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.
Introduction: The implementation of oncology care pathways that standardize organizational procedures has improved cancer care in recent years. However, the involvement of “authentic” patients and caregivers in quality improvement of these predetermined pathways is in its infancy, especially the scholarly reflection on this process. We, therefore, aim to explore the multidisciplinary challenges both in practice, when cancer patients, their caregivers, and a multidisciplinary team of professionals work together on quality improvement, as well as in our research team, in which a social scientist, health care professionals, health care researchers, and experience experts design a research project together. Methods and design: Experience-based co-design will be used to involve cancer patients and their caregivers in a qualitative research design. In-depth open discovery interviews with 12 colorectal cancer patients, 12 breast cancer patients, and seven patients with cancer-associated thrombosis and their caregivers, and focus group discussions with professionals from various disciplines will be conducted. During the subsequent prioritization events and various co-design quality improvement meetings, observational field notes will be made on the multidisciplinary challenges these participants face in the process of co-design, and evaluation interviews will be done afterwards. Similar data will be collected during the monthly meetings of our multidisciplinary research team. The data will be analyzed according to the constant comparative method. Discussion: This study may facilitate quality improvement programs in oncologic care pathways, by increasing our real-world knowledge about the challenges of involving “experience experts” together with a team of multidisciplinary professionals in the implementation process of quality improvement. Such co-creation might be challenging due to the traditional paternalistic relationship, actual disease-/treatment-related constraints, and a lack of shared language and culture between patients, caregivers, and professionals and between professionals from various disciplines. These challenges have to be met in order to establish equality, respect, team spirit, and eventual meaningful participation.
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.
Due to the existing pressure for a more rational use of the water, many public managers and industries have to re-think/adapt their processes towards a more circular approach. Such pressure is even more critical in the Rio Doce region, Minas Gerais, due to the large environmental accident occurred in 2015. Cenibra (pulp mill) is an example of such industries due to the fact that it is situated in the river basin and that it has a water demanding process. The current proposal is meant as an academic and engineering study to propose possible solutions to decrease the total water consumption of the mill and, thus, decrease the total stress on the Rio Doce basin. The work will be divided in three working packages, namely: (i) evaluation (modelling) of the mill process and water balance (ii) application and operation of a pilot scale wastewater treatment plant (iii) analysis of the impacts caused by the improvement of the process. The second work package will also be conducted (in parallel) with a lab scale setup in The Netherlands to allow fast adjustments and broaden evaluation of the setup/process performance. The actions will focus on reducing the mill total water consumption in 20%.
Background:Many business intelligence surveys demonstrate that Digital Realities (Virtual reality and Augmented Reality) are becoming a huge market trend in many sectors, and North America is taking the lead in this emerging domain. Tourism is no exception and the sector in Europe must innovate to get ahead of the curve of this technological revolution, but this innovation needs public support.Project partnership:In order to provide labs, startups and SMEs willing to take this unique opportunity with the most appropriate support policies, 9 partner organizations from 8 countries (FR, IT, HU, UK, NO, ES, PL, NL) decided to work together: regional and local authorities, development agencies, private non-profit association and universities.Objective of the project:Thanks to their complementary experiences and know-how, they intend to improve policies of the partner regions (structural funds and regional policies), in order to foster a tourist channeled innovation in the Digital Realities sector.Approach:All partners will work together on policy analysis tasks before exchanging their best initiatives and transferring them from one country to another. This strong cooperation will allow them to build the best conditions to foster innovation thanks to more effective structural funds policies and regional policies.Main activities & outputs:8 policy instruments are addressed, among which 7 relate to structural funds programmes. Basis for exchange of experience: Reciprocal improvement analysis and 8 study trips with peer-review of each partner’s practices. Video reportages for an effective dissemination towards other territories in Europe.Main expected results:At least 16 good practices identified. 8 targeted policy instruments improved. At least 27 staff members will transfer new capacities in their intervention fields. At least 8 involved stakeholders with increased skills and knowledge from exchange of experience. Expected 17 appearances in press and media, including at European level.
Within the framework of resource efficiency it is important to recycle and reusematerials, replace fossil fuel based products with bio-based alternatives and avoidthe use of toxic substances. New applications are being sought for locally grownbiomass. In the area of Groningen buildings need reinforcement to guarantee safetyfor its users, due to man-induced earthquakes. Plans are to combine the workneeded for reinforcement with the improvement of energy performance of thesebuildings. The idea is to use bio-based building materials, preferably grown andprocessed in the region.In this study it is investigated whether it is feasible to use Typha (a swap plant) as abasis for a bio-based insulation product. In order to start the activities necessary tofurther develop this idea into a commercial product and start a dedicated company,a number of important questions have to be answered in terms of feasibility. Thisstudy therefore aims at mapping economic, organisational and technical issues andassociated risks and possibilities. On the basis of these results a developmenttrajectory can be started to set up a dedicated supply chain with the appropriatepartners, research projects can be designed to develop the missing knowledge andthe required funding can be acquired.
