BackgroundSexual boundary violations in healthcare are harmful and exploitative sexual transgressions in the professional–client relationship. Persons with mental health issues or intellectual disabilities, especially those living in residential settings, are especially vulnerable to SBV because they often receive long-term intimate care. Promoting good sexual health and preventing SBV in these care contexts is a moral and practical challenge for healthcare organizations.MethodsWe carried out a qualitative interview study with 16 Dutch policy advisors, regulators, healthcare professionals and other relevant experts to explore (...) their perspectives on preventing SBV in mental health and disability care organizations. We used inductive thematic analysis to interpret our data.ResultsWe found three main themes on how healthcare organizations can prevent SBV in mental health and disability care: setting rules and regulations, engaging in dialogue about sexuality, and addressing systemic and organizational dimensions.ConclusionOur findings suggest that preventing SBV in mental health and disability care organizations necessitates setting suitable rules and regulations and facilitating dialogue about positive aspects of sexuality and intimacy, as well as about boundaries, and inappropriate behaviors or feelings. Combining both further requires organizational policies and practices that promote transparency and reflection, and focus on creating a safe environment. Our findings will help prevent SBV and promote sexual health in mental health and disability care organizations. (shrink)

A woman is found lying dead on the floor of the living room of her house in Leiden, the Netherlands, and because of a swollen and a slightly wounded eyelid, an autopsy is performed on the body the day after it is found. Behind the wound, there is a whole ballpoint pen, which entered the head of the deceased through her right eye causing mortal brain damage. How did it get there? This question was to cause a stir in Dutch (...) society, holding a group of police detectives and several scientists in its grip for several years. In this article, the ballpoint case is analyzed as to the boundary work between credible and noncredible expertise. As it is often assumed that boundary work in continental law is preempted by the structure of these law models, this case study adds a comparative note to the growing literature about science and the law. (shrink)

This article addresses the role of science and science advisory bodies in modeling practices for the support of policy-making procedures in the Netherlands in the field of health care. The authors show, based on a detailed investigation of a prestigious interdisciplinary modeling project in which an economic care model was developed for governmental use, that science advisory bodies are entangled with the policy actors they advise in what we call boundary configurations. Boundary configurations are strongly situated interconnections between science advisory (...) institutes and policy institutions that share a specific approach to problem definitions and methods and that are embedded in specific social, discursive, and material elements. Importantly, as the case study shows, such boundary configurations shape the kind of science, and related, the kind of social and political theories about the world, that is effectuated in modeling practices. In this case study, the boundary configuration in which economic experts and policy makers participated contributed to the articulation of health care in terms of a market-based policy program for the health care sector. (shrink)

Researchers are increasingly expected to deliver “socially robust knowledge” that is not only scientifically reliable but also takes into account demands from societal actors. This article focuses on an empirical example where these additional criteria are explicitly organized into research settings. We investigate how the multiple “accountabilities” are managed in such “responsive research settings.” This article provides an empirical account of such an organizational format: the Dutch Academic Collaborative Centres for Public Health. We present a cross-case analysis of four collaborative (...) research projects conducted within this context. We build on Miller’s notion of “hybrid management.” The article shows that the extended concept of hybrid management is useful to study the different accountabilities encountered in such settings. We analyze how the collaboration developed and which conflicts or dilemmas arose. We then focus on the different hybrid management strategies used in the collaboration. The empirical material shows how the different aspects of hybrid management feature in various configurations in the four projects. We highlight that hybrid management strategies may be used by different groups or at different moments, may reinforce or contradict each other, and may be more or less effective at different points in time. (shrink)

This article’s aim is to understand if and how the efforts to accumulate and organize clinical data transformed the regulation of pharmaceutical care. The authors analyze how the employment of databases by collectives of physicians and researchers shape both clinical and policy practice—and thereby reshape the relation between clinical work and policy. Since the late 1990s, Dutch government has supported the development of clinical databases for specific expensive medicines to gain oversight about actual medicine use. To be able to produce (...) evidence for appropriate medicine use, the collectives set regulations in clinical practice. These internal regulations provide a framework for establishing “appropriate medicine use”, steering reimbursement decisions. However, internal regulation and policy rules differ in how quickly they can change. While the employment of databases in clinical practices results in a constant adjustment of the protocols, policy makers require the databases to provide for static moments of “proven appropriate medicine use” in order to account for and define a fixed and closed formulary. Subsequently, the employment of the databases did not deliver on the promise of oversight and control due to different clinical and policy requirements. Nevertheless, the databases did stimulate appropriate medicine use and reimbursement in clinical practice. (shrink)

Studying and discussing boundary violations between people is important for potentially averting future harm. Organizations typically respond to boundary violations in retributive ways, by punishing the perpetrator. Interestingly, prior research has largely ignored the impact of sexual boundary violations and retributive dynamics on teams. This is problematic as teams provide an obvious setting not only to detect and discuss troubling behavior by peers, but also for learning how to prevent future harm. Therefore, in this study we explore team-level experiences regarding (...) sexual boundary violations and organizational responses to these incidents. Drawing on an in-depth case study, our findings shed light on the profound negative consequences of a retributive organizational response to sexual boundary violations. Additionally, our findings show how a restorative approach, inviting teams to reflect on the violations and their impact, can help teams to recover. Our main contribution involves a model that demonstrates how the interplay between sexual boundary violations, retributive, and restorative organizational responses affects teams. This model shows how combining these responses can acknowledge distress within teams, heal relationships between team members through dialogue, and open up the possibility to learn from these events. This model extends prior research focusing on individual actions and outcomes regarding violations. Additionally, by combining retributive and restorative organizational responses in one model, we extend the literature on restorative organizational responses to boundary violations. (shrink)

While recent science and technology studies literature focuses on “projectification” and its felt tensions for researchers, a surprising scarcity of empirical work addresses experiences at the “other end,” such as funding bodies often held “responsible” for tensions encountered by researchers. Actors in funding bodies experience similar tensions, however. While projectification necessitates predictability and individual project objectives, research funding is also increasingly organized in networks promoting local experimentation. Moreover, funding bodies are part of a system of accountability in which investments are (...) legitimized politically in often reductionist ways. We argue for the salience of more detailed empirical investigations into the work of funding bodies as they navigate these tensions. We apply a dramaturgical perspective to investigate the “staging work” of program committees responsible for the management of funded programs, identifying three forms of staging work: setting the scene, temporal narration, and signifying success. All come with discursive, material, and symbolic dimensions. We develop the notion “adaptive coherence” to show how the program committee sought to maintain the coherence of the overall program despite continuous risks of fragmentation due to projectification, local experimentation, and divergence in interests. “Adaptive coherence” proves productive in incorporating the temporal and spatial dimensions of staging work in networked contexts. (shrink)

The availability of medical and health information on the world wide web has led to a long discussion about the reliability of that information. Various medical, political, and independent organizations have created user-friendly tools for finding reliable medical/health information on the web and have been faced with the challenge of defining what it means for information to be reliable. Little attention has been given to the work of reviewing web-based information and applying selection criteria to individual sites. In this article, (...) the authors examine how guidelines are applied in practice and discuss how the selection criteria and the practices of applying them reinforce distinctions that current medical sociology and informatics literature suggests have been broken down by internet technologies and the availability of web-based medical information. (shrink)

The Health Council of the Netherlands is an independent scientific advisory board to the Dutch government in matters of public health. In this article we argue that even for an independent body such as the Health Council there seems to be no escape from the increasing intertwinement of scientific and societal processes. In order to produce a serviceable truth for policymaking, the council needs to reflect on what goes on in its socio-political surroundings. On the other hand, how could we (...) ever come to understand the legitimacy of the council when notions of scientific objectivity dissolve in such a reflexive, inherently political stance? In a situation where science and society are thoroughly interrelated, the Health Council somehow succeeds in bringing about or re-claiming some sense of objectivity. Our central question will be how to conceptualise this notion of 'objectivity' without having to rely on idealized notions of objectivity that are criticized in philosophical, sociological and historical studies of science and society. In order to do so, we will regard the objectivity of advisory reports of the Health Council as being constructed out of heterogeneous elements and under complex circumstances. The theoretical point will be empirically underpinned with case material drawn from activities of the Health Council in the period 1985-2002 in predominantly the subject areas healthcare and medical technology. (shrink)

Serious incident investigations—often conducted by means of Root Cause Analysis methodologies—are increasingly seen as platforms to learn from multiple perspectives and experiences: professionals, patients and their families alike. Underlying this principle of inclusiveness is the idea that healthcare staff and service users hold unique and valuable knowledge that can inform learning, as well as the notion that learning is a social process that involves people actively reflecting on shared knowledge. Despite initiatives to facilitate inclusiveness, research shows that embracing and learning (...) from diverse perspectives is difficult. Using the concept of ‘epistemic injustice’, pointing at practices of someone’s knowledge being unjustly disqualified or devalued, we analyze the way incident investigations are organized and executed with the aim to understand why it is difficult to embrace and learn from the multiple perspectives voiced in incident investigations. We draw from 73 semi-structured interviews with healthcare leaders, managers, healthcare professionals, incident investigators and inspectors, document analyses and ethnographic observations. Our analysis identified several structures in the incident investigation process, that can promote or hinder an actor’s epistemic contribution in the process of incident investigations. Rather than repeat calls to ‘involve more’ and ‘listen better’, we encourage policy makers to be mindful of and address the structures that can cause epistemic injustice. This can improve the outcome of incident investigations and can help to do justice to the lived experiences of the involved actors in the aftermath of a serious incident. (shrink)

In this paper we discuss expected and reported effects on care provider-patient relations of the introduction of electronic patient records (EPRs) in consultation settings by reviewing exemplary studies and literature on the subject from the past decade. We argue that in order for such assessments to be meaningful, talk of effects of “the” EPR needs to be replaced by an “unpacking” of EPR systems into their constituent parts and functionalities, the effects of which need to be assessed individually. Following from (...) this principle, the paper discusses EPR systems ranging from simple data entry and retrieval systems to more sophisticated multi-user and multifunctional on-line systems. On a second level, our analysis of the literature is informed by the question which model of ideal patienthood underlies the assessment of effects of EPRs. To this end, we identify three “models of patienthood” implicit in writing about benefits and drawbacks of EPRs for patients: the autonomy, the consumer, and the holistic models, and argue that assumptions concerning these models need to be reflected upon more critically to improve understanding of what exactly EPR use does to the doctor-patient relationship. (shrink)

In this paper we discuss expected and reported effects on care provider-patient relations of the introduction of electronic patient records (EPRs) in consultation settings by reviewing exemplary studies and literature on the subject from the past decade. We argue that in order for such assessments to be meaningful, talk of effects of “the” EPR needs to be replaced by an “unpacking” of EPR systems into their constituent parts and functionalities, the effects of which need to be assessed individually. Following from (...) this principle, the paper discusses EPR systems ranging from simple data entry and retrieval systems to more sophisticated multi-user and multifunctional on-line systems. On a second level, our analysis of the literature is informed by the question which model of ideal patienthood underlies the assessment of effects of EPRs. To this end, we identify three “models of patienthood” implicit in writing about benefits and drawbacks of EPRs for patients: the autonomy, the consumer, and the holistic models, and argue that assumptions concerning these models need to be reflected upon more critically to improve understanding of what exactly EPR use does to the doctor-patient relationship. (shrink)