This paper presents four Destination Stewardship scenarios based on different levels of engagement from the public and private sector. The scenarios serve to support destination stakeholders in assessing their current context and the pathway towards greater stewardship. A Destination Stewardship Governance Diagnostic framework is built on the scenarios to support its stakeholders in considering how to move along that pathway, identifying the key aspects of governance that are either facilitating or frustrating a destination stewardship approach, and the required actions and resources to achieve an improved scenario. Moreover, the scenarios and diagnostic framework support stakeholders to come together to debate and scrutinise how tourism is managed in a way that meets the needs of the destination, casting new light on the barriers and opportunities for greater destination stewardship.
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Aims: In-hospital prescribing errors may result in patient harm, such as prolonged hospitalisation and hospital (re)admission, and may be an emotional burden for the prescribers and healthcare professionals involved. Despite efforts, in-hospital prescribing errors and related harm still occur, necessitating an innovative approach. We therefore propose a novel approach, in-hospital pharmacotherapeutic stewardship (IPS). The aim of this study was to reach consensus on a set of quality indicators (QIs) as a basis for IPS. Methods: A three-round modified Delphi procedure was performed. Potential QIs were retrieved from two systematic searches of the literature, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. In two written questionnaires and a focus meeting (held between the written questionnaire rounds), potential QIs were appraised by an international, multidisciplinary expert panel composed of members of the European Association for Clinical Pharmacology and Therapeutics (EACPT). Results: The expert panel rated 59 QIs and four general statements, of which 35 QIs were accepted with consensus rates ranging between 79% and 97%. These QIs describe the activities of an IPS programme, the team delivering IPS, the patients eligible for the programme and the outcome measures that should be used to evaluate the care delivered. Conclusions: A framework of 35 QIs for an IPS programme was systematically developed. These QIs can guide hospitals in setting up a pharmacotherapeutic stewardship programme to reduce in-hospital prescribing errors and improve in-hospital medication safety.
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In this chapter, we propose an ethical framework for serious game design, which we term the Ecosystem for Designing Games Ethically (EDGE).EDGE expands on Zagal’s categorization of ethical areas in game design by incorporating the different contexts of design and their use. In addition, we leverage these contexts to suggest four guidelines that support Ethical Stewardship in serious game design. We conclude by discussing a number of specific areas inwhich ethics plays a role in serious game design. These include games in (a) amilitary context, (b) the consideration of privacy issues, and (c) the evaluation ofgame design choices.
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Research suggests that construction clients, as building owner-occupier, are struggling to implement smart maintenance. This thesis assumes that this is due to a failure to fully understand the institutional complexities of smart maintenance. Hence, the aim of this thesis was to improve our understanding of these complexities and to develop theoretical and practical knowledge on the professionalization of construction clients in commissioning smart maintenance through stewardship. Stewardship theory portrays managers and employees as collectivists, pro-organizational and trustworthy, and can be used for designing collaborations based on intrinsic motivation and trust. A first insight from this thesis relates to how institutional complexity in smart maintenance management (SMM) can be understood (study 1). Institutional complexity is defined as the combined effect of 15 interorganizational and intraorganizational tensions that are active simultaneously. A second insight from this thesis relates to the capabilities that construction clients need to address the institutional complexities of SMM and connect various institutional fields (study 2). Using data collected from four cases involving two construction clients, a framework with eight maturity dimensions, involving 23 sub-dimensions, has been developed and validated. The third insight from this thesis relates to the role of the purchasing function in commissioning smart maintenance and emerged from considering the service triad concept (study 3). The findings indicate that the service triad concept fails to provide sufficient detail to adequately describe the construction client’s role in SMM. Hence, the service triad is extended to a service hexad. Our fourth insight relates to intrapreneurial stewardship (study 4). A process model for change implementation through stewardship interventions has been developed and then evaluated in a case study. The process model combines constructs from stewardship theory with intrapreneurship concepts and describes how employees can be coached by leaders during periods of organizational change. Together, the insights from the four studies are synthesized in a framework for client-led innovation in SMM and describe how construction clients can increase SMM maturity in institutionally complex environments through stewardship.
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While digitalisation requires facilities management (FM) organisations to change at an increasing rate, little is known about the mechanisms that create ownership and enable individuals to implement changes in everyday FM practice. In this study, these mechanisms are explored from a stewardship perspective. The purpose of this paper is to provide insights in the dynamics of organisational change in FM by analysing how stewardship behaviour leads to change.A process model for implementing organisational change is constructed, based on existing theoretical insights from stewardship and intrapreneurship literature. The model is evaluated in a case study through analysis of critical events. Interviewing was the key data collection method.The process model gives an event-driven explanation of change through psychological ownership. Analysis of multiple critical events suggests that the model explains intra-organisational as well as inter-organisational change. The case data further suggests that, compared to intra-organisational change, tailored relational and motivational support is more important for inter-organisational change because of the higher risks involved. Job crafting emerged as an unanticipated finding that offers interesting prospects for future FM research.The process model offers guidance for leaders in FM organisations on providing tailored support to internal and external employees during periods of organisational change.Stewardship and intrapreneurship are combined to provide insights on organisational change in FM. The study demonstrates how intrapreneurial behaviour and stewardship behaviour can be linked to create innovation within and between organisations.
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Interview: Bureau Social Media tijdens social spreekuur in gesprek met Frans van der Reep - Stewardship
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1e alinea column: Natuurlijk gaat deze bijdrage niet letterlijk over de zaalarts zoals we die in ziekenhuizen kennen. Ik wil het met je hebben over stewardship. Stewards vind je allerlei vormen en ik voorspel hen een grote toekomst.
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The adoption of new technologies requires people to work differently and adopt new ways of thinking. This, however, is complicated because social conventions in professional disciplines are deeply rooted and have a long history. An extreme case as an exemplar was studied to investigate social change in a maintenance network. With concepts from stewardship theory and entrepreneurship literature, the case study is used to develop a preliminary model for managing social change in maintenance networks. The model presented is a first attempt to link stewardship theory to the practice of maintenance management. It will be refined and validated in future research and can complement other theories, such as agency theory and transaction cost economics, in explaining socio-technical phenomena in construction management. The practical contribution of this research to the construction management field is that it deepens our understanding of the clients’ leadership role.
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Abstract Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has challenged healthcare globally. An acute increase in the number of hospitalized patients has neces‑ sitated a rigorous reorganization of hospital care, thereby creating circumstances that previously have been identifed as facilitating prescribing errors (PEs), e.g. a demanding work environment, a high turnover of doctors, and prescrib‑ ing beyond expertise. Hospitalized COVID-19 patients may be at risk of PEs, potentially resulting in patient harm. We determined the prevalence, severity, and risk factors for PEs in post–COVID-19 patients, hospitalized during the frst wave of COVID-19 in the Netherlands, 3months after discharge. Methods: This prospective observational cohort study recruited patients who visited a post-COVID-19 outpatient clinic of an academic hospital in the Netherlands, 3months after COVID-19 hospitalization, between June 1 and October 1 2020. All patients with appointments were eligible for inclusion. The prevalence and severity of PEs were assessed in a multidisciplinary consensus meeting. Odds ratios (ORs) were calculated by univariate and multivariate analysis to identify independent risk factors for PEs. Results: Ninety-eight patients were included, of whom 92% had ≥1 PE and 8% experienced medication-related harm requiring an immediate change in medication therapy to prevent detoriation. Overall, 68% of all identifed PEs were made during or after the COVID-19 related hospitalization. Multivariate analyses identifed ICU admission (OR 6.08, 95% CI 2.16–17.09) and a medical history of COPD / asthma (OR 5.36, 95% CI 1.34–21.5) as independent risk fac‑ tors for PEs. Conclusions: PEs occurred frequently during the SARS-CoV-2 pandemic. Patients admitted to an ICU during COVID19 hospitalization or who had a medical history of COPD / asthma were at risk of PEs. These risk factors can be used to identify high-risk patients and to implement targeted interventions. Awareness of prescribing safely is crucial to prevent harm in this new patient population.
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City growth threatens sustainable development of cities. Over the past decades increased urbanization has created more pressure - not only on the suburban outskirts - but also in the inner core of the cities, putting important environmental issues such as water management and cultural heritage under stress. Cultural heritage, either standing monuments or archaeological remains, is internationally recognized as an important legacy of our history. The European Convention on the Protection of the Archaeological Heritage incorporates concepts and ideas that have become accepted practice in Europe. Conservation and enhancement of archaeological heritage is one of the goals of urban planning policies. One of the key objectives of the European policy is to protect, preferably in-situ, archaeological remains buried in the soil or seabed and to incorporate archaeological heritage into spatial planning policies. Conflicts with prior uses and unappreciated impacts on other subsurface resources, amongst them archaeological heritage, make use of underground space in cities suboptimal. In terms of ecosystem services, the subsurface environment acts either as a carrier of archaeological heritage in situ (stewardship) or supports above-ground cultural heritage. Often, it’s not enough to protect the heritage site or monument itself: new developments outside a specific protected area can lead to changes in groundwater level, and cause serious damage to heritage buildings and archaeological deposits. This paper presents good practices in cultural heritage management and the use of subsurface knowledge in urban areas.
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