Quality systems in health care: A sociotechnical approach

In this paper, we explore a sociotechnical approach to construct quality systems as an alternative to the traditional, ISO orientated approach. A sociotechnical approach is characterised as bottom-up, incremental, information technology facilitated and indicator driven. Its purpose is to ground quality assurance in medical practice and to provide meaning to those directly involved (patients, health care providers and medical professionals). Meaning depends on information. According to contemporary theory of meaning, facts become information on quality if the structure of data represents the structure of the quality concept. The structure of the quality concept is exemplified by definitions of the quality of care, most of them comparing actual properties of care with requirements, expectations, standards or guidelines. So, raw data or measurements have to be compared with a normative frame of reference in order to become information on the quality of care. Quality indicators conceptualise this theory of meaning. Therefore, constructing quality systems by developing quality indicators is important for the meaning of quality assurance in health care. It makes a system to a quality system and suits a sociotechnical approach by grounding the formal structure of the system in a social reality

The Nine Steps of a Philosophical Walk

Since 2007, I conduct philosophical walks as individual consultations, teachings or Socratic group exercises. A philosophical walk is intended to make participants think, to deepen thoughts and to become conscious of oneself in relation to the surroundings by walking. It is a form of philosophical practice, facilitating dialogue so that a meaningful story can be obtained. Participants are encouraged to (i) walk in such a way that they obtain space for thoughts and thinking, (ii) conceptualize, (iii) identify a place related to a concept, (iv) question concepts, place and space, and (v) connect concepts with their experience. In this paper, I will describe the method of my philosophical walks and give an example: a philosophical walk at the campus of Nanjing University, China, in 2013. The aim is to provide readers a tool for conducting philosophical walks themselves and walk just like Lao-Tzu, Confucius, Socrates, Aristotle, Nietzsche and many other philosophers have done in order to philosophize and produce concepts related to life, person and place

Philosopher sur la mort

One of the founding fathers of philosophical practice, Pierre Hadot, defines such a practice as a spiritual exercise in learning how to read, write, live and die. In this paper, I want to focus on dying. How to philosophise about dying? I will approach this question from the point of view of a philosophical counsellor who meets the topic during the consultation, and I will give several examples of such consultations. I will approach the topic along the lines of the ancient Stoic tradition and distinguish the physics, logic and ethics of dying. The facts will limit and define the appropriate form (i.e. logic) and content (i.e. ethics) of the philosophising during a consultation. I will argue that we can and have to develop an attitude suiting our death. Philosophical counselling can help in developing such an attitude.Jedan je od osnivača filozofijske prakse, Pierre Hadot, odredio takvu praksu kao duhovnu vježbu učenja kako pisati, čitati, živjeti i umrijeti. U ovom se radu želim usmjeriti na umiranje. Kako filozofirati o smrti? Pristupit ću ovom pitanju sa stajališta filozofijskog savjetnika koji se s tim pitanjem susreće tijekom savjetovanja i dat ću nekoliko primjera takvog savjetovanja. Približit ću se temi u skladu s drevnom stoičkom tradicijom i razlikovati fiziku, logiku i etiku umiranja. Činjenice će ograničiti i odrediti prikladni oblik (logika) i sadržaj (etika) filozofiranja tijekom savjetovanja. Argumentirat ću da možemo i trebamo razviti stav prikladan našoj smrti. Filozofijsko savjetovanje može pomoći u razvoju takvog stava.Einer der Begründer der philosophischen Praxis, Pierre Hadot, definierte diese Praxis als eine spirituelle Übung, um zu lernen, wie man schreibt, liest, lebt und stirbt. In diesem Artikel möchte ich mich auf das Sterben konzentrieren. Wie lässt es sich über den Tod philosophieren? Ich gehe an diese Frage aus dem Blickwinkel eines philosophischen Beraters heran, der im Rahmen der Beratung auf diese Frage stößt, und nenne ein paar Beispiele für eine solche Beratung. Ich werde mich dem Thema in Anlehnung an die uralte stoische Tradition nähern und zwischen Physik, Logik und Ethik des Sterbens unterscheiden. Die Fakten werden die geeignete Form (Logik) und den Inhalt (Ethik) des Philosophierens im Laufe der Beratung einschränken und bestimmen. Ich werde argumentieren, dass wir eine Einstellung entwickeln können und sollten, die im Hinblick auf unseren Tod gebührend ist. Die philosophische Beratung kann mithelfen, eine solche Einstellung herauszubilden.L’un des fondateurs de la pratique philosophique, Pierre Hadot, a défini une telle pratique de la même manière qu’il a défini l’exercice spirituel d’apprendre à écrire, lire, vivre et mourir. Dans ce travail, je souhaite me consacrer à la mort. Comment philosopher sur la mort ? J’aborderai cette question à partir de la perspective du conseiller en philosophie qui est confronté à cette question lors des consultations et je donnerai quelques exemples de ce genre de consultations. Je me rapprocherai du thème en accord avec la tradition ancienne stoïque qui différencie la physique, la logique et l’éthique de la mort. Les faits délimiteront et détermineront la forme appropriée (logique) à adopter et le contenu (éthique) de l’acte de philosopher durant la consultation. Je soutiendrai que l’on peut et que l’on doit développer une attitude appropriée envers notre mort. Le conseil philosophique peut aider à développer une telle attitude

De betekenis van het begrip kwaliteit in de gezondheidszorg: Van intuïtie naar rationele reconstructie

Op verschillende gebieden is er in de laatste decennia van de Twintigste eeuw een sterk toegenomen aandacht voor kwaliteit. In het bedrijfsleven, het onderwijs, het milieu en de politiek wordt meer en meer belang gehecht aan een visie op kwaliteit, methoden en technieken om de kwaliteit te waarborgen, of een gericht kwaliteitsbeleid. De immer toenemende aandacht voor kwaliteit is een maatschappelijk verschijnsel waaraan de gezondheidszorg zich niet onttrekt. De afgelopen decennia is er dan ook een levendig debat over de kwaliteit van zorg gevoerd. Dit debat is onderwerp van het voorliggende proefschrift. In het eerste hoofdstuk worden probleem- en vraagstelling geformuleerd, alsmede opzet en uitwerking van het onderzoek uiteengezet. Begripsverwarring is de aanleiding om de vraag naar de betekenis van het begrip kwaliteit te stellen. We gaan vervolgens op zoek naar een criterium op basis waarvan beweringen of handelingen als uitdrukkingen van kwaliteit kunnen worden herkend. Daarbij wordt een wijsgerig analyse instrumentarium gehanteerd (deel J). Het onderzoeksmateriaal wordt gevormd door een aantal voorbeelden van betekenisverlening, te weten de ontwikkeling van de inhoud van het begrip kwaliteit (deel IJ) en de interpretatie van gegevens over gezondheidszorg in termen van kwaliteit (deel lIl). Analyse van de normatieve inhoud van deze voorbeelden leidt tot een specifiek inzicht in het gebruik van het begrip kwaliteit in de gezondheidszorg, zodanig dat daarmee aan uitgangspunten van de analytische filosofie, een van de belangrijkste wijsgerige stromingen in de Twintigste eeuw, tegemoet wordt gekomen (deel IV)

A Novel Time Series Approach to Bridge Coding Changes with a Consistent Solution Across Causes of Death

Revisions of the International Classification of Diseases (ICD) can lead to biases in cause-specific mortality levels and trends. We propose a novel time series approach to bridge ICD coding changes which provides a consistent solution across causes of death. Using a state space model with interventions, we performed time series analysis to cause-proportional mortality for ICD9 and ICD10 in the Netherlands (1979–2010), Canada (1979–2007) and Italy (1990–2007) on chapter level. A constraint was used to keep the sum of cause-specific interventions zero. Comparability ratios (CRs) were estimated and compared to existing bridge coding CRs for Italy and Canada. A significant ICD9 to ICD10 transition occurred among 13 cause of death groups in Italy, 7 in Canada and 3 in the Netherlands. Without the constraint, all-cause mortality after the classification change would be overestimated by 0.4 % (NL), 0.03 % (Canada) and 0.2 % (Italy). The time series CRs were in the same direction as the bridge coding CRs but deviated more from 1. A smooth corrected trend over the ICD-transition resulted from applying the time series approach. Comparing the time series CRs for Italy (2003), Canada (1999) and the Netherlands (1995) revealed interesting commonalities and differences. We demonstrated the importance of adding the constraint, the validity of our methodology and its advantages above earlier methods. Applying the method to more specific causes of death and integrating medical content to a larger extent is advocated

A novel time series approach to bridge coding changes with a consistent solution across causes of death

Revisions of the International Classification of Diseases (ICD) can lead to biases in cause-specific mortality levels and trends. We propose a novel time series approach to bridge ICD coding changes which provides a consistent solution across causes of death. Using a state space model with interventions, we performed time series analysis to cause-proportional mortality for ICD9 and ICD10 in the Netherlands (1979–2010), Canada (1979–2007) and Italy (1990–2007) on chapter level. A constraint was used to keep the sum of cause-specific interventions zero. Comparability ratios (CRs) were estimated and compared to existing bridge coding CRs for Italy and Canada. A significant ICD9 to ICD10 transition occurred among 13 cause of death groups in Italy, 7 in Canada and 3 in the Netherlands. Without the constraint, all-cause mortality after the classification change would be overestimated by 0.4 % (NL), 0.03 % (Canada) and 0.2 %(Italy).ThetimeseriesCRswereinthesamedirectionasthebridgecodingCRsbut deviated more from 1. A smooth corrected trend over the ICD-transition resulted from applying the time series approach. Comparing the time series CRs for Italy (2003), Canada (1999) and the Netherlands (1995) revealed interesting commonalities and dif- ferences. We demonstrated the importance of adding the constraint, the validity of our methodology and its advantages above earlier methods. Applying the method to more specific causes of death and integrating medical content to a larger extent is advocated

Hildegard of Bingen: Philosophical Life and Spirituality

Hildegard of Bingen (1098–1179) was a medieval mystic. From a young age, she had many colorful visions and became well known and influential not only in her own time but in ours as well. Her music reached the mellow house scene in the 1990s, reviving Hildegard’s spirituality for people today. In this paper, I will approach Hildegard as a philosophical practitioner and conduct an imaginary philosophical consultation. I will study her biography, listen to her words by some authentic text fragments and propose a spiritual exercise on her music in order not to just think about Hildegard of Bingen but to try and think like Hildegard of Bingen, in line with the principles of philosophical practice. This way, I will try to understand Hildegard in a practical way and not (just) annotate the regular (theoretical) interpretations of her life. I will distinguish three phases in her life as movements towards spirituality: (1) her relationship with the world, (2) her relationship with God, and (3) her relationship with herself as a spiritual being. I will argue that her life is an example of a philosophical life. Hildegard’s “not fitting in any place” (being átopos) and her development define such a life as a path towards an authentic self, attained by spirituality. The paper intends to contribute both to the understanding of philosophical consultations and to the understanding of Hildegard of Bingen