De ranglijst is een slechte raadgever

Ziekenhuisranglijsten kunnen reputaties maken en breken. De waarde ervan blijkt echter zeer relatief. Ziekenhuizen moeten zich dus niet gek laten maken en kunnen hun energie beter steken in een goed intern kwaliteitssysteem

Working with layers: The governance and regulation of healthcare quality in an institutionally layered system

Institutional arrangements used to steer public policies have increasingly become layered. Inspired by the literature on institutional layering and institutional work, this paper aims to make a contribution to our understanding of institutional layering. We do so by studying an interesting case of layering: the Dutch hospital sector. We focus on the actors responsible for the internal governance (Board of Directors and Supervisory Boards) and the external regulation (the Healthcare Inspectorate) of hospitals. In the paper, we explore the institutional work of these actors, more specifically how institutional work results from and is influenced by institutional layering and how this in turn influences the institutional makeup of both healthcare organizations and their institutional context. Our approach allowed us to see that layering changes the activities of actors in the public sector, can be used to strengthen one’s position but also presents actors with new struggles, which they in turn can try to overcome by relating and using the institutionally layered context. Layering and institutional work are therefore in continuous interaction. Combining institutional layering with a focus on the lived experiences of actors and their institutional work makes it possible to move into the layered arrangement and better understand its consequences

Ethical Dilemmas of Participation of Service Users With Serious Mental Illness: A Thematic Synthesis

Mental health professionals are expected to stimulate the participation of service users with serious mental illness. This not only changes what is expected from service users and professionals, it also changes the values underlying their relationship. The value of autonomy becomes more important as a result. This raises potential ethical dilemmas. This paper reports the findings of a thematic synthesis of 28 papers on the views of service users, professionals and family members on the care relationship in inpatient, outpatient and community services for people with serious mental illness. It puts forward various perspectives on participation of service users, foregrounding differing values, which in turn can lead to ethical dilemmas for professionals. The key implications for mental health professionals and future research are discussed

Ethical Dilemmas of Participation of Service Users With Serious Mental Illness: A Thematic Synthesis

Mental health professionals are expected to stimulate the participation of service users with serious mental illness. This not only changes what is expected from service users and professionals, it also changes the values underlying their relationship. The value of autonomy becomes more important as a result. This raises potential ethical dilemmas. This paper reports the findings of a thematic synthesis of 28 papers on the views of service users, professionals and family members on the care relationship in inpatient, outpatient and community services for people with serious mental illness. It puts forward various perspectives on participation of service users, foregrounding differing values, which in turn can lead to ethical dilemmas for professionals. The key implications for mental health professionals and future research are discussed

Tackling the problem of regulatory pressure in Dutch elderly care

Regulatory pressure is widely recognized as a problem in healthcare. At first sight the solution seems simple: discard rules and give caregivers more resources to provide personalize

A host-parasite catalogue of the haematozoa of the sub-Saharan birds

The prevalence of avian haematozoa in 826 species of birds representing 73 families of sub-Saharan birds as recorded in the literature or in the files of the International Reference Centre for Avian Haematozoa and the Veterinary Research Institute is presented. The most commonly occurring blood parasites were members of the genus Haemoproteus which were represented by 63 species which occurred in 19,1% of the sample. Twenty-five species of Leucocytozoon were recorded in 8,3% of the birds and represented the second most frequently encountered group of haematozoa. Species of Plasmodium, Trypanosoma, and filarioids (as microfilariae) occurred in 3,5%, 2,5% and 2,8% respectively of the birds sampled; species of Aegyptianella, Atoxoplasma, Babesia and Hepatozoon were infrequently seen. An annotated list of the birds examined for haematozoa is presented and brief descriptions of the species of Haemoproteus and Leucocytozoon in birds of the sub-Saharan zone are included.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat XI Pro was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.Foundation for Research Development. Natural Sciences and Engineering Research Council of Canada.mn201

Non-stationary Rayleigh-Taylor instability in supernovae ejecta

The Rayleigh-Taylor instability plays an important role in the dynamics of several astronomical objects, in particular, in supernovae (SN) evolution. In this paper we develop an analytical approach to study the stability analysis of spherical expansion of the SN ejecta by using a special transformation in the co-moving coordinate frame. We first study a non-stationary spherical expansion of a gas shell under the pressure of a central source. Then we analyze its stability with respect to a no radial, non spherically symmetric perturbation of the of the shell. We consider the case where the polytropic constant of the SN shell is $\gamma=5/3$ and we examine the evolution of a arbitrary shell perturbation. The dispersion relation is derived. The growth rate of the perturbation is found and its temporal and spatial evolution is discussed. The stability domain depends on the ejecta shell thickness, its acceleration, and the perturbation wavelength.Comment: 16 page

Persoonsgerichte zorg, regeldruk en regelruimte: van regelreflex naar spiegelreflex

Regeldruk in de zorg is een breed gedeelde ergernis die verbonden is aan waardenconflicten. Dit komt doordat regels vaak een te beperkte invulling kennen van kwaliteit van zorg en daarmee sturen op de verkeerde dingen. Op basis van ons onderzoek naar regeldruk en regelruimte in de ouderenzorg pleiten we voor een verschuiving van een regelreflex naar een spiegelreflex. Om regeldruk op te lossen wordt vaak gepleit voor het schrappen van regels. Maar er moet ook gezocht worden naar passende regels. Hier is blijvende reflectie op en discussie over kwaliteit van zorg door verschillende actoren voor nodig. Een dergelijke spiegelreflex draagt bij aan het herkoppelen van het werk van verschillende actoren die actief zijn op verschillende niveaus in de zorg, waaronder zorgverleners, managers en externe partijen zoals toezichthouders