INTRODUCTION: In the Netherlands, Diagnostic Reference Levels (DRLs) have not been based on a national survey as proposed by ICRP. Instead, local exposure data, expert judgment and the international scientific literature were used as sources. This study investigated whether the current DRLs are reasonable for Dutch radiological practice.METHODS: A national project was set up, in which radiography students carried out dose measurements in hospitals supervised by medical physicists. The project ran from 2014 to 2017 and dose values were analysed for a trend over time. In the absence of such a trend, the joint yearly data sets were considered a single data set and were analysed together. In this way the national project mimicked a national survey.RESULTS: For six out of eleven radiological procedures enough data was collected for further analysis. In the first step of the analysis no trend was found over time for any of these procedures. In the second step the joint analysis lead to suggestions for five new DRL values that are far below the current ones. The new DRLs are based on the 75 percentile values of the distributions of all dose data per procedure.CONCLUSION: The results show that the current DRLs are too high for five of the six procedures that have been analysed. For the other five procedures more data needs to be collected. Moreover, the mean weights of the patients are higher than expected. This introduces bias when these are not recorded and the mean weight is assumed to be 77 kg.IMPLICATIONS FOR PRACTICE: The current checking of doses for compliance with the DRLs needs to be changed. Both the procedure (regarding weights) and the values of the DRLs should be updated.
he reorientation of the public sector along market lines has led to the paradigm of New Public Management (NPM): the assumption that the public sector can be improved by management principles and techniques traditionally associated with the private sector. However, market orientation has also become associated with a number of problems, particularly in the public sector. Recent literature suggests that brand orientation can serve as an alternative to market orientation. Our chapter reviews the concept of brand orientation in the healthcare sector, the extent to which Dutch hospitals are currently managed as brands and the key issues in implementing brand management principles in Dutch hospitals.
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Some nurses are responding rebelliously to the changing healthcare landscape by challenging the status quo and deviating from suboptimal practices, professional norms, and organizational rules. While some view rebel nurse leadership as challenging traditional structures to improve patient care, others see it as disruptive and harmful. These diverging opinions create dilemmas for nurses and nurse managers in daily practice. To understand the context, dilemmas, and interactions in rebel nurse leadership, we conducted a multiple case study in two Dutch hospitals. We delved into the mundane practices to expand the concept of leadership-as-practice. By shadowing rebel nurse practices, we identified three typical leadership practices which present the most common “lived” experiences and dilemmas of nurses and nurse managers. Overall, we noticed that deviating acts were more often quick fixes rather than sustainable changes. Our research points to what is needed to change the status quo in a sustainable manner. To change unworkable practices, nurses need to share their experienced dilemmas with their managers. In addition, nurse managers must build relationships with other nurses, value different perspectives, and support experimenting to promote collective learning.
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The pressure on the European health care system is increasing considerably: more elderly people and patients with chronic diseases in need of (rehabilitation) care, a diminishing work force and health care costs continuing to rise. Several measures to counteract this are proposed, such as reduction of the length of stay in hospitals or rehabilitation centres by improving interprofessional and person-centred collaboration between health and social care professionals. Although there is a lot of attention for interprofessional education and collaborative practice (IPECP), the consortium senses a gap between competence levels of future professionals and the levels needed in rehabilitation practice. Therefore, the transfer from tertiary education to practice concerning IPECP in rehabilitation is the central theme of the project. Regional bonds between higher education institutions and rehabilitation centres will be strengthened in order to align IPECP. On the one hand we deliver a set of basic and advanced modules on functioning according to the WHO’s International Classification of Functioning, Disability and Health and a set of (assessment) tools on interprofessional skills training. Also, applications of this theory in promising approaches, both in education and in rehabilitation practice, are regionally being piloted and adapted for use in other regions. Field visits by professionals from practice to exchange experiences is included in this work package. We aim to deliver a range of learning materials, from modules on theory to guidelines on how to set up and run a student-run interprofessional learning ward in a rehabilitation centre. All tested outputs will be published on the INPRO-website and made available to be implemented in the core curricula in tertiary education and for lifelong learning in health care practice. This will ultimately contribute to improve functioning and health outcomes and quality of life of patients in rehabilitation centres and beyond.
A feeling of worry, anxiety, loneliness and anticipation are commonplace in both medical and non-medical arenas such as elderly care. An innovative solution such as the ‘simple and effective’ comfyhand would offer better patient care and improved care efficiency with a high chance of long-term, economic efficiency. ComfyHand is a start-up in the healthcare sector that aims to develop sustainable products to improve patient wellbeing in healthcare settings. It does this by emulating the experience of holding a hand which gives the person comfort and support in moments where real human contact is not possible. Right now the comfyhand is in the development phase, working on several prototypes for test trials in elderly care and hospitals. In this project we want to explore the use of 3D printing for producing a comfyhand. Desired properties for the prototype include optimal heat transfer, softness, regulation of sweat, durability and sustainability. The goal of this study is to develop a prototype to test in a trial with patients within Envida, a care centre. The trial itself is out of scope of this project. This proposal focuses on researching the material of choice and the processability. Building on knowledge gained in a previous Kiem GoChem project and a Use Case (Shape3Dup) of a currently running Raak MKB project (Enlighten) on 3D printing of breast prostheses, several materials, designs and printing parameters will be tested.
Cross-Re-Tour supports European tourism SME while implementing digital and circular economy innovations. The three year project promotes uptake and replication by tourism SMEs of tools and solutions developed in other sectors, to mainstream green and circular tourism business operations.At the start of the project existing knowledge-gaps of tourism SMEs will be researched through online dialogues. This will be followed by a market scan, an overview of existing state of the art solutions to digital and green constraints in other economic sectors, which may be applied to tourism SME business operations: water, energy, food, plastic, transport and furniture /equipment. The scan identifies best practices from other sectors related to nudging of clients towards sustainable behaviour and nudging of staff on how to best engage with new tourism market segments.The next stage of the project relates to two design processes: an online diagnostic tool that allows for measuring and assessing (160) SME’s potential to adapt existing solutions in digital and green challenges, developed in other economic sectors. Next to this, a knowledge hub, addresses knowledge constraints and proposes solutions, business advisory services, training activities to SMEs participating. The hub acts as a matchmaker, bringing together 160 tourism SMEs searching for solutions, with suppliers of existing solutions developed in other sectors. The next key activity is a cross-domain open innovation programme, that will provide 80 tourism SMEs with financial support (up to EUR 30K). Examples of partnerships could be: a hotel and a supplier of refurbished matrasses for hospitals; a restaurant and a supplier of food rejected by supermarkets, a dance event organiser and a supplier of refurbished water bottles operating in the cruise industry, etc.The 80 cross-domain partnerships will be supported through the knowledge hub and their business innovation advisors. The goal is to develop a variety of innovative partnerships to assure that examples in all operational levels of tourism SMEs.The innovation projects shall be presented during a show-and-share event, combined with an investors’ pitch. The diagnostic tool, market scan, knowledge hub, as well as the show and share offer excellent opportunities to communicate results and possible impact of open innovation processes to a wider international audience of destination stakeholders and non-tourism partners. Societal issueSupporting the implementation of digital and circular economy solutions in tourism SMEs is key for its transition towards sustainable low-impact industry and society. Benefit for societySolutions are already developed in other sectors but the cross-over towards tourism is not happening. The project bridges this gap.
