Background: A quality improvement collaborative is an intensive project involving a combination of implementation strategies applied in a limited “breakthrough” time window. After an implementation project, it is generally difficult to sustain its success. In the current study, sustainability was described as maintaining an implemented innovation and its benefits over a longer period of time after the implementation project has ended. The aim of the study was to explore potentially promising strategies for sustaining the Enhanced Recovery After Surgery (ERAS) programme in colonic surgery as perceived by professionals, three to six years after the hospital had successfully finished a quality improvement collaborative. Methods: A qualitative case study was performed to identify promising strategies to sustain key outcome variables related to the ERAS programme in terms of adherence, time needed for functional recovery and hospital length of stay (LOS), as achieved immediately after implementation. Ten hospitals were selected which had successfully implemented the ERAS programme in colonic surgery (2006–2009), with success defined as a median LOS of 6 days or less and protocol adherence rates above 70%. Fourteen semi-structured interviews were held with eighteen key participants of the care process three to six years after implementation, starting with the project leader in every hospital. The interviews started by confronting them with the level of sustained implementation results. A direct content analysis with an inductive coding approach was used to identify promising strategies. The mean duration of the interviews was 37 minutes (min 26 minutes – max 51 minutes). Results: The current study revealed strategies targeting professionals and the organisation. They comprised internal audit and feedback on outcomes, small-scale educational booster meetings, reminders, changing the physical structure of the organisation, changing the care process, making work agreements and delegating responsibility, and involving a coordinator. A multifaceted self-driven promising strategy was applied in most hospitals, and in most hospitals promising strategies were suggested to sustain the ERAS programme. Conclusions: Joining a quality improvement collaborative may not be enough to achieve long-term normalisation of transformed care, and additional investments may be needed. The findings suggest that certain post-implementation strategies are valuable in sustaining implementation successes achieved after joining a quality improvement collaborative.
After being hospitalised, 30–60% of older patients experience a decline in functioning, resulting in a decreased quality of life and autonomy. The objective of this study was to establish a screening instrument for identifying older hospitalised patients at risk for functional decline by comparing the predictive values of three screening instruments: identification of seniors at risk, care complexity prediction instrument and hospital admission risk profile.
Article about social work and social policy in the Netherlands. It gives information about the background, history, the meaning of the profession and the different types of professional areas in which the profession is divided. Other subjects are: social work curricula, the European dimension of social work an current challenges for social professionals in the Netherlands.
In dit project wordt onderzocht hoe je burgers niet alleen kunt betrekken maar ook aan het roer kunt zetten bij de invulling van de ambitieuze doelstelling om als stad energieneutraal te worden.Een Positive Energy District (PED) brengt alle elementen van de energietransitie samen op een locatie: energieopwek, energieopslag, energiegebruik, energiebesparing, balancering en transport. Ontwikkeling, eigenaarschap en acceptatie van dit nieuwe socio-technische arrangement zijn onderwerp van het onderzoek. In het nieuwe speelveld komen volgens Grunneger Power niet 2 helften, maar drie helften bij elkaar: burgers, bedrijfsleven en overheden. Wij menen dat er nog een vierde belangrijke speler is: kennisinstellingen. Dit betekent dat een transdisciplinaire benadering van het onderzoek gewenst is, waarin het centrale thema wordt benaderd vanuit verschillende disciplines enerzijds en diverse maatschappelijke stakeholders anderzijds.In het onderzoek wordt een aanpak ontwikkeld die aansluit bij de beleving van gewone burgers. De aanpak identificeert concrete stappen die burgers kunnen nemen en benoemt randvoorwaarden die borgen dat zij daartoe ook de ruimte krijgen. Deze randvoorwaarden hebben onder meer betrekking op het beleid van de gemeente, de manier waarop het PED, inclusief technische en sociale aspecten, wordt ingericht, welke oplossingen bedrijven aanbieden, en tenslotte hoe de lokale energiebeweging en hun achterban optimaal bij het PED betrokken kunnen worden.De ontwikkeling van de City Vision 2050 in WP1 begint met het betrekken van burgers: 'Launching a co-creation process, engaging stakeholders and citizens from the very beginning. This can facilitate the early identification of social barriers and foster future acceptance of the changes.' Ook in de 'Follower Cities' is dit het geval: 'Citizen and stakeholders engagement. Once the area is selected, the engagement strategy will be launched to ensure a relevant participation of local actors in the process, in order to maximize acceptability and replicability. At least civic centres and individual citizens will be invited to participate in some sessions, focused on collecting needs and opinions and making them participants of the definition process.'(p.46).In dit project wordt onderzocht hoe je burgers niet alleen kunt betrekken maar ook aan het roer kunt zetten bij de invulling van de ambitieuze doelstelling om als stad energieneutraal te worden.Een Positive Energy District (PED) brengt alle elementen van de energietransitie samen op een locatie: energieopwek, energieopslag, energiegebruik, energiebesparing, balancering en transport. Ontwikkeling, eigenaarschap en acceptatie van dit nieuwe socio-technische arrangement zijn onderwerp van het onderzoek. In het nieuwe speelveld komen volgens Grunneger Power niet 2 helften, maar drie helften bij elkaar: burgers, bedrijfsleven en overheden. Wij menen dat er nog een vierde belangrijke speler is: kennisinstellingen. Dit betekent dat een transdisciplinaire benadering van het onderzoek gewenst is, waarin het centrale thema wordt benaderd vanuit verschillende disciplines enerzijds en diverse maatschappelijke stakeholders anderzijds.In het onderzoek wordt een aanpak ontwikkeld die aansluit bij de beleving van gewone burgers. De aanpak identificeert concrete stappen die burgers kunnen nemen en benoemt randvoorwaarden die borgen dat zij daartoe ook de ruimte krijgen. Deze randvoorwaarden hebben onder meer betrekking op het beleid van de gemeente, de manier waarop het PED, inclusief technische en sociale aspecten, wordt ingericht, welke oplossingen bedrijven aanbieden, en tenslotte hoe de lokale energiebeweging en hun achterban optimaal bij het PED betrokken kunnen worden.De ontwikkeling van de City Vision 2050 in WP1 begint met het betrekken van burgers: 'Launching a co-creation process, engaging stakeholders and citizens from the very beginning. This can facilitate the early identification of social barriers and foster future acceptance of the changes.' Ook in de 'Follower Cities' is dit het geval: 'Citizen and stakeholders engagement. Once the area is selected, the engagement strategy will be launched to ensure a relevant participation of local actors in the process, in order to maximize acceptability and replicability. At least civic centres and individual citizens will be invited to participate in some sessions, focused on collecting needs and opinions and making them participants of the definition process.'(p.46).
In the Netherlands, 125 people suffer a stroke every day, which annually results in 46.000 new stroke patients Stroke patients are confronted with combinations of physical, psychological and social consequences impacting their long term functioning and quality of live. Fortunately many patients recover to their pre-stroke level of functioning, however, almost half of them never will. Consequently, rehabilitation often means that patients need to adapt to a new reality in their lives, requiring not only physical but also psychosocial adjustments. Nurses play a key role during rehabilitation of stroke patients. However, when confronted with psychosocial problems, they often feel insecure about identifying the specific psycho-social needs of the individual patient and providing adequate care. In our project ‘Early Detection of Post-Stroke Depression’, (SIA RAAK; 2010-12-36P), we developed a toolkit focusing on early identification of depression after stroke continued with interventions nurses can use during hospitalisation. During this project it became clear that evidence regarding possible interventions is scarce and inclusive. Moreover feasibility of interventions is often not confirmed. Our project showed that during the period of hospital admission patients and health care providers strongly focus on surviving the stroke and on the physical rehabilitation. Therefore, we concluded that to make one step beyond we first have to go one step back. To strengthen psychosocial care for patients after stroke we have to add, reconsider and shape knowledge in context of health care practices in a systematic way, resulting in evidence based and practice informed stepping stones. With this project we aim to collect these stepping stones and develop a nursing care programme that improves psychosocial well-being of patients after stroke, is tailored to the particular concerns and needs of patients, and is considered feasible for use in the usual care process of nurses in the stroke rehabilitation pathway.
The clubfoot deformity is one of the most common congenital orthopaedic “conditions”. Worldwide approximately 100,000 children are born with unilateral or bilateral clubfoot every year. In the Netherlands the incidence is approximately 175 every year. This three dimensional deformity of the foot involves, equinus, varus, adductus, and cavus . Left untreated the clubfoot leads to deformity, functional disability and pain. Physical impairments of children with clubfoot might lead to limitations in activities and therefore impede a child’s participation. In clinical practice, the orthopaedic surgeon and physiotherapists are regularly consulted by (parents of) clubfoot patients for functional problems such as impaired walking and other daily activities. This does not only affect long-term and physical health of a child, it will also affect the development of social relationships and skills as well. Since walking is a main activity in children to be able to participate in daily life, our previous study (financially supported by SIA Raak Publiek) focussed on gait differences between children with clubfoot and controls. However, differences in gait characteristics do not necessarily lead to functional limitations and restricted participation. Therefore, providing insight in participation and a child’s performance in other activities than walking is necessary. Insight in a child’s participation will also indicate the functional outcome of the treatment, which on its turn could provide essential information concerning a possible relapse.. Early identification of a relapse is important since it could prevent the need for major surgical interventions. The occurrence of a relapse clubfoot will probably also lead to functional differences in the foot as well as problems during activity and participation. Therefore, the main focus of this study is the functional outcomes of physical activities and the characterisation of participation of children with clubfeet in daily activities of childhood.
