Purpose: Self-managed institutional homeless programmes started as an alternative to regular shelters. Using institutional theory as a lens, we aim to explore the experiences of stakeholders with the institutional aspects of a self-managed programs.Method: The data we analysed (56 interviews, both open and semi-structured) were generated in a longitudinal participatory case-study into JES, a self-managed homeless shelter. In our analysis we went back and forth between our empirical data and theory, using a combination of systematic coding and interpretation. Participants were involved in all stages of the research.Results: Our analysis revealed similarities between JES and regular shelters, stemming from institutional similarities. Participants shared space and facilities with sixteen people, which caused an ongoing discussion on (enforcement of) rules. Participants loathed lack of private space. However, participants experienced freedom of choice over both their own life and management of JES and structures were experienced more fluid than in regular care. Somestructures also appeared stimulated self-management.Conclusion: Our analysis showed how an institutional context influences self-management and suggested opportunities for introducing freedom and fluidity in institutional care.
Background: The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch ‘Blue Care’ pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision. Methods: This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors. Results: A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient’s diagnosis independently influenced the referral decisions following PC+. Conclusion: The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.
This qualitative study examined how the complex institutional context of gas extraction in Groningen affects relations and processes of trust, and seeks to better understand what is necessary for restoring trust. In the Groningen gas case, responsibilities for dealing with multiple negative consequences of gas extraction are shared by many different organizations who together form a complex institutional system. Numerous professionals are doing their best to help solve the problems. As individuals, case managers and other professionals are seen as benevolent and hard-working people. But as representatives of (large) institutions these professionals struggle to be seen as trustworthy because of persistent problems with institutional performance, with professionals themselves feeling they have insufficient discretionary power. More than interpersonal trust, a different form of trust appears to be at stake here: confidence in the system itself. According to many respondents, confidence in the system is low because the perceived interests of the institutions that shaped this system are not aligned with those of residents and the region. In addition, the positions of power and responsibility within this system are opaque to both residents and professionals. Moreover, the institutional system is perceived to be based on a distrustful attitude toward citizens in general, resulting in elaborate procedures for accountability, control and monitoring. These factors have become obstacles to restoring confidence in the system, no matter how well residents and professionals get along as individuals.
The pressure on the European health care system is increasing considerably: more elderly people and patients with chronic diseases in need of (rehabilitation) care, a diminishing work force and health care costs continuing to rise. Several measures to counteract this are proposed, such as reduction of the length of stay in hospitals or rehabilitation centres by improving interprofessional and person-centred collaboration between health and social care professionals. Although there is a lot of attention for interprofessional education and collaborative practice (IPECP), the consortium senses a gap between competence levels of future professionals and the levels needed in rehabilitation practice. Therefore, the transfer from tertiary education to practice concerning IPECP in rehabilitation is the central theme of the project. Regional bonds between higher education institutions and rehabilitation centres will be strengthened in order to align IPECP. On the one hand we deliver a set of basic and advanced modules on functioning according to the WHO’s International Classification of Functioning, Disability and Health and a set of (assessment) tools on interprofessional skills training. Also, applications of this theory in promising approaches, both in education and in rehabilitation practice, are regionally being piloted and adapted for use in other regions. Field visits by professionals from practice to exchange experiences is included in this work package. We aim to deliver a range of learning materials, from modules on theory to guidelines on how to set up and run a student-run interprofessional learning ward in a rehabilitation centre. All tested outputs will be published on the INPRO-website and made available to be implemented in the core curricula in tertiary education and for lifelong learning in health care practice. This will ultimately contribute to improve functioning and health outcomes and quality of life of patients in rehabilitation centres and beyond.
The GeNEdu project aims to renew nursing curricula through building capacities of the Chinese partner institutions to develop gerontological nursing education for future health care professionals to meet the needs of the ageing society in China. It is financed from the Erasmus+ Programme, Key Action 2, Capacity Building in the Field of Higher Education 2019.
The ELLAN is a Lifelong Learning Programme project funded by the European Commission for the period September 2013 – September 2016. The consortium included 26 partners from 25 countries in Europe. The ELLAN project promotes European cooperation and exchange of innovation and good practice related to the ageing population and to the educational preparation of those professionals in health and social care that work with older people. The desired outcome of the ELLAN project is a better quality of higher education related to the care and services of people in later life. The project includes several research based workpackage with the main project result being the "European Core Competences Framework for health and social care professionals working with older people". The project directly targets educators and management staff at the partner organizations and other higher education institutions in Europe. The indirect target groups are the students, professional communities and older people themselves.
