OBJECTIVES: To improve transmural palliative care for acutely admitted older patients, the PalliSupport transmural care pathway was developed. Implementation of this care pathway was challenging. The aim of this study was to improve understanding why the implementation partly failed.DESIGN: A qualitative process evaluation study.SETTING/PARTICIPANTS: 17 professionals who were involved in the PalliSupport program were interviewed.METHODS: Online semi-structured interviews. Thematic analysis to create themes according to the implementation framework of Grol & Wensing.RESULTS: From this study, themes within four levels of implementation emerged: 1) The innovation: challenges in current palliative care, the setting of the pathway and boost for improvement; 2) Individual professional: feeling (un)involved and motivation; 3) Organizational level: project management; 4) Political and economic level: project plan and evaluation.CONCLUSION AND IMPLICATIONS: We learned that the challenges involved in implementing a transmural care pathway in palliative care should not be underestimated. For successful implementation, we emphasize the importance of creating a program that fits the complexity of transmural palliative care. We suggest starting on a small scale and invest in project management. This could help to involve all stakeholders and anticipate current challenges in palliative care. To increase acceptance, create one care pathway that can start and be used in all care settings. Make sure that there is sufficient flexibility in time and room to adjust the project plan, so that a second pilot study can possibly be performed, and choose a scientific evaluation with both rigor and practical usefulness to evaluate effectiveness.
Physical rehabilitation programs revolve around the repetitive execution of exercises since it has been proven to lead to better rehabilitation results. Although beginning the motor (re)learning process early is paramount to obtain good recovery outcomes, patients do not normally see/experience any short-term improvement, which has a toll on their motivation. Therefore, patients find it difficult to stay engaged in seemingly mundane exercises, not only in terms of adhering to the rehabilitation program, but also in terms of proper execution of the movements. One way in which this motivation problem has been tackled is to employ games in the rehabilitation process. These games are designed to reward patients for performing the exercises correctly or regularly. The rewards can take many forms, for instance providing an experience that is engaging (fun), one that is aesthetically pleasing (appealing visual and aural feedback), or one that employs gamification elements such as points, badges, or achievements. However, even though some of these serious game systems are designed together with physiotherapists and with the patients’ needs in mind, many of them end up not being used consistently during physical rehabilitation past the first few sessions (i.e. novelty effect). Thus, in this project, we aim to 1) Identify, by means of literature reviews, focus groups, and interviews with the involved stakeholders, why this is happening, 2) Develop a set of guidelines for the successful deployment of serious games for rehabilitation, and 3) Develop an initial implementation process and ideas for potential serious games. In a follow-up application, we intend to build on this knowledge and apply it in the design of a (set of) serious game for rehabilitation to be deployed at one of the partners centers and conduct a longitudinal evaluation to measure the success of the application of the deployment guidelines.
Nederland kent ongeveer 220.000 bedrijfsongevallen per jaar (met 60 mensen die overlijden). Vandaar dat elke werkgever verplicht is om bedrijfshulpverlening (BHV) te organiseren, waaronder BHV-trainingen. Desondanks brengt slechts een-derde van alle bedrijven de arbeidsrisico’s in kaart via een Risico-Inventarisatie & Evaluatie (RI&E) en blijft het aandeel werknemers met een arbeidsongeval hoog. Daarom wordt er continu geïnnoveerd om BHV-trainingen te optimaliseren, o.a. door middel van Virtual Reality (VR). VR is niet nieuw, maar is wel doorontwikkeld en betaalbaarder geworden. VR biedt de mogelijkheid om veilige realistische BHV-noodsimulaties te ontwikkelen waarbij de cursist het gevoel heeft daar echt te zijn. Ondanks de toename in VR-BHV-trainingen, is er weinig onderzoek gedaan naar het effect van VR in BHV-trainingen en zijn resultaten tegenstrijdig. Daarnaast zijn er nieuwe technologische ontwikkelingen die het mogelijk maken om kijkgedrag te meten in VR m.b.v. Eye-Tracking. Tijdens een BHV-training kan met Eye-Tracking gemeten worden hoe een instructie wordt opgevolgd, of cursisten worden afgeleid en belangrijke elementen (gevaar en oplossingen) waarnemen tijdens de simulatie. Echter, een BHV-training met VR en Eye-Tracking (interacties) bestaat niet. In dit project wordt een prototype ontwikkeld waarin Eye-Tracking wordt verwerkt in een 2021 ontwikkelde VR-BHV-training, waarin noodsituaties zoals een kantoorbrand worden gesimuleerd (de BHVR-toepassing). Door middel van een experiment zal het prototype getest worden om zo voor een deel de vraag te beantwoorden in hoeverre en op welke manier Eye-Tracking in VR een meerwaarde biedt voor (RI&E) BHV-trainingen. Dit project sluit daarmee aan op het missie-gedreven innovatiebeleid ‘De Veiligheidsprofessional’ en helpt het MKB dat vaak middelen en kennis ontbreekt voor onderzoek naar effectiviteit rondom innovatieve-technologieën in educatie/training. Het project levert onder meer een prototype op, een productie-rapport en onderzoeks-artikel, en staat open voor nieuwe deelnemers bij het schrijven van een grotere aanvraag rondom de toepassing en effect van VR en Eye-Tracking in BHV-trainingen.
In order to achieve much-needed transitions in energy and health, systemic changes are required that are firmly based on the principles of regard for others and community values, while at the same time operating in market conditions. Social entrepreneurship and community entrepreneurship (SCE) hold the promise to catalyze such transitions, as they combine bottom-up social initiatives with a focus on financially viable business models. SCE requires a facilitating ecosystem in order to be able to fully realize its potential. As yet it is unclear in which way the entrepreneurial ecosystem for social and community entrepreneurship facilitates or hinders the flourishing and scaling of such entrepreneurship. It is also unclear how exactly entrepreneurs and stakeholders influence their ecosystem to become more facilitative. This research programme addresses these questions. Conceptually it integrates entrepreneurial ecosystem frameworks with upcoming theories on civic wealth creation, collaborative governance, participative learning and collective action frameworks.This multidisciplinary research project capitalizes on a unique consortium: the Dutch City Deal ‘Impact Ondernemen’. In this collaborative research, we enhance and expand current data collection efforts and adopt a living-lab setting centered on nine local and regional cases for collaborative learning through experimenting with innovative financial and business models. We develop meaningful, participatory design and evaluation methods and state-of-the-art digital tools to increase the effectiveness of impact measurement and management. Educational modules for professionals are developed to boost the abovementioned transition. The project’s learnings on mechanisms and processes can easily be adapted and translated to a broad range of impact areas.
