based practice in nursing. We start by describing the following three possible approaches to guide the decision-making process: the paternalistic approach, the informed approach, and the shared decision-making approach. Implementation of shared decision making has gained considerable interest in cases lacking a strong best-treatment recommendation, and when the available treatment options are equivalent to some extent. We discuss that in chronic care it is important to always invite the patient to participate in the decision-making process. We delineate the following six attributes of health care interventions in chronic care that influence the degree of shared decision making: the level of research evidence, the number of available intervention options, the burden of side effects, the impact on lifestyle, the patient group values, and the impact on resources. Furthermore, the patient’s willingness to participate in shared decision making, the clinical expertise of the nurse, and the context in which the decision making takes place affect the shared decision-making process. A knowledgeable and skilled nurse with a positive attitude towards shared decision making – integrated with evidence-based practice – can facilitate the shared decision-making process. We conclude that nurses as well as other health care professionals in chronic care should integrate shared decision making with evidence- based practice to deliver patient-centred care.
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Purpose: This study aimed to develop and pretest a systematic conversation approach for nurses to tailor aftercare to oncology patient's goals, unmet needs and wishes. Methods: We used an iterative developmental process for complex interventions: 1. Identifying problems 2. Identifying overall objectives 3. Designing the intervention 4. Pretesting and adapting the intervention. Results: The main results of the problem identification were: non-systematic and incomplete screening of potential issues, caveats in providing information, and shared decision-making. The overall objective formulated was: To develop a model for aftercare conversations based on shared goal-setting and decision-making. The conversation approach consists of four phases: 1. Preparation of the consultation including a questionnaire, 2. Shared goal-setting by means of a tool visualizing domains of life, and 3. Shared care planning by means of an overview of possible choices in aftercare, a database with health care professionals and a cancer survivorship care plan. 4. Evaluation. The results of the pretest revealed that the conversation approach needs to be flexible and tailored to the patient and practice setting, and embedded in the care processes. The conversation approach was perceived as enhancing patient-centeredness and leading to more in-depth consultations. Conclusion: The conversation approach was developed in co-creation with stakeholders. The results of the pretest revealed important implications and suggestions for implementation in routine care. The aftercare conversation approach can be used by nurses to provide tailored patient-centered evidence-based aftercare. Tailored aftercare should support oncology patient's goals, unmet needs and wishes. Further tailoring is needed.
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Artificial Intelligence systems are more and more being introduced into first response; however, this introduction needs to be done responsibly. While generic claims on what this entails already exist, more details are required to understand the exact nature of responsible application of AI within the first response domain. The context in which AI systems are applied largely determines the ethical, legal, and societal impact and how to deal with this impact responsibly. For that reason, we empirically investigate relevant human values that are affected by the introduction of a specific AI-based Decision Aid (AIDA), a decision support system under development for Fire Services in the Netherlands. We held 10 expert group sessions and discussed the impact of AIDA on different stakeholders. This paper presents the design and implementation of the study and, as we are still in process of analyzing the sessions in detail, summarizes preliminary insights and steps forward.
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Background: For most women, participation in decision-making during maternity care has a positive impact on their childbirth experiences. Shared decision-making (SDM) is widely advocated as a way to support people in their healthcare choices. The aim of this study was to identify quality criteria and professional competencies for applying shared decision-making in maternity care. We focused on decision-making in everyday maternity care practice for healthy women. Methods: An international three-round web-based Delphi study was conducted. The Delphi panel included international experts in SDM and in maternity care: mostly midwives, and additionally obstetricians, educators, researchers, policy makers and representatives of care users. Round 1 contained open-ended questions to explore relevant ingredients for SDM in maternity care and to identify the competencies needed for this. In rounds 2 and 3, experts rated statements on quality criteria and competencies on a 1 to 7 Likert-scale. A priori, positive consensus was defined as 70% or more of the experts scoring ≥6 (70% panel agreement). Results: Consensus was reached on 45 quality criteria statements and 4 competency statements. SDM in maternity care is a dynamic process that starts in antenatal care and ends after birth. Experts agreed that the regular visits during pregnancy offer opportunities to build a relationship, anticipate situations and revisit complex decisions. Professionals need to prepare women antenatally for unexpected, urgent decisions in birth and revisit these decisions postnatally. Open and respectful communication between women and care professionals is essential; information needs to be accurate, evidence-based and understandable to women. Experts were divided about the contribution of professional advice in shared decision-making and about the partner’s role. Conclusions: SDM in maternity care is a dynamic process that takes into consideration women’s individual needs and the context of the pregnancy or birth. The identified ingredients for good quality SDM will help practitioners to apply SDM in practice and educators to prepare (future) professionals for SDM, contributing to women’s positive birth experience and satisfaction with care.
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Mobility hubs facilitate multimodal transport and have the potential to improve the accessibility and usability of new mobility services. However, in the context of increasing digitalisation, using mobility hubs requires digital literacy or even owning a smartphone. This constraint may result in the exclusion of current and potential users. Digital kiosks might prove to be a solution, as they can facilitate the use of the services found at mobility hubs. Nevertheless, knowledge of how digital kiosks may improve the experience of disadvantaged groups remains limited in the literature. As part of the SmartHubs project, a field test with a digital kiosk was conducted with 105 participants in Brussels (Belgium) and Rotterdam (The Netherlands) to investigate the intention to use it and its usability in the context of mobility hubs. This study adopted a mixed methods approach, combining participant observation and questionnaire surveys. Firstly, participants were asked to accomplish seven tasks with the digital kiosk while being observed by the researchers. Finally, assisted questionnaire surveys were conducted with the same participants, including close-ended, open-ended and socio-demographic questions. The results offer insights into the experience of the users of a digital kiosk in a mobility hub and the differences across specific social groups. These findings may be relevant for decision-makers and practitioners working in urban mobility on subjects such as mobility hubs and shared mobility, and for user interface developers concerned with the inclusivity of digital kiosks.
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