About
100
Publications
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Introduction
Additional affiliations
August 1999 - March 2005
March 2005 - June 2021
Position
- Professor (Associate)
Description
- Trained as a nurse and health policy scientist, Iris is an associate professor at the Erasmus University Rotterdam. She studies practices of healthcare transition, using a practice-based research approach. She is interested in how local practices (new technologies like artificial intelligence, healthcare demands in specific geographical areas, new professional roles) are related to patient experience, professions and healthcare policies. She is an expert on healthcare workforce development.
Publications
Publications (100)
Feminised sectors such as healthcare are underrepresented in labour platform research. This study focuses on emerging platforms for licensed nurses and combines a multimodal analysis of the promotional materials of twelve Dutch nursing platforms with interviews with platform directors and representatives. Our analysis shows how nursing platforms co...
Background
Primary healthcare has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. This study aims to bridge the gap between the primary healthcare policy and the ongoing healthcare workforce crisis debate by in...
See https://www.socialevraagstukken.nl/alleen-betere-werkomstandigheden-kunnen-zzp-schap-in-zorg-keren/
Background
The nursing work environment is crucial for nurses' well-being and patients’ quality of care. Despite effective interventions to improve the nursing work environment, understanding the most effective types and integration mechanisms for nurses remain challenging. As nursing practices evolve amid complex care demands and staff shortages,...
Este artigo aborda a reforma contemporânea da educação médica de pós-graduação que visa padronizar o treinamento. As reformas são orientadas por intervenções de políticas públicas para aumentar a qualidade do atendimento, objetivar o desempenho e preparar os residentes para as mudanças nas necessidades de assistência médica. Este artigo se baseia e...
Background. Primary healthcare has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. This study aims to bridge the gap between the primary healthcare policy and the ongoing healthcare workforce crisis debate by i...
This paper examines the conflicting temporal orders of the regional nurse, a role which has been introduced to deal with the increasing demands of aged care and workforce shortages in regional settings. We build on ethnographic research in the Netherlands, in which we examine regional district nurses as a new professional role that attends to (sub)...
De zorg wordt complexer en vraagt meer van verpleegkundigen. Verpleegkundigen willen daarnaast meer zeggenschap over hun werk en een prominentere rol in de organisatie van zorg en de borging van kwaliteit. Dit heeft ertoe geleid dat landelijk wordt nagedacht over het creëren van nieuwe verpleegkundige functies en rollen. Belangrijke drijfveren acht...
The persistence of multiple educational pathways into the nursing profession continues to occupy scholars internationally. In the Netherlands, various groups within the Dutch healthcare sector have tried to differentiate nursing practice on the basis of educational backgrounds for over 50 years. Proponents argue that such reforms are needed to reta...
This article analyses how regional actors and national authorities shape and transform ‘the region’ from a geographical place into an object of governance for organising and delivering older person care. Drawing on an extensive ethnographic research project in the Netherlands, our findings show that these actors in interaction constitute the region...
Nursing shortages in the global north are soaring. Of particular concern is the high turnover among bachelor‐trained nurses. Nurses tend to leave the profession shortly after graduating, often citing a lack of appreciation and voice in clinical and organisational decision‐making. Healthcare organisations seek to increase the sustainability of the n...
Health care systems are facing soaring workforce shortages, challenging their ability to secure timely access to good-quality care. In this context, nurses make difficult decisions about which patients to deliver care to, transfer to other providers, or strategically ignore. Yet, we still know little about how nurses engage in situated practices of...
The centralisation of acute health care is a key policy concern in many countries. Less attention has been given to the side effects of centralisation: peripheralisation, occurring mainly in rural areas and post‐industrial towns. In this research, we start filling this gap by exploring how this trend of concentration of health care can contribute t...
Background
Post-Covid health policies seek to adapt to the ‘new normal'. Their success depends on the capacities of healthcare workforce (HCWF). Policies need to tackle rapidly growing shortages, high levels of stress and increases in violence against the HCWF. We lack more systematic comparisons of how countries respond, also across different sect...
Nurse workforce shortages put healthcare systems under pressure, moving the nursing profession into the core of healthcare policymaking. In this paper, we shift the focus from workforce policy to workforce politics and highlight the political role of nurses in healthcare systems in England, Spain, Sweden, and the Netherlands. Using a comparative di...
Task reallocation is increasingly foregrounded as a promising solution for capacity problems. Numerous studies show, however, that task reallocation between medical professionals is a highly contested issue and difficult to institutionalise. Conflicts are omnipresent and often arise from 'intraprofessional competition': Zero-sum games between profe...
Networks are increasingly seen as promising generic solutions to complex public problems. This article analyzes network‐building in action within a specific regional setting as an attempt to cope with increasing and varied demands for older person care, studying everyday organizational and policy activities of actors. Drawing on a qualitative in‐de...
Dossier
In this feature authors discuss recent research findings that are of interest to readers of Beleid en Maatschappij.
Background:
Peripheral areas are often overlooked in health-care research but they in fact deserve specific attention. Such areas struggle to maintain access to good quality health-care services due to their geographical context. At the same time, new interventions or promising innovations often emerge in places where creativity is urgently needed...
The COVID-19 pandemic has been an ultimate challenge for health systems as a whole rather than just single sectors (e.g. hospital care). Particularly, interface management between health system sectors and cooperation among stakeholders turned out to be crucial for an adequate crisis response. Dealing with such interfaces, it is argued in the liter...
Background
A just culture is regarded as vital for learning from errors and fostering patient safety. Key to a just culture after incidents is a focus on learning rather than blaming. Existing research on just culture is mostly theoretical in nature.
Aim
This study aims to explore requirements and challenges for fostering a just culture within hea...
This article draws on ethnographic research to conceptualise how nurses mobilise assemblages of caring to organise and deliver COVID care; particularly so by reorganising organisational infrastructures and practices of safe and good care. Based on participatory observations, interviews and nurse diaries, all collected during the early phase of the...
Organisation-wide studies in cost and qualiy of care are rare, and Wackers et al. make a valuable contribution in synthesizing the literature on this issue. Their paper provides a good overview of initiatives and a list of factors that help in furthering organisation-wide change. The eleven factors they distill from the literure however remain rath...
Objectives
A just culture is considered a promising way to improve patient safety and working conditions in the healthcare sector, and as such is also of relevance to healthcare regulators who are tasked with monitoring and overseeing quality and safety of care. The objective of the current study is to explore the experiences in healthcare organisa...
‘De regio’ wordt veelvuldig genoemd als centraal en ‘nieuw’ sturings- en ordeningsprincipe om capaciteitsproblemen in de ouderenzorg tegen te gaan. Regionalisering lijkt ogenschijnlijk tegenstrijdig binnen het huidige zorgstelsel van gereguleerde marktwerking, en wordt bovendien gestapeld bovenop al bestaande sturingsarrangementen zoals professione...
Background
The health workforce is a key component of any health system and the present crisis offers a unique opportunity to better understand its specific contribution to health system resilience. The literature acknowledges the importance of the health workforce, but there is little systematic knowledge about how the health workforce matters acr...
In this article, we reconstruct a Dutch case in which policymakers, experts, and professional organizations proposed to amend a law so as to differentiate between different kinds of nurses and the work they do. In doing so, they specifically sought to support and reposition higher educated nurses. The amendment was met with fierce opposition from w...
This paper uses the metaphor of the dance to envision how hospitals in the Netherlands engaged in organizing and delivering care during the first months of the COVID-19 outbreak. Drawing on an ongoing ethnographic study in a Dutch university study and interviews with nurses in various hospitals, we show how hospital actors (nurses, physicians, mana...
Background
The present crisis offers a unique opportunity to better understanding the specific contribution of the health workforce to health system resilience, and more specifically to the adaptive, absorptive and transformative capacities that influence how health systems respond to the COVID-19 pandemic.
Methods
The study examined different cap...
The health workforce is a key component of any health system. The present crisis offers a unique opportunity to better understand the specific contribution of the health workforce to health system resilience. The literature acknowledges the importance of the health workforce, but there is little systematic knowledge about how the health workforce m...
Objective
Nurses are vital in providing and improving quality of care. To enhance the quality improvement (QI) competencies of nurses, hospitals in the Netherlands run developmental programmes generally led by internal policy advisors (IPAs). In this study, we identify the roles IPAs play during these programmes to enhance the development of nurses...
This article explores how professionals in older persons care work on a triage system in the daily care setting. We follow how triage is introduced in older persons care organizations in The Netherlands, to deal with a scarcity of physicians and distribute care among health workers in the region. We offer a sociological analysis in which we use the...
Background
Transitions in healthcare delivery, such as the rapidly growing numbers of older people and increasing social and healthcare needs, combined with nursing shortages has sparked renewed interest in differentiations in nursing staff and skill mix. Policy attempts to implement new competency frameworks and job profiles often fails for not se...
Rebellious healthcare professionals: juggling with rules, passion and accountability
Bureaucracy and ‘red tape’ are seen as a main annoyance in healthcare practice. ‘Rules’ like guidelines and performance indicators would withdraw professionals from their real work, that is, helping patients. However, rules may also improve quality of care if they...
The Covid-19 pandemic has put policy systems to the test. In this paper, we unmask the institutionalized resilience of the Dutch health care system to pandemic crisis. Building on logics of crisis decision-making and on the notion of ‘tact’, we reveal how the Dutch government initially succeeded in orchestrating collective action through aligning p...
Etnografische methoden worden steeds meer toegepast binnen onderzoek naar verpleegkundigen en verpleegkundig werk. Ze worden bijvoorbeeld gebruikt om beter te begrijpen wat verpleegkundigen doen in de dagdagelijkse zorgpraktijk en hoe zij daarmee bijdragen aan (de organisatie van) de kwaliteit en veiligheid van zorg[1]. Bij een etnografisch onderzo...
Purpose
The purpose of this paper is to explore the formation and composition of “regions” as places of care, both empirically and conceptually.
Design/methodology/approach
This paper draws on action-oriented research involving experiments aimed at designing, implementing and evaluating promising solutions to the entwined problems of a burgeoning...
Background
The Dutch healthcare inspectorate publishes its inspection frameworks to inform both the public and healthcare providers about regulatory procedures and in the hope that publication will motivate healthcare providers to improve quality and comply with standards. This study explores the consequences of publishing these frameworks for the...
Scholars describe organizing professionalism as 'the intertwinement of professional and organizational logics in one professional role'. Organizing professionalism bridges the gap between the often-described conflicting relationship between professionals and managers. However, the ways in which professionals shape this organizing role in daily prac...
In this commentary, we reflect on Rinaldi and Bekker's scoping review of the literature on populist radical right (PRR) parties and welfare policies. We argue that their review provides political scientists and healthcare scholars with a firm basis to further explore the relationships between populism and welfare policies in different political sys...
Background
National regulatory regimes for supervising ongoing clinical trials are affected by external challenges, both international, such as harmonization of EU legislation, and national, such as critical reviews of incidents. This study examines how supervisory bodies dealing with ongoing trials respond to external challenges of the past two de...
Modern healthcare systems are highly data-and evidence-driven. The use of indicators and other performance management devices, introduced by healthcare leaders and regulators to monitor performance and address patient safety matters, are just two examples. Research has shown that the wish to manage and address risks via measuring practices does not...
As Corona virus is putting a huge stress on healthcare systems around the world, analysts of health policy will have to respond with starting up research on the consequences of current policies. In this paper, we propose an agenda for research of health policy from a governance perspective, focussing on the consequences of decision-making structure...
Distributing responsibility for patient safety between individual professionals and organisational systems is a pressing issue in contemporary healthcare. This article draws on Habermas' distinction between 'lifeworld' and 'system' to explore patient-safety culture in medical residency training. Sociological accounts of medical training have indica...
Purpose
The purpose of this paper is to empirically explore and conceptualize how healthcare professionals and managers give shape to the increasing call for compassionate care as an alternative for system-based quality management systems. The research demonstrates how quality rebels craft deviant practices of good care and how they account for the...
This article explores how datafication, as an increasing use of quantified performance data (e.g. performance indicators, rating sites), and social media are enacted in everyday healthcare practice. Drawing on the literature about the quantified self, this article shows that datafication evokes practices of gamification: the application of frames o...
The concept of place has become fertile ground for sociological investigations, yet it is still undertheorized and in need of further development. Its most advanced employment is to be found within a sociological agenda on materialities of care and health architecture. In this article, we build on this work to conceptualize ‘placed care’ and to sho...
A recent report by the Netherlands Centre for Ethics and Health (CEG) is a valuable contribution to the discussion around patient safety and regulatory pressure in healthcare. The CEG criticizes the recent tendency to make safety the sole and absolute value in healthcare practice. Doing so, not only downplays the dilemmas healthcare professionals a...
In this paper we use the notions of play and (finite and infinite) games to analyze performance management practices in professional work. Whilst evaluative metrics are often described as ‘monsters’ impacting on professional work, we illustrate how metrics can also become part of practices of caring for such work. Analyzing the use of evaluative me...
While we know that upcoding of diagnosis-related groups (DRGs) regularly occurs, we have little knowledge of the role of the technical features of coding systems in inducing coding behaviour. This paper presents methods for investigating the financial structure of the Dutch DRG system, and more in particular the grouper software, to gain such insig...
This article studies the role of a public regulator in managing the performance of healthcare professionals. It combines a networked governance perspective with responsive regulation theory to show the mechanisms that have added to significant changes in medical cost management in the Netherlands. In a five‐year period, hospital practices transitio...
This article presents two cases of policymaking concerning the vaccine against Human Papilloma Virus (HPV), which is sexually transmitted and carcinogenic. Our analysis focuses on its introduction in Austria and the Netherlands. In both contexts, we find prevention and screening to be at once complementary and competing public health logics and we...
Background
Despite the introduction of Human papillomavirus (HPV) vaccination in national immunization programs (NIPs), vaccination rates in most countries remain relatively low. An understanding of the reasons underlying decisions about whether to vaccinate is essential in order to promote wider spread of HPV vaccination. This is particularly impo...
Werkloosheid onder jonge artsen vormt al een jaren een lastig
oplosbaar probleem. In deze bijdrage plaatsen we het
vraagstuk van krapte op de medische arbeidsmarkt in historisch
perspectief. Het artikel laat zien dat de opleiding van
basisartsen en medisch specialisten van oudsher gepolitiseerd
is, waarbij steeds andere partijen en belangen een rol...
Hoe kom je tot goede innovatie in de zorg? In elk geval moet daartoe meer aandacht komen voor het proces van innoveren in de praktijk: bij beleidsmakers, managers én professionals. Dit kan de innovatiekracht van zorgorganisaties versterken. En het kan de bijdrage van innovaties vergroten: aan de betaalbaarheid, toegankelijkheid en de kwaliteit van...
Unemployment among young physicians has been a difficult problem for years. In this contribution, we are looking at the difficult medical job market from a historical perspective. The article shows that education of medical doctors and medical specialists has been politicised for a very long time, that ever-changing parties and interests are playin...
Rankings have become ubiquitous in public service settings. Although there are high hopes that comparative analysis leads to improved processes and outcomes, there is also a growing criticism of rankings as creating perverse effects. In this article, we analyze how public service governance is affected by rankings with a special focus on how, in wh...
Background:
Over the past decade the healthcare workforce has diversified in several directions with formalised roles for health care assistants, specialised roles for nurses and technicians, advanced roles for physician associates and nurse practitioners and new professions for new services, such as case managers. Hence the composition of health...
In this article we analyse the process of the multiple ways place and care shape each other and are co-produced and co-functioning. The resulting emerging assemblage of this co-constituent process we call a carescape. Focusing on a case study of a nursing home on a Dutch island, we use place as a theoretical construct for analysing how current chan...
Over the past few years several new occupations have been introduced in health care next to those of vested professionals. In this chapter we analyze the introduction and development of the physician assistant (PA) as one of them. A PA is an allied professional or nurse who has obtained additional university training and who is allowed to work inde...
Although much has been written on changing professionalism, only limited attention has been given to the ways in which professionals
themselves give shape to new requirements in everyday professional practice. This article investigates the understudied reform
of postgraduate medical education. The reform takes in a shift from apprenticeship-based t...
Verpleegkundig specialisten hebben een innovatieve rol in de zorg, omdat zij een patiëntgerichte benadering van het medisch handelen centraal stellen. Tegelijkertijd staan ze nog sterk in de schaduw van medisch specialisten. Zo blijkt uit ons diepte-onderzoek naar de rol en positie van de verpleegkundig specialist in de Nederlandse zorgpraktijk. We...
Objectives:
Emergency medicine is a fast-growing medical profession. Nevertheless, the clinical activities emergency physicians (EPs) carry out and the responsibilities they have differ considerably between hospitals. This article addresses the question how the role of EPs is shaped and institutionalized in the everyday context of acute care in ho...
This paper addresses contemporary reform in postgraduate medical education that aims to standardise training. The reforms are guided by public policy interventions to increase quality of care, objectify performance, and to prepare residents for changing health care needs. This paper draws on an ethnographic study in the Netherlands, studying how ne...
Currently, most surgical training programs are focused on the development and evaluation of professional competencies. Also in the Netherlands, competency-based training and assessment programs were introduced to restructure postgraduate medical training. The current surgical residency program is based on the Canadian Medical Education Directives f...
Medical doctors in teaching hospitals aim to serve the two central goals of patient care and medical training. Whereas patient care asks for experience, expertise and close supervision, medical training requires space to practise and the 'invisibility' of medical residents. Yet current reforms in postgraduate medical training point to an increasing...
Recently the medical profession has faced increased outside pressure to reform postgraduate medical training programs to better equip young doctors for changing health care needs and public expectations. In this article we explore the impact of reform on professional self-governance by conducting a comparative historical-institutional analysis of p...
Postgraduate medical training was reformed to be more responsive to changing societal needs. In the Netherlands, as in various other Western countries, a competency-based curriculum was introduced reflecting the clinical and nonclinical roles a modern doctor should fulfill. It is still unclear, however, what this modernization process exactly compr...