Across all health care settings, certain patients are perceived as ‘difficult’ by clinicians. This paper’s aim is to understand how certain patients come to be perceived and labelled as ‘difficult’ patients in community mental health care, through mixed-methods research in The Netherlands between June 2006 and October 2009. A literature review, a Delphi-study among experts, a survey study among professionals, a Grounded Theory interview study among ‘difficult’ patients, and three case studies of ‘difficult’ patients were undertaken. Analysis of the results of these qualitative and quantitative studies took place within the concept of the sick role, and resulted in the construction of a tentative explanatory model. The ‘difficult’ patient-label is associated with professional pessimism, passive treatment and possible discharge or referral out of care. The label is given by professionals when certain patient characteristics are present and a specific causal attribution (psychological, social or moral versus neurobiological) about the patient’s behaviours is made. The status of ‘difficult’ patient is easily reinforced by subsequent patient and professional behaviour, turning initial unusual help-seeking behaviour into ‘difficult’ or ineffective chronic illness behaviour, and ineffective professional behaviour. These findings illustrate that the course of mental illness, or at least the course of patients’ contact with mental health professionals and services, is determined by patient and professional and reinforced by the social and mental health care system. This model adds to the broader sick role concept a micro-perspective in which attribution and learning principles are incorporated. On a practical level, it implies that professionals need to look into their own role in the perpetuation of difficult behaviours as described here.
Across all health care settings, certain patients are perceived as ‘difficult’ by clinicians. This paper’s aim is to understand how certain patients come to be perceived and labelled as ‘difficult’ patients in community mental health care, through mixed-methods research in The Netherlands between June 2006 and October 2009. A literature review, a Delphi-study among experts, a survey study among professionals, a Grounded Theory interview study among ‘difficult’ patients, and three case studies of ‘difficult’ patients were undertaken. Analysis of the results of these qualitative and quantitative studies took place within the concept of the sick role, and resulted in the construction of a tentative explanatory model. The ‘difficult’ patient-label is associated with professional pessimism, passive treatment and possible discharge or referral out of care. The label is given by professionals when certain patient characteristics are present and a specific causal attribution (psychological, social or moral versus neurobiological) about the patient’s behaviours is made. The status of ‘difficult’ patient is easily reinforced by subsequent patient and professional behaviour, turning initial unusual help-seeking behaviour into ‘difficult’ or ineffective chronic illness behaviour, and ineffective professional behaviour. These findings illustrate that the course of mental illness, or at least the course of patients’ contact with mental health professionals and services, is determined by patient and professional and reinforced by the social and mental health care system. This model adds to the broader sick role concept a micro-perspective in which attribution and learning principles are incorporated. On a practical level, it implies that professionals need to look into their own role in the perpetuation of difficult behaviours as described here.
Introduction F-ACT is a flexible version of Assertive Community Treatment to deliver care in a changing intensity depending on needs of individuals with severe mental illnesses (Van Veldhuizen, 2007). In 2016 a number of the FACT-teams in the Dutch region of Utrecht moved to locations in neighborhoods and started to work as one network team together with neighborhood based facilities in primary care (GP’s) and in the social domain (supported living, social district teams, etc.). This should create better chances on clinical, social and personal recovery of service users. Objectives This study describes the implementation, obstacles and outcomes for service users. The main question is whether this Collaborative Mental Health Care in the Community produces better outcome than regular FACT. Measures include (met/unmet) needs for care, quality of life, clinical, functional and personal recovery, and hospital admission days. Methods Data on care utilization regarding the innovation are compared to regular FACT. Qualitative interviews are conducted to gain insight in the experiences of service users, their family members and mental health care workers. Changes in outcome measures of service users in pilot areas (N=400) were compared to outcomes of users (matched on gender and level of functioning) in regular FACT teams in the period 2015-2018 (total N=800). Results Data-analyses will take place from January to March 2019. Initial analyses point at a greater feeling of holding and safety for service users in the pilot areas and less hospital admission days. Conclusions Preliminary results support the development from FACT to a community based collaborative care service.
Digital transformation has been recognized for its potential to contribute to sustainability goals. It requires companies to develop their Data Analytic Capability (DAC), defined as their ability to collect, manage and analyze data effectively. Despite the governmental efforts to promote digitalization, there seems to be a knowledge gap on how to proceed, with 37% of Dutch SMEs reporting a lack of knowledge, and 33% reporting a lack of support in developing DAC. Participants in the interviews that we organized preparing this proposal indicated a need for guidance on how to develop DAC within their organization given their unique context (e.g. age and experience of the workforce, presence of legacy systems, high daily workload, lack of knowledge of digitalization). While a lot of attention has been given to the technological aspects of DAC, the people, process, and organizational culture aspects are as important, requiring a comprehensive approach and thus a bundling of knowledge from different expertise. Therefore, the objective of this KIEM proposal is to identify organizational enablers and inhibitors of DAC through a series of interviews and case studies, and use these to formulate a preliminary roadmap to DAC. From a structure perspective, the objective of the KIEM proposal will be to explore and solidify the partnership between Breda University of Applied Sciences (BUas), Avans University of Applied Sciences (Avans), Logistics Community Brabant (LCB), van Berkel Logistics BV, Smink Group BV, and iValueImprovement BV. This partnership will be used to develop the preliminary roadmap and pre-test it using action methodology. The action research protocol and preliminary roadmap thereby developed in this KIEM project will form the basis for a subsequent RAAK proposal.
A series of tests performed on as-built and strengthened timber joist-masonry-wall specimens. The test aims at providing a complete characterization of the behaviour of the timber-joist connections under axial cyclic loading. The obtained results will be used as inputs to calibrate numerical models to simulate the connection between the cavity wall and timber joist.
Logistics represents around 10-11% of global CO2 emissions, around 75% of which come from road freight transport. ‘The European Green Deal’ is calling for drastic CO2 reduction in this sector. This requires advanced and very expensive technological innovations; i.e. re-design of vehicle units, hybridization of powertrains and automatic vehicle technology. Another promising way to reach these environmental ambitions, without excessive technological investments, is the deployment of SUPER ECO COMBI’s (SEC). SEC is the umbrella name for multiple permutations of 32 meter, 70 tons, road-train combinations that can carry the payload-equivalent of 2 normal tractor-semitrailer combinations and even 3 rigid trucks. To fully deploy a SEC into the transport system the compliance with the existing infrastructure network and safety needs to be guaranteed; i.e. to deploy a specific SEC we should be able to determine which SEC-permutation is most optimal on specific routes with respect to regulations (a.o. damage to the pavement/bridges), the dimensions of specific infrastructures (roundabouts, slopes) and safety. The complexity of a SEC compared to a regular truck (double articulation, length) means that traditional optimisation methods are not applicable. The aim of this project is therefore to develop a first methodology enabling the deployment of the optimal SEC permutation. This will help transport companies (KIEM: Ewals) and trailer manufactures (KIEM: Emons) to invest in the most suitable designs for future SEC use. Additionally the methodology will help governments to be able to admit specific SEC’s to specific routes. The knowledge gained in this project will be combined with the knowledge of the broader project ENVELOPE (NWA-IDG). This will be the start of broader research into an overall methodology of deploying optimal vehicle combinations and a new regulatory framework. The knowledge will be used in master courses on vehicle dynamics.
