Management, structuur en cultuur : over het gebruik van organisatietheorieën in Breda

This book deals with organizational change in two different ways. One way is the historical description of several attempts to implement organizational change in one particular organization. That organization is the local civil service of Breda, a city in the southern part of the Netherlands with a history that goes back to the thirteenth century. This book covers the period of about thirty years from 1965 until 1996. In this period Breda had between 120.000 and 130.000 inhabitants and the civil service varied between 1200 and 1800 employees. The historical description focuses not only on the changes as such but also on the situation that existed when the attempts to change were undertaken (the environmental conditions). Main goal in this part of the study is to create a basis for an answer to the question: What factors or conditions were decisive for the claimed success of the changes that took place in 1992, where similar attempts at earlier dates seemed to have failed?The other way to treat organizational change in this study is induced by the question: Which organization theory or theories were used in the reorganizations described in the historical part? In order to obtain an answer to this question it was necessary to go into the character of organizations theory - which is thought to be a body of knowledge - and into the relevancy of organizations theory for practical use - which is thought to be small. A theoretical model for research is proposed in part 2. This model is based upon three major assumptions.guidelines and directions derived from organizations theory are insufficient to support organizational change in practice. This causes "changers" (those who initiate the desired change) to develop their own, "private" organization theory. An important part of this study is concerned with the reconstruction of those private theories.the private theories of changers are expressed one way or another in the documents used to realise the desired organizational change. In the addendum to this study quotes from the documents used are translated into "central concepts" of the changers. These central concepts are considered to be the framework of the private organization theories.organizational change is realised on one or more of three organizational dimensions: management, structure and culture. These dimensions are influenced strongly by environmental factors. Technologic possibilities available, the actual economic situation, prevailing social values and political and governmental conditions are considered to be the most important environmental conditions.The last section of part 2 (chapter 6) gives a short analysis of the specific character of Dutch local government and public service. In the local civil service the position of the town clerk in most cities has evolved to that of city manager in the period considered.The historical account in part 3 is subdivided into 5 chapters, the first being a short and global sketch of the history of the Netherlands since World War II in order to give a general background for the developments in Breda. Each of the other four give a description of one of the successive attempts to reorganize the civil service of Breda. In these chapters attention is also given to several problems of local policy that filled, for the most part, the political agenda.In part 4, the model developed in part 2 is applied on documents used to realise the desired changes described in part 3. The private theories for each period are reconstructed and compared to the general organization theory existing at the time. An important aspect of this analysis is that private and general organization theory and the desired and realised organization are described in terms of the three dimensions (management, structure and culture) of the proposed referential model in part 2. Each chapter of part 4 closes with a summary of conclusions with respect to that period.General conclusions derived from the whole study and a few suggestions for further research are gathered in part 5. The most important conclusions can be presented in the following statements.Writers on organizations agree to a large extent on the fact that environmental conditions have a bearing on the structure and functioning of organizations. Many of them even agree on the fact that organizations theories are influenced by the economic and social forces of their time. Nevertheless proposed organization theories hardly ever try to specify the situation in which they are developed.An explanation for this lack of attention may be found in the emphasis on comparative analysis of organizational research. In comparing organizations in a specific historical period, technological economic, social and political conditions can be viewed as the same for all organizations at the time. In that case those environmental conditions have no bearing on the results of the research and need not be made explicit.Organizational change can be considered as change on the three dimensions: management, structure and culture. In the case observed in this study the same set of rather simple rules was used for creating change in each of the four successive periods on the dimensions management: (replace sitting managers) and structure (enhance line-staff relations, put together what belongs together; though criteria to do this differ from period to period; and decrease span of control).The most important motive to introduce large scale changes in the case observed, therefore, seems to be the need to change organizational culture. In the case considered, the organization started with a power oriented culture. The first attempt on change tried to implement a role oriented culture but failed for the most part as a result of the existing power structure.The second attempt was accompanied by the wave of democratization of the late sixties and early seventies which undermined the power structure in the organization. The rather low pressure on reinforcing role relations, except for those belonging to project management, caused a major shift towards a task culture in which hardly anybody seemed to have authority. In this situation project management played a major role.In the third attempt, under pressure of the economic recession, legitimate authority, the political power of mayor and aldermen, reinforced a strong role culture. As a result of this change the existing structural elements of project management were practically eliminated. The position of the chief executive level (the town clerk) was weak.In the fourth attempt power shifted from the political to the chief executive level. This shift was enabled by the weak political position of mayor and aldermen and the authority bestowed on the town clerk.</p

Using routine clinical and administrative data to produce a dataset of attendances at Emergency Departments following self-harm

Background: Self-harm is a significant public health concern in the UK. This is reflected in the recent addition to the English Public Health Outcomes Framework of rates of attendance at Emergency Departments (EDs) following self-harm. However there is currently no source of data to measure this outcome. Routinely available data for inpatient admissions following self-harm miss the majority of cases presenting to services. Methods: Using the Clinical Record Interactive Search system, the electronic health records (EHRs) used in four EDs were linked to Hospital Episode Statistics to create a dataset of attendances following self-harm. This dataset was compared with an audit dataset of ED attendances created by manual searching of ED records. The proportion of total cases detected by each dataset was compared. Results: There were 1932 attendances detected by the EHR dataset and 1906 by the audit. The EHR and audit datasets detected 77 and 76 of all attendances respectively and both detected 82 of individual patients. There were no differences in terms of age, sex, ethnicity or marital status between those detected and those missed using the EHR method. Both datasets revealed more than double the number of self-harm incidents than could be identified from inpatient admission records. Conclusions: It was possible to use routinely collected EHR data to create a dataset of attendances at EDs following self-harm. The dataset detected the same proportion of attendances and individuals as the audit dataset, proved more comprehensive than the use of inpatient admission records, and did not show a systematic bias in those cases it missed. © 2015 Polling et al

Rates of self-harm presenting to general hospitals: a comparison of data from the Multicentre Study of Self-Harm in England and Hospital Episode Statistics

Objective: Rates of hospital presentation for self-harm in England were compared using different national and local data sources. Design: The study was descriptive and compared bespoke data collection methods for recording self-harm presentations to hospital with routinely collected hospital data. Setting: Local area data on self-harm from the 3 centres of the Multicentre Study of Self-harm in England (Oxford, Manchester and Derby) were used along with national and local routinely collected data on self-harm admissions and emergency department attendances from Hospital Episode Statistics (HES). Primary outcome: Rate ratios were calculated to compare rates of self-harm generated using different data sources nationally and locally (between 2010 and 2012) and rates of hospital presentations for self-harm were plotted over time (between 2003 and 2012), based on different data sources. Results The total number of self-harm episodes between 2010 and 2012 was 13 547 based on Multicentre Study data, 9600 based on HES emergency department data and 8096 based on HES admission data. Nationally, routine HES data underestimated overall rates of self-harm by approximately 60% compared with rates based on Multicentre Study data (rate ratio for HES emergency department data, 0.41 (95% CI 0.35 to 0.49); rate ratio for HES admission data, 0.42 (95% CI 0.36 to 0.49)). Direct local area comparisons confirmed an overall underascertainment in the HES data, although the difference varied between centres. There was a general increase in self-harm over time according to HES data which contrasted with a fall and then a rise in the Multicentre Study data. Conclusions: There was a consistent underestimation of presentations for self-harm recorded by HES emergency department data, and fluctuations in year-on-year figures. HES admission data appeared more reliable but missed non-admitted episodes. Routinely collected data may miss important trends in self-harm and cannot be used in isolation as the basis for a robust national indicator of self-harm

The impact of computer use on myopia development in childhood

Environmental factors are important in the development of myopia. There is still limited evidence as to whether computer use is a risk factor. The aim of this study is to investigate the association between computer use and myopia in the context of other near work activities. Within the birth cohort study Generation R, we studied 5074 children born in Rotterdam between 2002 and 2006. Refractive error and axial length was measured at ages 6 and 9. Information on computer use and outdoor exposure was obtained at age 3, 6 and 9 years using a questionnaire, and reading time and reading distance were assessed at age 9 years. Myopia prevalence (spherical equivalent ≤–0.5 dioptre) was 11.5% at 9 years. Mean computer use was associated with myopia at age 9 (OR = 1.005, 95% CI = 1.001–1.009), as was reading time and reading distance (OR = 1.031; 95% CI = 1.007–1.055 (5–10 h/wk); OR = 1.113; 95% CI = 1.073–1.155 (>10 h/wk) and OR = 1.072; 95% CI = 1.048–1.097 respectively). The combined effect of near work (computer use, reading time and reading distance) showed an increased odds ratio for myopia at age 9 (OR = 1.072; 95% CI = 1.047–1.098), while outdoor exposure showed a decreased odds ratio (OR = 0.996; 95% CI = 0.994–0.999) and the interaction term was significant (P = 0.036). From our results, we can conclude that within our sample of children, increased computer use is associated with myopia development. The effect of combined near work was decreased by outdoor exposure. The risks of digital devices on myopia and the protection by outdoor exposure should become widely known. Public campaigns are warranted

Use of ‘acute behavioural disturbance’ in mental health records: differences over time and by ethnicity in a London NHS mental health Trust

Background Acute behavioural disturbance (ABD) is a controversial descriptor for presentations of severe agitation, aggression and physiological compromise. Aims To characterise the use of ABD-related terms in the electronic record of a large UK provider of mental health services during 2006–2021. Method The free text of all records relating to patient contacts with acute assessment mental health teams during 2006–2021 were searched for references to ABD. Identified text was coded for context of use and presence of clinical features of ABD described in the literature. Poisson regression was used to analyse differences in rates of use over time and between demographic groups. Results Mentions of ABD increased by an average of 1.12 (95% confidence interval (CI), 1.08–1.17) per year, with the greatest increase from 2019 to 2021. Black people were more than twice as likely as White people to have reference to ABD included in their assessments (rate: 2.4/1000 (95% CI 1.8–3.1) in Black people compared with 1.0/1000 (95% CI 0.8–1.3) in White people). The clinical characteristics in notes describing a current presentation of ABD rarely corresponded to those included in UK medical guidelines on ABD. Conclusions The term ABD in mental health notes appears to often, but not exclusively, be a synonym for severe agitation and conveys little meaning beyond this. However, the term's connection to a literature emphasising the high risk of physical health collapse and need for urgent treatment means that its disproportionate use in Black people may contribute to existing racial inequalities in the use of coercive measures during crisis presentations

Myopia progression from wearing first glasses to adult age: The DREAM Study

Purpose: Data on myopia progression during its entire course are scarce. The aim of this study is to investigate myopia progression in Europeans as a function of age and degree of myopia from first prescription to final refractive error. Methods: The Drentse Refractive Error and Myopia Study assessed data from a branch of opticians in the Netherlands from 1985 onwards in a retrospective study. First pair of glasses prescribed was defined as a spherical equivalent of refraction (SER) ≤-0.5 D to ≥-3.0 D. Subjects with prescriptions at an interval of at least 1 year were included in the analysis. Results: A total of 2555 persons (57.3% female) met the inclusion criteria. Those with first prescription before the age of 10 years showed the strongest progression (-0.50 D; IQR: -0.75 to -0.19) and a significantly (p<0.001) more negative median final SER (-4.48 D; IQR: -5.37 to -3.42). All children who developed SER ≤-3 D at 10 years were highly myopic (SER ≤-6D) as adults, children who had SER between -1.5 D and -3 D at 10 years had 46.0% risk of high myopia, and children with SER between -0.5 D and -1.5 D had 32.6% risk of high myopia. Myopia progression diminished with age; all refractive categories stabilised after age 15 years except for SER ≤-5 D who progressed up to -0.25 D annually until age 21 years. Conclusion: Our trajectories of the natural course of myopia progression may serve as a guide for myopia management in European children. SER at 10 years is an important prognostic indicator and will help determine treatment intensity

Detection of visual field defects using Eye Movement Pediatric Perimetry in children with intracranial lesions:feasibility and applicability

The study aimed at evaluating the feasibility of Eye Movement Pediatric Perimetry (EMPP) among children in detecting Visual Field Defects (VFDs) associated with Intracranial Lesions (IL). Healthy controls (n = 35) and patients diagnosed with IL (n = 19) underwent a comprehensive clinical evaluation followed by a Goldmann Visual Field (GVF) and a customised EMPP protocol. During EMPP, all the participants were encouraged to fixate on a central target and initiate Saccadic Eye Movement (SEM) responses towards randomly appearing peripheral stimuli. The SEM responses were recorded using an eye-tracking device and further inspected to calculate Performance Scores (PS), Saccadic Reaction Times (SRTs), and an EMPP Index (EMPI). The mean age (years) of the controls and cases were 7.3 (SD: 1.5) and 9.4 (SD: 2.4) respectively. Among the controls, the older children (≥7 years) showed statistically significantly faster SRTs (p = 0.008) compared to the younger group. The binocular EMPP measurements compared between the controls and the cases revealed no statistically significant differences in PS (p = 0.34) and SRT (p = 0.51). EMPP failed in 4 children because of data loss or unacceptably poor PS whereas GVF failed in 7 children due to unreliable subjective responses. Of the 16 reports, with regard to the central 30-degree VF, 63% of the outputs obtained from both methods were comparable. EMPP is a reliable method to estimate and characterise the central 30-degree VF in greater detail in children with IL. EMPP can supplement the conventional methods, especially in those children who fail to complete a long duration GVF test