Teun Zuiderent-Jerak | Vrije Universiteit Amsterdam (original) (raw)
Books & Special Issues by Teun Zuiderent-Jerak
Book chapters by Teun Zuiderent-Jerak
Articles by Teun Zuiderent-Jerak
Health policy (Amsterdam, Netherlands), Jan 23, 2015
The Project on a Framework for Rating Evidence in Public Health (PRECEPT) is an international col... more The Project on a Framework for Rating Evidence in Public Health (PRECEPT) is an international collaboration of public health institutes and universities which has been funded by the European Centre for Disease Prevention and Control (ECDC) since 2012. Main objective is to define a framework for evaluating and grading evidence in the field of public health, with particular focus on infectious disease prevention and control. As part of the peer review process, an international expert meeting was held on 13-14 June 2013 in Berlin. Participants were members of the PRECEPT team and selected experts from national public health institutes, World Health Organization (WHO), and academic institutions. The aim of the meeting was to discuss the draft framework and its application to two examples from infectious disease prevention and control. This article introduces the draft PRECEPT framework and reports on the meeting, its structure, most relevant discussions and major conclusions.
In the medical sociological literature, 'standardization' and 'patient-centred care&#... more In the medical sociological literature, 'standardization' and 'patient-centred care' have been positioned as perfect conceptual opposites. In this study we explore what the specificities of this opposition are, what their limitations are, and in which sense a re- conceptualization of both concepts could lead to their pragmatic commensurability. We do this empirically by drawing upon an 'interventionist' research project where
Social Studies of Science, 2009
Health Expectations, 2013
BACKGROUND: Patient participation on both the individual and the collective level attracts broad ... more BACKGROUND: Patient participation on both the individual and the collective level attracts broad attention from policy makers and researchers. Participation is expected to make decision making more democratic and increase the quality of decisions, but empirical evidence for this remains wanting. OBJECTIVE: To study why problems arise in participation practice and to think critically about the consequence for future participation practices. We contribute to this discussion by looking at patient participation in guideline development. METHODS: Dutch guidelines (n = 62) were analysed using an extended version of the AGREE instrument. In addition, semi-structured interviews were conducted with actors involved in guideline development (n = 25). RESULTS: The guidelines analysed generally scored low on the item of patient participation. The interviews provided us with important information on why this is the case. Although some respondents point out the added value of participation, many report on difficulties in the participation practice. Patient experiences sit uncomfortably with the EBM structure of guideline development. Moreover, patients who develop epistemic credibility needed to participate in evidence-based guideline development lose credibility as representatives for 'true' patients. DISCUSSION AND CONCLUSIONS: We conclude that other options may increase the quality of care for patients by paying attention to their (individual) experiences. It will mean that patients are not present at every decision-making table in health care, which may produce a more elegant version of democratic patienthood; a version that neither produces tokenistic practices of direct participation nor that denies patients the chance to contribute to matters where this may be truly meaningful.
Social Science & Medicine - SOC SCI MED, 2009
The increasing focus on patient safety in the field of health policy is accompanied by research p... more The increasing focus on patient safety in the field of health policy is accompanied by research programs that articulate the role of the social sciences as one of contributing to enhancing safety in healthcare. Through these programs, new approaches to studying safety are facing a narrow definition of 'usefulness' in which researchers are to discover the factors that support or hamper the implementation of existing policy agendas. This is unfortunate since such claims for useful involvement in predefined policy agendas may undo one of the strongest assets of good social science research: the capacity to complexify the taken-for-granted conceptualizations of the object of study. As an alternative to this definition of 'usefulness', this article proposes a focus on multiple ontologies in the making when studying patient safety. Through such a focus, the role of social scientists becomes the involvement in refiguring the problem space of patient safety, the relations between research subjects and objects, and the existing policy agendas. This role gives medical sociologists the opportunity to focus on the question of which practices of 'effective care' are being enacted through different approaches for dealing with patient safety and what their consequences are for the care practices under study.
(Special issue: “Unpacking “Intervention” in Science and Technology Studies”. 227-237., 2007
Beleid en …, Jan 1, 2010
... Auteursinformatie. Teun Zuiderent-Jerak Teun Zuiderent-Jerak is universitair docent wetenscha... more ... Auteursinformatie. Teun Zuiderent-Jerak Teun Zuiderent-Jerak is universitair docent wetenschaps-en techniekonderzoek aan het instituut Beleid en Management Gezondheidszorg (iBMG) van de Erasmus Universiteit Rotterdam. ...
Science as …, Jan 1, 2007
bmg.eur.nl
In the medical sociological literature, 'standardization' and 'patient-centred care' have been po... more In the medical sociological literature, 'standardization' and 'patient-centred care' have been positioned as perfect conceptual opposites. In this study we explore what the specificities of this opposition are, what their limitations are, and in which sense a reconceptualization of both concepts could lead to their pragmatic commensurability.
Health Care Analysis, Jan 1, 2011
Health care organizations are constantly seeking ways to improve quality of care and one of the o... more Health care organizations are constantly seeking ways to improve quality of care and one of the often-posed solutions to deliver 'good care' is reflexivity. Several authors stress that enhancing the organizations' and caregivers' reflexivity allows for more situated, and therefore better care. Within quality improvement initiatives, devices that guarantee quality are also seen as key to the delivery of good care. These devices do not solely aim at standardizing work practices, but are also of importance in facilitating reflexivity. In this article, we study how quality improvement devices position the relationship between situated reflection and standardization of work processes. By exploring the work of Michel Callon, Michael Lynch, and Lucy Suchman on reflexivity in work practices, we study the development and introduction of the Care Living Plan. This device aimed to transform care organizations of older people from their orientation towards the system of care into organizations that take a client-centred approach. Our analysis of the construction of specific forms of reflexivity in quality devices indicates that the question of reflexivity does not need to be opposed to standardization and needs to be addressed not only at the level of where reflexivity is organizationally situated and who gets to do the reflecting, but also on the content of reflexivity, such as what are the issues that care workers can and cannot reflect upon. In this paper we point out the theoretical importance of a more detailed empirical study of the framing of reflexivity in care practices.
Paper presented at the 4S conference in Vancouver, Jan 1, 2006
Health Economics, Policy and …, Jan 1, 2011
The Dutch health system is seen as one in which conflicting demands–equity, quality and affordabi... more The Dutch health system is seen as one in which conflicting demands–equity, quality and affordability–have been relatively successfully met. A recent report by the Commonwealth Fund placed the Dutch health system first out of seven countries, ranking it high or highest ...
Discussions on the role of markets in healthcare easily lead to political and unfruitful polarize... more Discussions on the role of markets in healthcare easily lead to political and unfruitful polarized positions. Actors arguing in favour of markets as a solution for the quality/cost conundrum entrench themselves against others pointing out the risk of markets for the delivery and governance of healthcare. These binary options of more or less marketization preclude a more empirical analysis of how markets, as multiple arrangements, are constructed and what their consequences are for public values like affordability and quality. To empirically explore the relation between markets and public values in healthcare, in this paper we analyze the construction of a market for hospital care in the Netherlands, based on a system of diagnoserelated groups (DBCs), and the development of a market for long term care based on care-load packages (ZZPs). In these cases we address the intended result of care markets according to various policy actors, the visible and invisible work done by various actors to make markets work and the values enacted in market practices. We show that where policy aims within these markets focus on providing choice and increasing diversity of care institutions, the instruments of DBCs and ZZPs rather produce isomorphism and homogenization. Furthermore, the strong influence of financial instruments in shaping healthcare markets assume that cost and quality can both be strengthened while it in fact has a profound influence on how public values like quality get defined in practice. These translations between values pursued and outcomes produced indicate that conceptualizing the role of the state as defining public values that markets (have to) implement is problematic, as this removes crucial normative work in the shaping of our welfare states to the realm of the technical operationalization of markets. An alternative relation between state, market and society can be conceived once we accept that such values are shaped in practice and that the relationship between policy aims and policy consequences can never be fully captured through a logic of implementation. This then calls for an experimental role of the state: a state that sees market developments as experimental devices in which the aim is a good composition of public values. We propose this experimentation could for example focus on market developments that do not ascribe a privileged status to financial devices and price-mechanism, such as a market for the DBC A-segment, in which prices are not freely negotiable. Such experiments could allow competition to focus on other public values like quality and maintaining accessibility while at the same time function as learning laboratories for reconceiving the role between state, market and society.
Science, Technology & Human Values, Jan 1, 2010
... Hemophilia Care Teun Zuiderent-Jerak1 ... 1 Erasmus University Rotterdam Corresponding Author... more ... Hemophilia Care Teun Zuiderent-Jerak1 ... 1 Erasmus University Rotterdam Corresponding Author:Teun Zuiderent-Jerak, Institute of Health Policy and Management, Erasmus University Rotter-dam, PO Box 1783, 3000 DR Rotterdam, Netherlands Email: zuiderent@bmg.eur.nl ...
BMJ quality & …, Jan 1, 2011
ObjectiveTo explore whether differences between collaboratives with respect to type of topic, typ... more ObjectiveTo explore whether differences between collaboratives with respect to type of topic, type of targets, measures (systems) are also reflected in the degree of effectiveness.Study setting182 teams from long-term healthcare organisation developed improvement initiatives in seven quality-improvement collaboratives (QICs) focusing on patient safety and autonomy.Study designMultiple case before–after study.Data collection75 team leaders completed a written questionnaire at the end of each QIC on achievability and degree of challenge of targets and measurability of progress. Main outcome indicators were collaborative-specific measures (such as prevalence of pressure ulcers).Principal findingsThe degree of effectiveness and percentage of teams realising targets varied between collaboratives. Collaboratives also varied widely in perceived measurability (F=6.798 and p=0.000) and with respect to formulating achievable targets (F=6.566 and p=0.000). The Problem Behaviour collaborative scored significantly lower than all other collaboratives on both dimensions. The collaborative on Autonomy and control scored significantly lower on measurability than the other collaboratives. Topics for which there are best practices and evidence of effective interventions do not necessarily score higher on effectiveness, measurability, achievable and challenging targets.ConclusionsThe effectiveness of a QIC is associated with the efforts of programme managers to create conditions that provide insight into which changes in processes of care and in client outcomes have been made. Measurability is not an inherent property of the improvement topic. Rather, creating measurability and formulating challenging and achievable targets is one of the crucial tasks for programme managers of QICs.
Social Studies of Science, Jan 1, 2009
The social study of markets experiences challenging theoretical developments through Callon's wor... more The social study of markets experiences challenging theoretical developments through Callon's work on 'the performativity of economics'. This notion opens up the construction of laws of markets to many previously excluded actors. However, Callon's focus on the role of materialities in performing spaces of calculation and the role of economics in creating materialities easily leads to over enthusiasm for active engagement by social scientists. An interventionist research project on performing healthcare markets as 'value'-rather than 'cost-saving'-driven will show that markets can 'work' despite the absence of well functioning materialities. I therefore pose to sensitize such interventions for prevailing market regimes and market practices as 'forms of the probable'. This is highly consequential for the acting space of social scientists in performing markets.
Results of the first year …, Jan 1, 2008
8 care) are assessed in order to be able to assess whether sector specific characteristics mitiga... more 8 care) are assessed in order to be able to assess whether sector specific characteristics mitigate program effects.
Social Science & Medicine, Jan 1, 2009
The increasing focus on patient safety in the field of health policy is accompanied by research p... more The increasing focus on patient safety in the field of health policy is accompanied by research programs that articulate the role of the social sciences as one of contributing to enhancing safety in healthcare. Through these programs, new approaches to studying safety are facing a narrow definition of 'usefulness' in which researchers are to discover the factors that support or hamper the implementation of existing policy agendas. This is unfortunate since such claims for useful involvement in predefined policy agendas may undo one of the strongest assets of good social science research: the capacity to complexify the taken-for-granted conceptualizations of the object of study. As an alternative to this definition of 'usefulness', this article proposes a focus on multiple ontologies in the making when studying patient safety. Through such a focus, the role of social scientists becomes the involvement in refiguring the problem space of patient safety, the relations between research subjects and objects, and the existing policy agendas. This role gives medical sociologists the opportunity to focus on the question of which practices of 'effective care' are being enacted through different approaches for dealing with patient safety and what their consequences are for the care practices under study.
Health policy (Amsterdam, Netherlands), Jan 23, 2015
The Project on a Framework for Rating Evidence in Public Health (PRECEPT) is an international col... more The Project on a Framework for Rating Evidence in Public Health (PRECEPT) is an international collaboration of public health institutes and universities which has been funded by the European Centre for Disease Prevention and Control (ECDC) since 2012. Main objective is to define a framework for evaluating and grading evidence in the field of public health, with particular focus on infectious disease prevention and control. As part of the peer review process, an international expert meeting was held on 13-14 June 2013 in Berlin. Participants were members of the PRECEPT team and selected experts from national public health institutes, World Health Organization (WHO), and academic institutions. The aim of the meeting was to discuss the draft framework and its application to two examples from infectious disease prevention and control. This article introduces the draft PRECEPT framework and reports on the meeting, its structure, most relevant discussions and major conclusions.
In the medical sociological literature, 'standardization' and 'patient-centred care&#... more In the medical sociological literature, 'standardization' and 'patient-centred care' have been positioned as perfect conceptual opposites. In this study we explore what the specificities of this opposition are, what their limitations are, and in which sense a re- conceptualization of both concepts could lead to their pragmatic commensurability. We do this empirically by drawing upon an 'interventionist' research project where
Social Studies of Science, 2009
Health Expectations, 2013
BACKGROUND: Patient participation on both the individual and the collective level attracts broad ... more BACKGROUND: Patient participation on both the individual and the collective level attracts broad attention from policy makers and researchers. Participation is expected to make decision making more democratic and increase the quality of decisions, but empirical evidence for this remains wanting. OBJECTIVE: To study why problems arise in participation practice and to think critically about the consequence for future participation practices. We contribute to this discussion by looking at patient participation in guideline development. METHODS: Dutch guidelines (n = 62) were analysed using an extended version of the AGREE instrument. In addition, semi-structured interviews were conducted with actors involved in guideline development (n = 25). RESULTS: The guidelines analysed generally scored low on the item of patient participation. The interviews provided us with important information on why this is the case. Although some respondents point out the added value of participation, many report on difficulties in the participation practice. Patient experiences sit uncomfortably with the EBM structure of guideline development. Moreover, patients who develop epistemic credibility needed to participate in evidence-based guideline development lose credibility as representatives for 'true' patients. DISCUSSION AND CONCLUSIONS: We conclude that other options may increase the quality of care for patients by paying attention to their (individual) experiences. It will mean that patients are not present at every decision-making table in health care, which may produce a more elegant version of democratic patienthood; a version that neither produces tokenistic practices of direct participation nor that denies patients the chance to contribute to matters where this may be truly meaningful.
Social Science & Medicine - SOC SCI MED, 2009
The increasing focus on patient safety in the field of health policy is accompanied by research p... more The increasing focus on patient safety in the field of health policy is accompanied by research programs that articulate the role of the social sciences as one of contributing to enhancing safety in healthcare. Through these programs, new approaches to studying safety are facing a narrow definition of 'usefulness' in which researchers are to discover the factors that support or hamper the implementation of existing policy agendas. This is unfortunate since such claims for useful involvement in predefined policy agendas may undo one of the strongest assets of good social science research: the capacity to complexify the taken-for-granted conceptualizations of the object of study. As an alternative to this definition of 'usefulness', this article proposes a focus on multiple ontologies in the making when studying patient safety. Through such a focus, the role of social scientists becomes the involvement in refiguring the problem space of patient safety, the relations between research subjects and objects, and the existing policy agendas. This role gives medical sociologists the opportunity to focus on the question of which practices of 'effective care' are being enacted through different approaches for dealing with patient safety and what their consequences are for the care practices under study.
(Special issue: “Unpacking “Intervention” in Science and Technology Studies”. 227-237., 2007
Beleid en …, Jan 1, 2010
... Auteursinformatie. Teun Zuiderent-Jerak Teun Zuiderent-Jerak is universitair docent wetenscha... more ... Auteursinformatie. Teun Zuiderent-Jerak Teun Zuiderent-Jerak is universitair docent wetenschaps-en techniekonderzoek aan het instituut Beleid en Management Gezondheidszorg (iBMG) van de Erasmus Universiteit Rotterdam. ...
Science as …, Jan 1, 2007
bmg.eur.nl
In the medical sociological literature, 'standardization' and 'patient-centred care' have been po... more In the medical sociological literature, 'standardization' and 'patient-centred care' have been positioned as perfect conceptual opposites. In this study we explore what the specificities of this opposition are, what their limitations are, and in which sense a reconceptualization of both concepts could lead to their pragmatic commensurability.
Health Care Analysis, Jan 1, 2011
Health care organizations are constantly seeking ways to improve quality of care and one of the o... more Health care organizations are constantly seeking ways to improve quality of care and one of the often-posed solutions to deliver 'good care' is reflexivity. Several authors stress that enhancing the organizations' and caregivers' reflexivity allows for more situated, and therefore better care. Within quality improvement initiatives, devices that guarantee quality are also seen as key to the delivery of good care. These devices do not solely aim at standardizing work practices, but are also of importance in facilitating reflexivity. In this article, we study how quality improvement devices position the relationship between situated reflection and standardization of work processes. By exploring the work of Michel Callon, Michael Lynch, and Lucy Suchman on reflexivity in work practices, we study the development and introduction of the Care Living Plan. This device aimed to transform care organizations of older people from their orientation towards the system of care into organizations that take a client-centred approach. Our analysis of the construction of specific forms of reflexivity in quality devices indicates that the question of reflexivity does not need to be opposed to standardization and needs to be addressed not only at the level of where reflexivity is organizationally situated and who gets to do the reflecting, but also on the content of reflexivity, such as what are the issues that care workers can and cannot reflect upon. In this paper we point out the theoretical importance of a more detailed empirical study of the framing of reflexivity in care practices.
Paper presented at the 4S conference in Vancouver, Jan 1, 2006
Health Economics, Policy and …, Jan 1, 2011
The Dutch health system is seen as one in which conflicting demands–equity, quality and affordabi... more The Dutch health system is seen as one in which conflicting demands–equity, quality and affordability–have been relatively successfully met. A recent report by the Commonwealth Fund placed the Dutch health system first out of seven countries, ranking it high or highest ...
Discussions on the role of markets in healthcare easily lead to political and unfruitful polarize... more Discussions on the role of markets in healthcare easily lead to political and unfruitful polarized positions. Actors arguing in favour of markets as a solution for the quality/cost conundrum entrench themselves against others pointing out the risk of markets for the delivery and governance of healthcare. These binary options of more or less marketization preclude a more empirical analysis of how markets, as multiple arrangements, are constructed and what their consequences are for public values like affordability and quality. To empirically explore the relation between markets and public values in healthcare, in this paper we analyze the construction of a market for hospital care in the Netherlands, based on a system of diagnoserelated groups (DBCs), and the development of a market for long term care based on care-load packages (ZZPs). In these cases we address the intended result of care markets according to various policy actors, the visible and invisible work done by various actors to make markets work and the values enacted in market practices. We show that where policy aims within these markets focus on providing choice and increasing diversity of care institutions, the instruments of DBCs and ZZPs rather produce isomorphism and homogenization. Furthermore, the strong influence of financial instruments in shaping healthcare markets assume that cost and quality can both be strengthened while it in fact has a profound influence on how public values like quality get defined in practice. These translations between values pursued and outcomes produced indicate that conceptualizing the role of the state as defining public values that markets (have to) implement is problematic, as this removes crucial normative work in the shaping of our welfare states to the realm of the technical operationalization of markets. An alternative relation between state, market and society can be conceived once we accept that such values are shaped in practice and that the relationship between policy aims and policy consequences can never be fully captured through a logic of implementation. This then calls for an experimental role of the state: a state that sees market developments as experimental devices in which the aim is a good composition of public values. We propose this experimentation could for example focus on market developments that do not ascribe a privileged status to financial devices and price-mechanism, such as a market for the DBC A-segment, in which prices are not freely negotiable. Such experiments could allow competition to focus on other public values like quality and maintaining accessibility while at the same time function as learning laboratories for reconceiving the role between state, market and society.
Science, Technology & Human Values, Jan 1, 2010
... Hemophilia Care Teun Zuiderent-Jerak1 ... 1 Erasmus University Rotterdam Corresponding Author... more ... Hemophilia Care Teun Zuiderent-Jerak1 ... 1 Erasmus University Rotterdam Corresponding Author:Teun Zuiderent-Jerak, Institute of Health Policy and Management, Erasmus University Rotter-dam, PO Box 1783, 3000 DR Rotterdam, Netherlands Email: zuiderent@bmg.eur.nl ...
BMJ quality & …, Jan 1, 2011
ObjectiveTo explore whether differences between collaboratives with respect to type of topic, typ... more ObjectiveTo explore whether differences between collaboratives with respect to type of topic, type of targets, measures (systems) are also reflected in the degree of effectiveness.Study setting182 teams from long-term healthcare organisation developed improvement initiatives in seven quality-improvement collaboratives (QICs) focusing on patient safety and autonomy.Study designMultiple case before–after study.Data collection75 team leaders completed a written questionnaire at the end of each QIC on achievability and degree of challenge of targets and measurability of progress. Main outcome indicators were collaborative-specific measures (such as prevalence of pressure ulcers).Principal findingsThe degree of effectiveness and percentage of teams realising targets varied between collaboratives. Collaboratives also varied widely in perceived measurability (F=6.798 and p=0.000) and with respect to formulating achievable targets (F=6.566 and p=0.000). The Problem Behaviour collaborative scored significantly lower than all other collaboratives on both dimensions. The collaborative on Autonomy and control scored significantly lower on measurability than the other collaboratives. Topics for which there are best practices and evidence of effective interventions do not necessarily score higher on effectiveness, measurability, achievable and challenging targets.ConclusionsThe effectiveness of a QIC is associated with the efforts of programme managers to create conditions that provide insight into which changes in processes of care and in client outcomes have been made. Measurability is not an inherent property of the improvement topic. Rather, creating measurability and formulating challenging and achievable targets is one of the crucial tasks for programme managers of QICs.
Social Studies of Science, Jan 1, 2009
The social study of markets experiences challenging theoretical developments through Callon's wor... more The social study of markets experiences challenging theoretical developments through Callon's work on 'the performativity of economics'. This notion opens up the construction of laws of markets to many previously excluded actors. However, Callon's focus on the role of materialities in performing spaces of calculation and the role of economics in creating materialities easily leads to over enthusiasm for active engagement by social scientists. An interventionist research project on performing healthcare markets as 'value'-rather than 'cost-saving'-driven will show that markets can 'work' despite the absence of well functioning materialities. I therefore pose to sensitize such interventions for prevailing market regimes and market practices as 'forms of the probable'. This is highly consequential for the acting space of social scientists in performing markets.
Results of the first year …, Jan 1, 2008
8 care) are assessed in order to be able to assess whether sector specific characteristics mitiga... more 8 care) are assessed in order to be able to assess whether sector specific characteristics mitigate program effects.
Social Science & Medicine, Jan 1, 2009
The increasing focus on patient safety in the field of health policy is accompanied by research p... more The increasing focus on patient safety in the field of health policy is accompanied by research programs that articulate the role of the social sciences as one of contributing to enhancing safety in healthcare. Through these programs, new approaches to studying safety are facing a narrow definition of 'usefulness' in which researchers are to discover the factors that support or hamper the implementation of existing policy agendas. This is unfortunate since such claims for useful involvement in predefined policy agendas may undo one of the strongest assets of good social science research: the capacity to complexify the taken-for-granted conceptualizations of the object of study. As an alternative to this definition of 'usefulness', this article proposes a focus on multiple ontologies in the making when studying patient safety. Through such a focus, the role of social scientists becomes the involvement in refiguring the problem space of patient safety, the relations between research subjects and objects, and the existing policy agendas. This role gives medical sociologists the opportunity to focus on the question of which practices of 'effective care' are being enacted through different approaches for dealing with patient safety and what their consequences are for the care practices under study.
Science as Culture, Jan 1, 2007
Human-Computer …, Jan 1, 2003
Evidence & Policy: A Journal of Research, Debate and Practice, 2021
Background: Promotion of healthy behaviour is increasingly highlighted worldwide as a way to impr... more Background: Promotion of healthy behaviour is increasingly highlighted worldwide as a way to improve public health, prevent disease incidence, and decrease long-term costs for healthcare. In Sweden the National Board of Health and Welfare (NBHW) used the well-established format of national guidelines to facilitate a more widespread use of approaches for promotion of healthy lifestyle habits in healthcare.Aims and objectives: The aim of this case study was to explore the tensions between public health knowledge and the tenets of evidence-based medicine (EBM) in the creation of national guidelines on lifestyle habits.Methods: Based on data from interviews with guideline professionals and the collected documents of the national guidelines, we examine how NBHW negotiated the conflicts between public health knowledge and the format of national guidelines. An analytical model based on approaches from the sociology of standardisation is used to explore the ramifications of these negotiatio...
Action Research, 2022
The use of vlogs is promising in participatory action research (PAR) that aims to enhance the hea... more The use of vlogs is promising in participatory action research (PAR) that aims to enhance the health and well-being of citizens. Vlogs have the potential to reach a wide audience, transcending the local scale of PAR. This article aims to explore the value of co-creating vlogs by investigating two exploratory studies involving adolescents and women from disadvantaged neighbourhoods. We reflected on the co-creation of vlogs by community members and professionals. The results show that co-creating vlogs enabled meaningful engagement of citizens living in vulnerable circumstances and promoted shared learning. Community members who were not involved in the vlog creation were critical of the vlogs. However, watching the vlogs stimulated discussion and reflection. Therefore, dissemination of vlogs in a setting guided by a professional seems to have the potential to facilitate shared learning. Despite the popularity of vlogs, this study highlights the need to carefully consider the use of v...
Additional file 1:. Overview of codes. Overview of codes. A table showing overarching themes, sub... more Additional file 1:. Overview of codes. Overview of codes. A table showing overarching themes, subthemes and codes used in analysis
The subscription rates (2018) for access to the electronic journal is 40 euros for individual sub... more The subscription rates (2018) for access to the electronic journal is 40 euros for individual subscribers and 100 euros for institutional subscribers. Copyright Abstract The focus on excellence and quality assurance in the academy has spawned a signifi cant increase in the use of bibliometric measures in performance assessments of individual researchers. This article investigates the organizational consequences of this development through a gender lens. Based on a qualitative case study of evaluation and selection practices at a Danish university, a number of potential gender biases related to the use of bibliometric performance measures are identifi ed. By taking as default the research preferences, approaches and career paths of a succesful group of predominantly male scholars, evaluators using bibliometrics risk disadvantaging candidates diverging from the norm with implications for gender stratifi cation. Despite these potential biases, bibliometric measures come to function as ...
Global Public Health, 2022
Due to barriers in accessing and using healthcare services, a large proportion of the care homele... more Due to barriers in accessing and using healthcare services, a large proportion of the care homeless populations receive comes from informal providers. In Delhi, one such informal programme, called Street Medicine, provides healthcare outreach to homeless communities. Clinical practice guidelines are set to be developed for Street Medicine teams in India and form the object of this research. This study uses a social-ecological model to understand the barriers facing Street Medicine teams and the homeless as they attempt to address the latter's healthcare needs; coupling it with an analytical approach which situates these barriers as the issues within practice through which standardisation can take place. A qualitative inquiry, comprising three months of observations of Street Medicine outreach and interviews with over 30 key informants, was conducted between April and July 2018. The analysis identified novel barriers to addressing the needs of homeless individuals, which bely a deficit between the design of health and social care systems and the agency homeless individuals possess within this system to influence their health outcomes. These barriers - which include user-dependent technological inscriptions, collaborating with untargeted providers and the distinct health needs of homeless individuals - are the entry points for standardising, or opening up, Street Medicine practices .
Evidence-based decision-making in infectious diseases epidemiology, prevention and control: match... more Evidence-based decision-making in infectious diseases epidemiology, prevention and control: matching research questions to study designs and quality appraisal tools.
Teaching and learning in medicine, 2021
PHENOMENON In order to tackle the persistent rise of healthcare costs, physicians as "stewar... more PHENOMENON In order to tackle the persistent rise of healthcare costs, physicians as "stewards of scarce resources" could be effective change agents, extending cost containment efforts from national policy to the micro level. Current programs focus on educating future doctors to deliver "high-value, cost-conscious care" (HVCCC). Although the importance of HVCCC education is increasingly recognized, there is a lag in implementation. Whereas recent efforts generated effective interventions that promote HVCCC in a local context, gaps persist in the examination of system factors that underlie broader successful and lasting implementation in educational and healthcare practices. APPROACH We conducted a realist evaluation of a program focused on embedding HVCCC in postgraduate education by encouraging and supporting residents to set up "HVCCC projects" to promote HVCCC delivery. We interviewed 39 medical residents and 10 attending physicians involved in such ...
Disability & Society, 2021
Social Science & Medicine, 2021
Mass drug administration (MDA), used increasingly in malaria eradication efforts, involves admini... more Mass drug administration (MDA), used increasingly in malaria eradication efforts, involves administering medication to an entire target population regardless of individual-level disease status. This strategy requires high levels of coverage and compliance. Previous studies have assessed individual and structural factors affecting MDA coverage, but there is a need to better understand the influence and expressions of community dynamics and social structures, such as social cohesion. We conducted a social science study concurrent to an MDA clinical trial for malaria control in The Gambia; ethnographic research was conducted prior to, throughout, and between MDA implementation July-November 2018, January-March 2019, and July-November 2019. We assessed how social cohesion, as expressed by the trial population, affects trial coverage through an in-depth ethnographic analysis of two trial villages, using observations, interviews, and focus group discussions with community members who took the trial medication and those who did not. We found that the villages had unique expressions of social cohesion. This was reflected through community participation in the trial implementation and may have affected coverage and compliance. The village with low coverage expressed a form of social cohesion where members followed advice to participate through a hierarchal system but did not actively participate in the MDA or its implementation. The village with high coverage expressed social cohesion as more participatory: individuals took the directive to participate but contextualized the trial implementation to their needs and wants. We analyze these different expressions of social cohesion and the important differences they make for the coverage and compliance levels reached in the two different villages.
Annals of Emergency Medicine, 2017
Study objective: Policy makers increasingly regard centralization of emergency care as a useful m... more Study objective: Policy makers increasingly regard centralization of emergency care as a useful measure to improve quality. However, the clinical studies that are used to justify centralization, arguing that volume indicators are a good proxy for quality of care ('practice makes perfect'), have significant shortcomings. In the light of the introduction of a new centralization policy in the Netherlands, we show that the use of volume indicators in emergency care is problematic and does not do justice to the daily care provided in EDs. Methods: We conducted an ethnographic study in three EDs, a primary care facility and an ambulance call center in the Netherlands, including 109 hours of observation, over 30 ethnographic interviews with professionals and managers and five semi-structured follow-up interviews. Results: We argue that emergency care is a complex, multilayered practice and distinguish four different repertoires: acute and complex care, uncertain diagnostics, basic care and physical-social-mental care. A 'repertoire' entails a definition of what good care is, what professional skills are needed and how emergency care should be organized. Conclusion: The first repertoire of acute and complex care might benefit from centralization. The other three repertoires however equally deserve attention, but are made invisible in policies that focus on the first repertoire and extrapolate the idea of centralization to emergency care as a whole. Emergency care research and policies should take all repertoires into account and pay more attention to alternative measures and indicators beyond volume, e.g. patient satisfaction, professional expertise and collaboration between EDs and other facilities.
Engaging Science, Technology, and Society, 2016
In STS and Researcher Intervention Strategies, Brian Martin expresses his concern about the lack ... more In STS and Researcher Intervention Strategies, Brian Martin expresses his concern about the lack of strategic guidance STS offers for intervening in controversies in which actors are being marginalized. This is an interesting contrast with some classic critiques of Actor-Network Theory. Leigh Star famously argued that the over-emphasis of ANT on strategic action made it particularly poorly equipped to study heterogeneity––an analytical and political problem at once. I argue that guidance on intervention as research method should actively resist the urge to make intervention “strategic.” Considering intervention as a scholarly method for producing novel insights about our topics is diametrically opposed to considering intervention strategically, that is, as means to achieving predefined scholarly or normative goals. Drawing on previous, recent, and ongoing work on intervention as an equally non-strategic and non-detached method for developing new knowledge and new normativities, I ex...
Valuation Studies, 2015
Valuation studies addresses how values are made in valuation practices. A next - or rather previo... more Valuation studies addresses how values are made in valuation practices. A next - or rather previous - question becomes: what then makes valuation practices? Two oppositional replies are starting to dominate how that question can be answered: a more materially oriented focus on devices of valuation and a more sociologically inclined focus on ineffable valuation cultures. The debate between proponents of both approaches may easily turn into the kind of leapfrog debates that have dominated many previous discussions on whether culture or materiality would play a decisive role in driving history. This paper explores a less repetitive reply. It does so by analyzing the puzzling case of the demise of solidarity as a core value within the recent Dutch health care system of regulated competition. While “solidarity among the insured” was both a strong cultural value within the Dutch welfare-based health system, and a value that was built into market devices by health economists, within a fair...
Value Practices in the Life Sciences and Medicine, 2015
BMJ (Clinical research ed.), Jan 5, 2012
Over the past 20 years, evidence based medicine has had a substantial influence on clinical decis... more Over the past 20 years, evidence based medicine has had a substantial influence on clinical decision making throughout the developed world. It now underpins healthcare policy and the burgeoning industry of clinical guideline development. Two problems have resulted. Firstly, so called high level evidence is increasingly equated with strong recommendations; and secondly, evidence other than that derived from randomised controlled trials (RCTs) is seen as intrinsically less valuable or reliable. The concept of a hierarchy of evidence with RCTs at the top is deeply ingrained, despite Sackett and colleagues’ warning that evidence based medicine “is not restricted to randomised trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions.”1 They pointed out that RCTs and systematic reviews of RCTs will provide the most reliable evidence that a therapy will do more good than harm but acknowledged that “some questions about therapy do not require randomised trials (successful interventions for otherwise fatal conditions) or cannot wait for the trials to be conducted.” They also made clear that other questions, such as those about diagnostic tests and prognosis, can only be answered using other forms of evidence. In his 2008 Harveian oration, Michael Rawlins, chairman of the National Institute for Health and Clinical Excellence (NICE), elegantly analysed the strengths and …
BMC Medical Research Methodology, 2014
Human-Computer Interaction, 2003
In this commentary we reflect on the articles in this special issue on computer-mediated communic... more In this commentary we reflect on the articles in this special issue on computer-mediated communication (CMC) "about things." We do this from our perspective as researchers of the sociotechnical practices of developing, using, and evaluating information technologies for health care work. The relevance of the articles for a medical setting is evaluated, and we also indicate that the material embeddedness of CMC should be "unpacked." By focusing on the materiality of CMC in its working practice, we can see the otherwise invisible work that performs the ecology needed to "make a CMC work." Only when seeing these activities, and when realizing the risks of possible miscommunications, can we assess the desirability and feasibility of (telemedicine) CMC projects.
Health Care Analysis, 2015
Many Western countries have introduced market principles in healthcare. The newly introduced fina... more Many Western countries have introduced market principles in healthcare. The newly introduced financial instrument of ''care-intensity packages'' in the Dutch long-term care sector fit this development since they have some characteristics of a market device. However, policy makers and care providers positioned these instruments as explicitly not belonging to the general trend of marketisation in healthcare. Using a qualitative case study approach, we study the work that the two providers have done to fit these instruments to their organisations and how that enables and legitimatises market development. Both providers have done various types of work that could be classified as market development, including creating accounting systems suitable for markets, redefining public values in the context of markets, and starting commercial initiatives. Paradoxically, denying the existence of markets for long-term care and thus avoiding ideological debates on the marketisation of healthcare has made the use of market devices all the more likely. Making the market invisible seems to be an operative element in making the market work. Our findings suggest that Dutch long-term care reform points to the need to study the 'making' rather than the 'liberalising' of markets and that the study of healthcare markets should not be confined to those practices that explicitly label themselves as such.
Journal of Evaluation in Clinical Practice
In this paper we explore the potential of the developments around trans* care in Argentina to ima... more In this paper we explore the potential of the developments around trans* care in Argentina to imagine ways of doing difference together, both in that empirical case, as well as in the field of STS. For the sake of experiment, we want to bracket both the notion of transnational STS, as well as the idea of Latin American STS, in order to see what other generative moments might then appear
*Under review.