The Health Council of the Netherlands

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Perceptions of the legitimacy of the courts are generally measured by means of surveys among the population. As legitimacy is an abstract concept, it has to be captured by simple questions. The questions posed in influential surveys use a variety of conceptualisations. Instead of asking for opinions about legitimacy, one can also examine whether the acceptance of the legitimacy of the courts is demonstrated by behaviour. This offers potentially a more reliable way to measure legitimacy: not by what people say but what they do. In this article, drawing on the conceptualisation of legitimacy in surveys, behavioural effects are derived. It would be preferable to measure these behaviours directly, but in the absence of such data we have to make do with observed behaviour. A study is presented on the legitimacy of the judiciary in European countries, based on observations by judges. It is a first step, but the results are different from and more insightful than surveys of citizens.

BackgroundA 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.AimThis study aims to explore requirements and challenges for fostering a just culture within healthcare organizations.MethodsWe examined initiatives to foster the development of a just culture in five healthcare organizations in the Netherlands. Data were collected through interviews with stakeholders and observations of project group meetings in the organizations.ResultsAccording to healthcare professionals, open communication is particularly important, paying attention to different perspectives on an incident. A challenge related to open communication is how to address individual responsibility and accountability. Next, room for emotions is regarded as crucial. Emotions are related to the direct consequences of incidents, but also to the response of the outside world, including the media and the health inspectorate.ConclusionsA challenge in relation to emotions is how to combine attention for emotions with focusing on facts, both within and outside the organization. Finally, healthcare professionals attach importance to commitment and exemplary behavior of management. A challenge as a manager here is how to keep distance while also showing commitment. Another challenge is how to combine openness with privacy of the parties involved, and how to deal with less nuanced views in other layers of the organization and in the outside world. Organizing reflection on the experienced tensions may help to find the right balance.

ObjectivesA 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 organisations regarding the role of the healthcare inspectorate in enabling a just culture.DesignQualitative study using interviews and focus groups that were transcribed verbatim, and observations of which written reports were made. Transcripts and observation reports were thematically analysed.SettingThree mental healthcare providers, two hospitals and the healthcare inspectorate in the Netherlands.ParticipantsWe conducted 61 interviews and 7 focus groups with healthcare professionals, managers and other staff in healthcare organisations and with inspectors. Additionally, 27 observations were conducted in healthcare organisations.ResultsWe identified three themes in our data. First, professionals and managers in healthcare organisations perceive the inspectorate as a potential catalyst for learning processes, for example, as an instigator of investigating incidents thoroughly, yet also as a potential barrier as its presence and procedures limit how open employees feel they can be. Second, a just culture is considered relational and layered, meaning that relationships between different layers within or outside the organisation might hinder or promote a just culture. Finally, for inspectors to enable a just culture requires finding a balance between allowing organisations the time to take responsibility for quality and safety issues, and timely regulatory intervention when healthcare providers are unwilling or unable to act.ConclusionsIf regulators intend to enable the development of a just culture within healthcare organisations, they must adopt regulatory procedures that support reflection and learning within the organisations they regulate and consider mutual trust as a vital regulatory tool.

A 61-year-old mountain hiker presented with acute pain of the medial-plantar aspect of the right foot. As the location, intensity and acute onset of the pain were atypical for fasciitis plantaris, an ultrasound was performed. This demonstrated a segmental plantar vein thrombosis (PVT), which was confirmed on consequent MRI. Patient was a non-smoker, without a medical or family history of coagulopathies. Four months previously, he suffered from metatarsalgia of the left, thus contralateral, foot, which prompted treatment with bilateral orthoses. In addition to metatarsal padding, medial-arch support was prescribed due to the presence of flexible flatfeet. Following internal medicine consultation, treatment consisted of discontinuing the use of orthoses, rest and non-steroidal anti-inflammatory drugs (NSAIDs). At 2-week follow-up, the patient was pain-free. In this case report, PVT, a rare cause for plantar heel pain, is discussed. In addition, a summary of the diagnosis and treatment of PVT is outlined.

International Review of MissionVolume 102, Issue 2 p. 191-198 Responses to the New Mission Affirmation “So What?” – Dutch Responses to the New Mission Statement Rev. Gerrit Noort, Rev. Gerrit Noort Director Netherlands Mission CouncilSearch for more papers by this author Rev. Gerrit Noort, Rev. Gerrit Noort Director Netherlands Mission CouncilSearch for more papers by this author First published: 07 October 2013 https://doi.org/10.1111/irom.12020Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume102, Issue2November 2013Pages 191-198 RelatedInformation

Human enhancement is a common theme in fiction and popular culture (i.e. science fiction films) and often constitutes an attempt at exploring the future. This chapter sets out to what extent it is also encountered in more ‘serious’ and scientific explorations of futures. There are different approaches to the exploration of futures: long-term explorations, essayistic reflections and diagnoses of our time. These investigations originate in the desire to be able to anticipate the impact of new societal developments, unknown mechanisms and unusual circumstances. The exploration of futures is now an officially recognised research area and has inspired a novel branch of scholarship, comprising a multitude of different approaches and opinions and exploring a wide variety of possible future scenarios. However, human enhancement is a topic that is usually treated only marginally in such studies. Ultimately, most explorers of futures do not believe that human beings will be ‘created’, but they do stress the importance of trying to visualise the possible future developments and scenarios which could emerge from new science and technologies.