Objectives There is a broad call for change towards € new era' quality systems in healthcare, in which the focus lies on learning and improving. A promising way to establish this in general practice care is to combine audit and feedback with peer group discussion. However, it is not known what different stakeholders think of this type of quality improvement. The aim of this research was to explore the opinions of different stakeholders in general practice on peer discussion of audit and feedback and on its opportunities and risks. Second, their thoughts on transparency versus accountability, regarding this system, were studied. Design An exploratory qualitative study within a constructivist paradigm. Semistructured interviews and focus group discussions were held and coded using thematic analysis. Included stakeholders were general practitioners (GP), patients, professional organisations and insurance companies. Setting General practice in the Netherlands. Participants 22 participants were purposively sampled for eight interviews and two focus group discussions. Results Three main opportunities of peer discussion of audit and feedback were identified: deeper levels of reflection on data, adding context to numbers and more ownership; and three main risks: handling of unwilling colleagues, lacking a safe group and the necessity of patient involvement. An additional theme concerned disagreement on the amount of transparency to be offered: insurance companies and patients advocated for complete transparency on data and improvement of outcomes, while GPs and professional organisations urged to restrict transparency to giving insight into the process. Conclusions Peer discussion of audit and feedback could be part of a change movement, towards a quality system based on learning and trust, that is initiated by the profession. Creating a safe learning environment and involving patients is key herein. Caution is needed when complete transparency is asked, since it could jeopardise practitioners' reflection and learning in safety.
Objectives: In the post-surgical setting, active involvement of family caregivers has the potential to improve patient outcomes by prevention of surgical complications that are sensitive to fundamental care. This paper describes the development of a theoretically grounded program to enhance the active involvement of family caregivers in fundamental care for post-surgical patients. Methods: We used a quality improvement project following a multi-phase design. In Phase 1, an iterative method was used to combine evidence from a narrative review and professionals’ preferences. In Phase 2, the logic model underlying the program was developed guided by four steps: (1) confirm situation, intervention aim, and target population; (2) documented expected outcomes, and outputs of the intervention; (3) identify and describe assumptions, external factors and inputs; and (4) confirm intervention components. Results: Phase 1 identified a minimum set of family involvement activities that were both supported by staff and the narrative review. In Phase 2, the logic model was developed and includes (1) the inputs (e.g. educational- and environmental support), (2) the ultimate outcomes (e.g. reduction of postoperative complications), (3) the intermediate outcomes (e.g. behavioural changes), and (4) immediate outcomes (e.g. improved knowledge, skills and attitude). Conclusions: We demonstrated how we aimed to change our practice to an environment in which family caregivers were stimulated to be actively involved in postoperative care on surgical wards, and how we took different factors into account. The description of this program may provide a solid basis for professionals to implement the family involvement program in their own setting.
Perceptions and values of care professionals are critical in successfully implementing technology in health care. The aim of this study was threefold: (1) to explore the main values of health care professionals, (2) to investigate the perceived influence of the technologies regarding these values, and (3) the accumulated views of care professionals with respect to the use of technology in the future. In total, 51 professionals were interviewed. Interpretative phenomenological analysis was applied. All care professionals highly valued being able to satisfy the needs of their care recipients. Mutual inter-collegial respect and appreciation of supervisors was also highly cherished. The opportunity to work in a careful manner was another important value. Conditions for the successful implementation of technology involved reliability of the technology at hand, training with team members in the practical use of new technology, and the availability of a help desk. Views regarding the future of health care were mainly related to financial cut backs and with a lower availability of staff. Interestingly, no spontaneous thoughts about the role of new technology were part of these views. It can be concluded that professionals need support in relating technological solutions to care recipients' needs. The role of health care organisations, including technological expertise, can be crucial here.
Alcohol use disorder (AUD) is a major problem. In the USA alone there are 15 million people with an AUD and more than 950,000 Dutch people drink excessively. Worldwide, 3-8% of all deaths and 5% of all illnesses and injuries are attributable to AUD. Care faces challenges. For example, more than half of AUD patients relapse within a year of treatment. A solution for this is the use of Cue-Exposure-Therapy (CET). Clients are exposed to triggers through objects, people and environments that arouse craving. Virtual Reality (VRET) is used to experience these triggers in a realistic, safe, and personalized way. In this way, coping skills are trained to counteract alcohol cravings. The effectiveness of VRET has been (clinically) proven. However, the advent of AR technologies raises the question of exploring possibilities of Augmented-Reality-Exposure-Therapy (ARET). ARET enjoys the same benefits as VRET (such as a realistic safe experience). But because AR integrates virtual components into the real environment, with the body visible, it presumably evokes a different type of experience. This may increase the ecological validity of CET in treatment. In addition, ARET is cheaper to develop (fewer virtual elements) and clients/clinics have easier access to AR (via smartphone/tablet). In addition, new AR glasses are being developed, which solve disadvantages such as a smartphone screen that is too small. Despite the demand from practitioners, ARET has never been developed and researched around addiction. In this project, the first ARET prototype is developed around AUD in the treatment of alcohol addiction. The prototype is being developed based on Volumetric-Captured-Digital-Humans and made accessible for AR glasses, tablets and smartphones. The prototype will be based on RECOVRY, a VRET around AUD developed by the consortium. A prototype test among (ex)AUD clients will provide insight into needs and points for improvement from patient and care provider and into the effect of ARET compared to VRET.
Flying insects like dragonflies, flies, bumblebees are able to couple hovering ability with the ability for a quick transition to forward flight. Therefore, they inspire us to investigate the application of swarms of flapping-wing mini-drones in horticulture. The production and trading of agricultural/horticultural goods account for the 9% of the Dutch gross domestic product. A significant part of the horticultural products are grown in greenhouses whose extension is becoming larger year by year. Swarms of bio-inspired mini-drones can be used in applications such as monitoring and control: the analysis of the data collected enables the greenhouse growers to achieve the optimal conditions for the plants health and thus a high productivity. Moreover, the bio-inspired mini-drones can detect eventual pest onset at plant level that leads to a strong reduction of chemicals utilization and an improvement of the food quality. The realization of these mini-drones is a multidisciplinary challenge as it requires a cross-domain collaboration between biologists, entomologists and engineers with expertise in robotics, mechanics, aerodynamics, electronics, etc. Moreover a co-creation based collaboration will be established with all the stakeholders involved. With this approach we can integrate technical and social-economic aspects and facilitate the adoption of this new technology that will make the Dutch horticulture industry more resilient and sustainable.
The livability of the cities and attractiveness of our environment can be improved by smarter choices for mobility products and travel modes. A change from current car-dependent lifestyles towards the use of healthier and less polluted transport modes, such as cycling, is needed. With awareness campaigns, cycling facilities and cycle infrastructure, the use of the bicycle will be stimulated. But which campaigns are effective? Can we stimulate cycling by adding cycling facilities along the cycle path? How can we design the best cycle infrastructure for a region? And what impact does good cycle infrastructure have on the increase of cycling?To find answers for these questions and come up with a future approach to stimulate bicycle use, BUas is participating in the InterReg V NWE-project CHIPS; Cycle Highways Innovation for smarter People transport and Spatial planning. Together with the city of Tilburg and other partners from The Netherlands, Belgium, Germany and United Kingdom we explore and demonstrate infrastructural improvements and tackle crucial elements related to engaging users and successful promotion of cycle highways. BUas is responsible for the monitoring and evaluation of the project. To measure the impact and effectiveness of cycle highway innovations we use Cyclespex and Cycleprint.With Cyclespex a virtual living lab is created which we will use to test several readability and wayfinding measures for cycle infrastructure. Cyclespex gives us the opportunity to test different scenario’s in virtual reality that will help us to make decisions about the final solution that will be realized on the cycle highway. Cycleprint will be used to develop a monitoring dashboard where municipalities of cities can easily monitor and evaluate the local bicycle use.
