Purpose: The aims of this study were to investigate how a variety of research methods is commonly employed to study technology and practitioner cognition. User-interface issues with infusion pumps were selected as a case because of its relevance to patient safety. Methods: Starting from a Cognitive Systems Engineering perspective, we developed an Impact Flow Diagram showing the relationship of computer technology, cognition, practitioner behavior, and system failure in the area of medical infusion devices. We subsequently conducted a systematic literature review on user-interface issues with infusion pumps, categorized the studies in terms of methods employed, and noted the usability problems found with particular methods. Next, we assigned usability problems and related methods to the levels in the Impact Flow Diagram. Results: Most study methods used to find user interface issues with infusion pumps focused on observable behavior rather than on how artifacts shape cognition and collaboration. A concerted and theorydriven application of these methods when testing infusion pumps is lacking in the literature. Detailed analysis of one case study provided an illustration of how to apply the Impact Flow Diagram, as well as how the scope of analysis may be broadened to include organizational and regulatory factors. Conclusion: Research methods to uncover use problems with technology may be used in many ways, with many different foci. We advocate the adoption of an Impact Flow Diagram perspective rather than merely focusing on usability issues in isolation. Truly advancing patient safety requires the systematic adoption of a systems perspective viewing people and technology as an ensemble, also in the design of medical device technology.
DOCUMENT
Emergence, the coming-into-being of new entities, new organizations, or new structures out of the interactions of individual agents in networks, is becoming a central concept in today's management literature. We are now evolving from the age of reductionism to the age of emergence, meaning that organizations in the connected society can no longer predict what is going to happen but will find themselves continuously doing things (creating value) in co-evolution with their environment, things that are not necessarily in line with actions planned in advance. In such a dynamic environment managers must learn to enable emergent processes in real time if an organization is to turn unpredictability to its competitive advantage. The importance of the perspective of emergence is introduced in regard to the growing complexity in society.
LINK
Abstract Chapter 4: Basing ourselves on a literature review and expert interviews we create an overview of methods and tools to identify and respond to ethical questions used in healthcare, social work, police and the military. We identify six main types of methods or tools that can support professionals or organisations in dealing with ethical issues. Some of these methods are already used in CT or could be used. Some methods or tools are targeted at individual professionals or small groups, whilst others are targeted at the organisational level. The methods and tools are described in brief. Samenvatting boek: Wat is ethisch wel en wat niet geoorloofd? De aanslagen die de Europese hoofdsteden teisteren wrijven het ons in: terrorismebestrijding is noodzakelijk en is onlosmakelijk verbonden met de moderne samenleving. De inlichtingendiensten en andere organisaties die zich hiermee bezighouden, stuiten echter telkens op de vraag hoe ver zij mogen gaan. Waar liggen de grenzen? Wat is ethisch wel en wat niet geoorloofd? En vooral: hoe gaan professionals met deze soms levensgrote dilemma's om? In deze Engelstalige uitgave reflecteren wetenschappers, terrorismebestrijders en ethici op dit zeer actuele thema.
MULTIFILE
The professional growth of midwives, essential for optimizing midwifery leadership globally, can be enhanced through twinning collaborations. How twinning promotes growth is unclear. This case study explores how professional growth is affected by cultural differences between twins. We used a longitudinal qualitative design including data from open-ended questionnaires and focus groups. These data were analyzed using a content analysis. Our findings show that cultural differences were capable of both hindering and facilitating professional growth. Within the complex dynamics of twinning, professional growth was facilitated by twins’ preparedness to bridge cultural differences. Common goals positively influenced this process. Friction was more likely, and professional growth was hindered, when midwives were unprepared to bridge cultural differences. To optimize professional growth through twinning, we recommend a clear focus on common goals and consideration of the interaction between the length of a project and the extent of the cultural differences between twins.
DOCUMENT
Objectives Most complex healthcare interventions target a network of healthcare professionals. Social network analysis (SNA) is a powerful technique to study how social relationships within a network are established and evolve. We identified in which phases of complex healthcare intervention research SNA is used and the value of SNA for developing and evaluating complex healthcare interventions. Methods A scoping review was conducted using the Arksey and O’Malley methodological framework. We included complex healthcare intervention studies using SNA to identify the study characteristics,level of complexity of the healthcare interventions, reported strengths and limitations, and reported implications of SNA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews 2018 was used to guide the reporting. Results Among 2466 identified studies, 40 studies were selected for analysis. At first, the results showed that SNA seems underused in evaluating complex intervention research. Second, SNA was not used in the development phase of the included studies. Third, the reported implications in the evaluation and implementation phase reflect the value of SNA in addressing the implementation and population complexity. Fourth, pathway complexity and contextual complexity of the included interventions were unclear or unable to access. Fifth, the use of a mixed methods approach was reported as a strength, as the combination and integration of a quantitative and qualitative method clearly establishes the results. Conclusion SNA is a widely applicable method that can be used in different phases of complex intervention research. SNA can be of value to disentangle and address the level of complexity of complex healthcare interventions. Furthermore, the routine use of SNA within a mixed method approach could yield actionable insights that would be useful in the transactional context of complex interventions.
DOCUMENT
Lectorale rede
DOCUMENT
Full text aan te vragen bij auteurs. This article describes the results of qualitative research into the moral issues faced by social work professionals working in projects targeted at teenage mothers. The research is part of the tradition of empirical and practice-driven ethics. The main questions were: How does morality become visible in the social services for teenage mothers and how do social workers deal with the moral dimension of their work? (How) can education, training and peer review offer space for moral reflection? Interviews and group meetings ('focus groups') were held to answer these questions. Nineteen professionals (front-line professionals as well as professionals in executive roles) participated in the research. The findings describe the moral issues and the moral actions of professionals and the organizational context respectively. The results reveal that the everyday practice of social work professionals can raise complex issues inherent to their work and that there is often no explicit reflection on the moral dimension of these issues. The authors argue that there needs to be greater focus on the complexity of moral issues and elaborate on three dimensions of this complexity.
MULTIFILE
In the wake of neo-liberal informed global trends to set performance standards and intensify accountability, the Dutch government aimed for ‘raising standards for basic skills’. While the implementation of literacy standards was hardly noticed, the introduction of numeracy standards caused a major backlash in secondary schools, which ended in a failed introduction of a high stakes test. How can these major differences be explained? Inspired by Foucault’s governmentality concept a theoretical framework is developed to allow for detailed empirical research on steering processes in complex systems in which many actors are involved in educational decision-making. A mixed-methods multiple embedded case-study was conducted comprising nine school boards and fifteen secondary schools. Analyses unveil processes of responsibilisation, normalisation and emerging dividing practices. Literacy standards reinforced responsibilities of Dutch language teachers; for numeracy, school leadership created entirely new roles and responsibilities for teachers. Literacy standards were incorporated in an already used instrument which made implementation both subtle and inevitable. For numeracy, schools distinguished students by risk of not passing the new test affirming the disciplinary nature of schools in the process. While little changed to address teachers main concerns about students’ literacy skills, the failed introduction of the numeracy test usurped most resources.
DOCUMENT
This paper seeks to highlight underlying issues of the tourism system that have led to tourism extremes of too much or too little tourism. Five phases are recognized that reflect different ways of dealing with too much tourism over time, after which the impact of a sudden lack of tourism is investigated in light of future renewal processes. This discussion highlights the remarkable capacity of the tourism industry to adjust to rapidly changing circumstances and crises, even when these cause anguish to individuals and within societies at large. The paper thus seeks to contextualize the current discussions regarding the transformation of tourism post COVID-19. It highlights the complexity of changing a tourism that multiple stakeholders depend on or have grown accustomed to. To come to a more balanced tourism, it is necessary to not only come up with alternative visions and strategies, but also to engage with the political economy nature of tourism development. A future research agenda should therefore also discuss facets of entangled power, social exclusion, inequalities and class differences to come to new reference points of what actually constitutes a more inclusive tourism success.
MULTIFILE
