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Abstract Background In the Netherlands, local authorities are required by law to develop local health memoranda, based on epidemiological analyses. The purpose of this study was to assess the actual use of these epidemiological reports by municipal health officials and associated factors that affect this use. Method Based on a conceptual framework, we designed a questionnaire in which we operationalized instrumental, conceptual, and symbolic use, the interaction between researchers and local health officials, and four clusters of barriers in this interaction process. We conducted an internet survey among 155 Dutch local health officials representing 35% of all Dutch municipalities. By means of multiple regression analyses, we gained insight into the related factors for each of the three types of research utilization. Results The results show that local health officials use epidemiological research more often in a conceptual than an instrumental or symbolic way. This can be explained by the complexity of the local policy process which is often linked to policies in other areas, and the various policy actors involved. Conceptual use was statistically associated with a presentation given by the epidemiologist during the policy process, the presence of obstructions regarding the report's accessibility, and the local official's personal belief systems and interests originating from different professional values and responsibilities. Instrumental and symbolic use increased with the involvement of local officials in the research process. Conclusions The results of this study provide a partial solution to understanding and influencing research utilization. The quantitative approach underpins earlier qualitative findings on this topic. The outcomes suggest that RPHS epidemiologists can use different strategies to improve research utilization. 'Blurring the boundaries', and the enhancement of interfaces between epidemiologists and local health officials, like direct interactions into each other's work processes, is expected to create better possibilities for optimizing research use.

Abstract Background In the Netherlands municipalities are legally required to draw up a Local Health Policy Memorandum every four years. This policy memorandum should be based on (local) epidemiological research as performed by the Regional Health Services. However, it is largely unknown if and in what way epidemiological research is used during local policy development. As part of a larger study on knowledge utilization at the local level in The Netherlands, an analytical framework on the use of epidemiological research in local health policy development in the Netherlands is presented here. Method Based on a literature search and a short inventory on experiences from Regional Health Services, we made a description of existing research utilization models and concepts about research utilization. Subsequently we mapped different barriers in research transmission. Results The interaction model is regarded as the main explanatory model. It acknowledges the interactive and incremental nature of policy development, which takes place in a context and includes diversity within the groups of researchers and policymakers. This fits well in the dynamic and complex setting of local Dutch health policy. For the conceptual framework we propose a network approach, in which we "extend" the interaction model. We not only focus on the one-to-one relation between an individual researcher and policymaker but include interactions between several actors participating in the research and policy process. In this model interaction between actors in the research and the policy network is expected to improve research utilization. Interaction can obstruct or promote four clusters of barriers between research and policy: expectations, transfer issues, acceptance, and interpretation. These elements of interactions and barriers provide an actual explanation of research utilization. Research utilization itself can be measured on the individual level of actors and on a policy process level. Conclusion The developed framework has added value on existing models on research utilization because it emphasizes on the 'logic' of the context of the research and policy networks. The framework will contribute to a better understanding of the impact of epidemiological research in local health policy development, however further operationalisation of the concepts mentioned in the framework remains necessary.

A comprehensive report has been prepared on the state of public health and healthcare in the Midden-Holland region of the Netherlands. This study describes the development of the report and the mechanisms behind public health knowledge utilisation by three groups of health policy actors: local authorities, public health professionals and regional care providers. The processes are studied in various qualitative ways. The mechanisms explaining the use of the report were found to be complex and different for each group of policy actors. Interaction between researchers and users is not the only factor that explains usage, but rather serves as an intermediate factor.

This study explores how actors deal with normative complexity in the design and implementation of practices of preventative care. Previous studies have identified conflicting (e)valuations of prevention within health care at large, but little empirical research describes how these conflicts are resolved in day‐to‐day interactions. Zooming in on the work of a single actor, our ethnographic study describes a Dutch psychiatrist developing a novel type of hospital bed that provides preventative psychiatric care for women in the post‐partum period. Drawing on pragmatic sociology of justification, we construe 'beds'—and the time, people and resources they represent—as points of convergence between conflicting valuations of care. The results show that embedded modes of valuation in a curative hospital setting generate significant normative complexity during implementation. We identify three main strategies through which normative complexity is managed: (a) translating between different modes of valuing prevention, (b) compromising in (material) design of care beds and (c) transcending embedded valuations through moral appeals. By showing the normative complexity of prevention in practice, our study highlights the need for a diverse and situated accounting for preventative care. [ABSTRACT FROM AUTHOR]

Dossier: In this feature authors discuss recent research findings that are of interest to readers of Beleid en Maatschappij. [ABSTRACT FROM AUTHOR]

Towards new dividing lines on the Dutch labour market? A plea for policy feasibility: Recent developments on the Dutch labour market raise questions about the emergence of new social dividing lines. In this paper we discuss two cases. Both address labour market disadvantages which can easily deepen and sharpen with unchanged policies. The first case shows that there are groups that are less able to respond to the defined trends in the labour market due to a lack of education or disabilities. In the second case we focus on the question of sustainable employability as such that creates dividing lines. A first conclusion from our contribution is that a thorough analysis of existing dividing lines in the labour market is crucial for effective policy, but that knowledge about deepening old and creating new dividing lines is at least as relevant. A second conclusion is that the outlined assumptions in policies around self-reliance of, for example, people with a disability or the possibilities of employers to realize sheltered work and to focus on retraining, for example outside working hours, are not always realistic. Much more will have to be done to match the real possibilities of people and organizations to achieve this. Financial, but also organizational and personal. The motivations and behaviors of employees, employers and educational authorities appear to be very relevant explanatory factors in practice, which are often not sufficiently taken into account. Recent experiences with the Participation Act and lifelong learning show us that. More interaction is needed in the coming years between research, policy and the practice of the labour market. [ABSTRACT FROM AUTHOR]

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Co-production in healthcare is receiving increasing attention; however, insight into the process of co-production is scarce. This article explores why hospitals involve patients and staff in co-production activities and hospitals’ experiences with co-production in practice. A qualitative study with semi-structured interviews (N = 27), observations (70 hours) and document analysis was conducted in five Dutch hospitals, which involved patients and staff in order to improve services. The results show that hospitals have different motives to involve patients and staff and have adapted existing methods to involve patients. Interestingly, areas of improvement proposed by patients were often already known. However, the process of co-production did contribute to quality improvement in other ways. The process of co-production stimulated hospitals’ thinking about how to realize quality improvements. Quality improvements were facilitated by this process as seeing patients and hearing their experiences created a sense of urgency among staff to act on the improvement issues raised. Moreover, the experiences served to legitimatize improvements to higher management bodies. Points for practitioners Different participation methods can bring patients’ experiences with healthcare services to the fore, which can be used for quality improvement. Our study shows that adapting existing methods to local hospital resources is likely to be beneficial for co-production processes within a given context. However, adapting and tailoring also poses risks. Tailoring activities, such as using criteria to select patients, influence what is considered to be legitimate patient input. In addition, as the co-production process is important, the method should consist of an organized trajectory in which patients and staff are involved and personal experiences are presented. Therefore, project teams need to critically reflect on the consequences of adaptations and tailoring actions, and their desirability, when carrying out quality improvement projects. [ABSTRACT FROM AUTHOR]

Within the complex context of the Dutch health care system, the Ministry of Health introduced a policy that shows parallels with pay-for-performance (P4P). It enabled hospital boards to differentiate between physicians’ individual wages. This study addresses the following question: What effects did this P4P instrument have on the relationship between hospital boards and physicians? We conclude that it had no positive effects on the relationship but did put it under a considerable degree of stress. Furthermore, its introduction - isolated to the market sphere only - lacked alignment with other spheres, designated as a “value gap.” This study adds empirical findings that P4P leads to inappropriate behavior and should be accompanied by proper side policies. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to improve the general operationalization of an “active patient,” by examining the specific activities and skills expected of active patients. Design/methodology/approach – Expected activities and necessary skills were studied through a qualitative case study into the development and use of an assistive technology (i.e. web site) aimed at stimulating active patient-ship. Interviews, observations and document analysis were used to capture and explore designers’ inscribing practices and their consequences regarding expected competences and activities of patients using the web site. Findings – Designers inscribed two “co-design roles” that active patients were expected to perform on the web site (co-designing their own healthcare and co-designing the healthcare of peers), for which at least eight different competencies were needed. The absence of skills or facilities to apply these skills resulted in incomplete use, a different use than intended by designers and non-use of the web site. Practical implications – Technological choices and inscribing processes determine who is able or facilitated to become active and who is not. Due to inscribed co-design roles, it also influences the extent to which already active peers are able to perform health-related activities. Different users with different conditions should be taken into account in the design as specific group characteristics can influence level of individual activity. Originality/value – This study is, as far as the authors know, the first that examines the “active patient” concept by studying an assistive technology and using scripting literature, resulting in an improved understanding of what it means to become “active” in terms of skills and activities. [ABSTRACT FROM AUTHOR]

Organizational and professional logics are often viewed as intrinsically conflicting. Organizational influences either encroach on professional work or professionals resist change and evade organizational rules. Increasingly however, this dualistic view is supplemented with the perspective of organized professionalism, which focuses on the negotiated and reciprocal relationship between organizational and professional logics. In this perspective, professionals increasingly engage in new organizational issues and incorporate those into their professional work. We build on these insights, but take the debate on organized professionalism one step further. Using the sociological concept of articulation work, we show that organizational tasks are not always ‘new’, but can be inherent to professionalism. In a study of Dutch neighbourhood nurses (NNs), we find three types of articulation work: intraprofessional, interprofessional, and lay articulation work. NNs perform articulation work to provide and organize care at the same time. They integrate taylorized home care services, coordinate the work of different professionals, and stimulate informal care. We conclude that articulation work traditionally lies at the heart of professionalism, but is not static and acquires new meaning because of changing organizational conditions and policy reforms. [ABSTRACT FROM AUTHOR]

The call for 'evidence-based health policy' in the Netherlands has to date been accommodated by the consensual policy tradition in this country and by the institutionalised arrangements for research funding, researcher career development and research accountability systems. The aim of this paper is to describe and explain from a sociological perspective how these arrangements for two-way research--policy interactions enable the co-production of 'useable knowledge' for 'doable problems' in health policy making. We conclude that many arrangements function as boundary objects that allow for mediation between research and policy. This mediation occurs via both frontstage and backstage processes. The backstage processes are an essential precondition for the co-production of acceptable evidence, policy advice and policy in the frontstage. However, as a result of the increasing emphasis on evidence-based policy, and an accompanying instrumentalisation of research use in the policy process, some of the characteristic, and until now productive, elements of the Dutch system are threatened. [ABSTRACT FROM AUTHOR]

The term “third sector” is increasingly used, but it is also increasingly difficult to define. It is characterized by fragmentation, fuzziness, and constant change. Furthermore, the bordering domains of community, market, and state are equally difficult to define and are becoming more blurred. One may have to accept that hybridity and change are permanent features of the organizations and arrangements involved. They could be classified not with reference to the structural characteristics of abstract domains but on the basis of how they cope with conditions of hybridity and change. The search for a valid empirical definition of the third sector, however modestly ambitious, must focus on the fringes of the domain where the “hard cases” can be found—the phenomena that are most difficult to identify and therefore most likely to reveal what is essential to the different domains. [ABSTRACT FROM AUTHOR]

One element of recent welfare state reform has been the introduction of market coordination in the implementation of social policy. The authors of this article have conducted a comparative study of social security, health care and housing policy implementation in the Netherlands, focusing on the conditions necessary for an effective mechanism of competition. The most important condition is that clients should be able to switch between providers without difficulty. Evidence shows that the providers in these fields of social policy engage in activities that undermine the potential for future competition. While this is not uncommon in itself, the new markets in social policy appear to be particularly vulnerable to such activities. This can be explained on the basis of two variables: (1) the institutional characteristics of the policy fields as they existed before the introduction of market coordination, and (2) the characteristics of the products that providers distribute. The combination of path dependency and product characteristics strengthens efforts to reduce competition. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To explore patients' experiences with online health communities in which both physicians and patients participate (i.e. patient-to-doctor or 'P2D' communities). METHODS: A qualitative content analysis was conducted, based on observations in five P2D communities ranging from 8 to 21 months, and semi-structured interviews (N=17) with patients. RESULTS: Patients consider information from physicians and peers as two distinct sources, value both sources differently and appreciate accessing both in the same web space. According to respondents, physicians can provide 'reliable' and evidence-based information, while patients add experience-based information. Patients use this information for multiple purposes, including being informed about scientific research and personal reflection. CONCLUSION: Patients find P2D communities beneficial because they help patients to collect information from both medical experts and experiential experts in one place. PRACTICE IMPLICATIONS: Patients use P2D communities to perform medical, emotional and lifestyle activities. The presence of physicians in P2D communities may inadvertently suggest that the quality of information used for the activities, is controlled. When information is not officially being checked, this should be stated explicitly on the website and supplemented with a statement that information is only indicative and that patients should at all times contact their own physicians. [ABSTRACT FROM AUTHOR]