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The introduction of the surgical robot resulted in increasing technical difficulty of these robot assisted surgeries (RAS). The qualification and certification of RAS skills are still in a preliminary phase within all surgical specialties, also in urology. New methods of training for novice surgeons (residents and fellows) in these highly specialised techniques should be implemented to guarantee patient safety. The challenge for novice surgeons is how to learn new surgical procedures and once the procedure is learned and they become experts how to analyse past performances and subsequently use this as a lesson for the future in order to improve postoperative outcome. In the first part of this these we explored the best methods to educate surgeons in robotic surgery. By using different modalities of training, (i.e., hands-on training combined with theoretical information of learning) we discovered (chapter 2) novice robot surgeons were too positive in the self-assessment of their own surgical skills after a training in RAS. To prevent overconfidence biases the novice surgeons should be provided with feedback (proctoring) to inform them about their results to enhance learning and inform them of their competence levels. Although results (chapter 3) show there is no significant difference in the acquisition of surgical skills between different types of proctoring provided to novice surgeons the participant satisfaction seems to be higher in the “human proctoring” group. Which could result in additional motivation for the participant to continue training in RAS. Additional research (chapter 4) shows residents in urology are allowed to perform RAS during their residency, but criteria for starting RAS differ significantly among the teaching hospitals. This shows there is a need for the implementation of a (multi-step) training and certification program in the Dutch urology residency curriculum. The long-term effects of the structured fellowship in RAS were investigated in chapter 5. The results of the survey showed that most respondents still perform RAS after the fellowship, which matches results from other research into the impact of RAS fellowships.34,35 A remarkable finding of this study is that a large proportion of respondents is unaware of the oncological (33%) and functional outcomes (66%) of their patients. Thus, participants of RAS fellowships should be coached to review their own results to learn from their past performance and reduce their learning curve. The second part of the thesis focuses the assessment of a robotic surgeon’s surgical performance. Different methods were used to identify which factors should be assed in surgical video analysis in order to ascertain a surgeon’s surgical skills. In robot assisted surgery. (Chapter 6 and 8). In addition, a research protocol is provided by which the non-technical skills can be assed in both laparotomic surgery and robot assisted surgery in order to discover the difference in non-technical skills between the two surgical modalities. The third part of the thesis focusses on the relation between a surgeon’s performance and postoperative outcome of patients. In this part multiple methods of surgical video analysis were used to identify factors which could influence the postoperative outcome of patients (Chapters 9, 10, 11, and 12). Results show the length of the urethral stump after dissection of the prostate could be a significant factor in the recovery of continence after prostatectomy.

This dissertation centers on the concept of “urgency for change” in narratives—how, in processes of change, several urgency narratives develop and interact dynamically, influencing the process and outcome of organizational change. Classically, urgency for change is the domain of organizational change scholars like Kotter, who adopted a “clock time” perspective on organizational change. Such scholars pay considerable attention to the role of management and the idea that a good change story facilitates change. These assumptions are challenged in this thesis, which has a temporal narrative focus and appreciates the multiplicity of stories. Martijn van Ooijen asks himself: How do multiple urgency narratives dynamically interact in organizational change processes with societal implications? While in this first chapter a framework for temporal narratives is developed, the next three chapters investigate the dynamic interaction of urgency narratives on several levels in two societal cases. The first case deals with implementation of a new health care law in the Netherlands (Wet Langdurige Zorg in Dutch). The new law that was passed to improve the system, had a big societal impact. First, this chapter adresses the urgency narratives and stakeholders that authored them in the public debate. Second, it investigates the impact of these public narratives on local processes of change in health care organizations. The second case was a change project in the Dutch earthquake region where the researcher was part of a change team. The project’s aim was to improve the safety culture of construction companies involved in the recovery of damaged houses. This case deals with the problematic societal acceptance of construction as a high-risk field with frequent injuries, sickness, absences, and disability retirement. The chapter provides an in-depth view of the development of various urgency narratives of several groups of stakeholders involved. Moreover, it pays attention to the thought processes and intervention strategies of the change consultants of the change platform. The results of the dissertation point to the value of combining temporality and narrative in the tempo-narrative framework. The framework supports researchers through the practical application of time and narrative in processes of change by highlighting various temporal narrative concepts and the necessity and ways to work with a multitude of stories. By focusing on temporality in the two cases, it became possible to explain the tensions in several narrative struggles. The dissertation also points to the importance of dialog on the often hidden and taken-for-granted ideas and beliefs as intervention strategy, and ways to do that. For instance, a good setting where people feel free to share their stories with others is important. Certain questions can help and in one of the chapters a multistory movie was used as an opener for dialog. Future researchers could benefit from the tempo-narrative research approach that was adopted and the various temporal narrative approaches it incorporates. Future research should further explore and integrate the way different intervention strategies are adopted and unfold in change processes characterized by a multitude of urgency narratives. Moreover, there is value in the researcher–practitioner combination but it also requires reflexivity, which is still an underexposed theme in this type of research.

This dissertation centers on the concept of “urgency for change” in narratives—how, in processes of change, several urgency narratives develop and interact dynamically, influencing the process and outcome of organizational change. Classically, urgency for change is the domain of organizational change scholars like Kotter, who adopted a “clock time” perspective on organizational change. Such scholars pay considerable attention to the role of management and the idea that a good change story facilitates change. These assumptions are challenged in this thesis, which has a temporal narrative focus and appreciates the multiplicity of stories. Martijn van Ooijen asks himself: How do multiple urgency narratives dynamically interact in organizational change processes with societal implications? While in this first chapter a framework for temporal narratives is developed, the next three chapters investigate the dynamic interaction of urgency narratives on several levels in two societal cases. The first case deals with implementation of a new health care law in the Netherlands (Wet Langdurige Zorg in Dutch). The new law that was passed to improve the system, had a big societal impact. First, this chapter adresses the urgency narratives and stakeholders that authored them in the public debate. Second, it investigates the impact of these public narratives on local processes of change in health care organizations. The second case was a change project in the Dutch earthquake region where the researcher was part of a change team. The project’s aim was to improve the safety culture of construction companies involved in the recovery of damaged houses. This case deals with the problematic societal acceptance of construction as a high-risk field with frequent injuries, sickness, absences, and disability retirement. The chapter provides an in-depth view of the development of various urgency narratives of several groups of stakeholders involved. Moreover, it pays attention to the thought processes and intervention strategies of the change consultants of the change platform. The results of the dissertation point to the value of combining temporality and narrative in the tempo-narrative framework. The framework supports researchers through the practical application of time and narrative in processes of change by highlighting various temporal narrative concepts and the necessity and ways to work with a multitude of stories. By focusing on temporality in the two cases, it became possible to explain the tensions in several narrative struggles. The dissertation also points to the importance of dialog on the often hidden and taken-for-granted ideas and beliefs as intervention strategy, and ways to do that. For instance, a good setting where people feel free to share their stories with others is important. Certain questions can help and in one of the chapters a multistory movie was used as an opener for dialog. Future researchers could benefit from the tempo-narrative research approach that was adopted and the various temporal narrative approaches it incorporates. Future research should further explore and integrate the way different intervention strategies are adopted and unfold in change processes characterized by a multitude of urgency narratives. Moreover, there is value in the researcher–practitioner combination but it also requires reflexivity, which is still an underexposed theme in this type of research.

Bij het verschijnsel ‘eergerelateerd geweld’ (dat hierna nader zal worden toegelicht) speelt de vraag of en in hoeverre religie daar een rol bij speelt.1 Toen bij de Nationale Politie bijna twintig jaar geleden op landelijk niveau de fundamenten voor de huidige politiële aanpak van eergerelateerd geweld werden gelegd, kreeg de politie met name casuïstiek onder ogen waarbij mensen met een Turkse en Marokkaanse achtergrond waren betrokken.2 Inmiddels spelen de meeste zaken zich af onder de Syriërs die zich in Nederland bevinden.

In deze kadertekst worden de contouren geschetst van het thema dat centraal staat in dit Cahier: big data policing. Wat verstaan we hieronder, hoe bakenen we het thema af en hoe kijken we ernaar vanuit verschillende perspectieven? Op basis van een brede conceptualisering kunnen ook de verschillende bijdragen in dit verzamelwerk gekaderd worden in een ruimer perspectief. De auteurs hopen hiermee bij te dragen aan de demystificatie van big data policing, waardoor een constructief debat kan worden gevoerd, onderzoek kan worden uitgevoerd en beleid kan worden geformuleerd op een op kennis gebaseerde wijze.

Whitepaper: Bescherming van Zeeland tegen water. Een panelonderzoek naar de percepties van Zeeuwen ten aanzien van overstromingskans, zeespiegelstijging en zeedijkversterking. Het klimaat verandert en de zeespiegel stijgt. Het Waterschap staat voor belangrijke besluiten als het gaat om de dijkversterking. De vraag is: ‘hoe kijken inwoners van Zeeland aan tegen de waterveiligheid in Zeeland en de mogelijkheden tot dijkversterking?’ Om een antwoord te geven op deze vraag benaderde het HZ Kenniscentrum Zeeuwse Samenleving (HZ KCZS), in opdracht van Waterschap Scheldestromen, deelnemers van het Panel Zeeland; een panel met Zeeuwse inwoners. Uiteindelijk vulden 895 panelleden de vragenlijst in, waarmee de respons op 47 procent lag. In het panel zijn mannen, hoger opgeleiden, ouderen en inwoners van Middelburg oververtegenwoordigd. De beschrijvende resultaten zijn daarom gewogen voor deze kenmerken. Desondanks zijn de resultaten niet representatief voor de inwoners van Zeeland. Voor meer informatie over het panel, de respons en de methode verwijzen we naar onze publicatiepagina. Met de resultaten van dit onderzoek geven wij inzicht in de perceptie van de panelleden ten aanzien van: • De bedreiging van de zee voor de directe woonomgeving • De ernst en effecten van klimaatverandering in het algemeen • Mogelijke maatregelen ter bescherming tegen de zee • Keuzes die gemaakt moeten worden bij een dijkverbreding

Whitepaper: Bescherming van Zeeland tegen water. Een panelonderzoek naar de percepties van Zeeuwen ten aanzien van overstromingskans, zeespiegelstijging en zeedijkversterking. Het klimaat verandert en de zeespiegel stijgt. Het Waterschap staat voor belangrijke besluiten als het gaat om de dijkversterking. De vraag is: ‘hoe kijken inwoners van Zeeland aan tegen de waterveiligheid in Zeeland en de mogelijkheden tot dijkversterking?’ Om een antwoord te geven op deze vraag benaderde het HZ Kenniscentrum Zeeuwse Samenleving (HZ KCZS), in opdracht van Waterschap Scheldestromen, deelnemers van het Panel Zeeland; een panel met Zeeuwse inwoners. Uiteindelijk vulden 895 panelleden de vragenlijst in, waarmee de respons op 47 procent lag. In het panel zijn mannen, hoger opgeleiden, ouderen en inwoners van Middelburg oververtegenwoordigd. De beschrijvende resultaten zijn daarom gewogen voor deze kenmerken. Desondanks zijn de resultaten niet representatief voor de inwoners van Zeeland. Voor meer informatie over het panel, de respons en de methode verwijzen we naar onze publicatiepagina. Met de resultaten van dit onderzoek geven wij inzicht in de perceptie van de panelleden ten aanzien van: • De bedreiging van de zee voor de directe woonomgeving • De ernst en effecten van klimaatverandering in het algemeen • Mogelijke maatregelen ter bescherming tegen de zee • Keuzes die gemaakt moeten worden bij een dijkverbreding

Achtergrond: Er is groeiende aandacht voor bewegingsvrijheid als onderdeel van persoonsgerichte dementiezorg. Hoewel een gesloten deur veiligheidsrisico’s kan terugdringen, vermindert het doorgaans ook de kwaliteit van leven. Zorgorganisatie tanteLouise streeft naar maximale verantwoorde vrijheid voor bewoners met dementie. Toch worden bewoners soms overgeplaatst van een open naar gesloten psychogeriatrie (PG) afdeling.Doel: Inzicht krijgen in de overwegingen van zorgprofessionals bij overplaatsing van bewoners met dementie van een open naar een gesloten PG-afdeling binnen tanteLouise.Methode: Semigestructureerde diepte-interviews met verzorgenden en verpleegkundigen van open en gesloten PGafdelingen en een multidisciplinaire focusgroep. De data zijn thematisch geanalyseerd.Resultaten: Zowel open als gesloten PG kunnen volgens de deelnemers een passende woonomgeving bieden, afhankelijk van individuele bewoners. Open PG faciliteert vrijheid en eigen regie, en gesloten PG biedt veiligheid, structuur en deskundigebegeleiding. Het multidisciplinaire team bespreekt voor een overplaatsing de mogelijkheden en risico’s op open PG. Desondanks verhuizen bewoners regelmatig naar gesloten PG zonder geldige reden. Deelnemers streven naar meer vrijheid voor bewoners met dementie, waarvoor volgens hen nog randvoorwaarden ontbreken.Conclusie: De geboden structuur en deskundige begeleiding op gesloten PG, moet ook op open PG aanwezig zijn om vrijheid voor bewoners met dementie te behouden. Daarnaast zijn een cultuuromslag en randvoorwaarden vanuit deorganisatie noodzakelijk.

Het veiliger maken van de fysieke leefomgeving is een complex vraagstuk. Integraal en sectoroverstijgend werken is hierbij dan ook onontbeerlijk. Veel professionals zijn dit echter niet gewend en komen op wijkniveau allerlei knelpunten tegen. Studenten die in interdisciplinair verband onderzoek doen via een lectoraat kunnen helpen met het vinden van goede oplossingen. Hiermee ontwikkelen zij tevens competenties om zelf integraal te werken.

Het veiliger maken van de fysieke leefomgeving is een complex vraagstuk. Integraal en sectoroverstijgend werken is hierbij dan ook onontbeerlijk. Veel professionals zijn dit echter niet gewend en komen op wijkniveau allerlei knelpunten tegen. Studenten die in interdisciplinair verband onderzoek doen via een lectoraat kunnen helpen met het vinden van goede oplossingen. Hiermee ontwikkelen zij tevens competenties om zelf integraal te werken.

Week tegen Pesten Van 26 tot en met 30 september is het de Week tegen Pesten, met als thema: Grapje! Moet toch kunnen?! Wanneer iets nog ‘grappig’ is, en wanneer het ‘pesten’ wordt, daar denkt iedereen verschillend over. Dat maakt het oplossen van pesten moeilijk, zeker als je dat samen met anderen wilt doen. Voor een goede samenwerking is het daarom belangrijk dat je op één lijn komt met de ander. Dat doe je door met elkaar te praten, maar vooral ook door goed naar elkaar te luisteren. Dat bleek uit recent onderzoek van Rosanne Spruijt (e.r.spruijt@pl.hanze.nl), promovenda aan de Hanzehogeschool Groningen en Rijksuniversiteit Groningen. Bespreek bijvoorbeeld met elkaar: •Wat weten jullie over de situatie en hoe denken jullie erover? •Wat zou kunnen helpen, en welke rol is daarbij voor jezelf en de ander weggelegd? •Wanneer en hoe houden jullie elkaar op de hoogte van de aanpak en de uitkomst? Over de aanpak van pesten lees je meer in de informatiekrant ‘Samen tegen Pesten’!

Presentatie op Surf Congres

Guest lecture by Marcus Borg from RISE institute

The article describes what a restorative city is by looking at research, experiences in different countries and by describing the developments in Restorative City Wrocław. A restorative city is a city that recognises its urban environment as a network of relations in which – in the case of conflict – citizens, institutions and organisations choose a restorative approach to finding a solution in the first place. This necessitates proactive responses to conflict resolution, which go beyond criminal justice and crime prevention strategies that are still predominantly of a reactive nature. The concept of the restorative justice city builds a ‘criminology of trust’, for which crime is not a risk to be managed and controlled but a harm to be addressed by penal policies based on respect, solidarity, inclusion and active participation The restorative city concept, as also seen in Wrocław, is gaining momentum and while it is becoming an appealing policy transfer in an increasingly globalized world.

Samen met de gemeente Rotterdam deed het lectoraat een experiment. Het doel was om de werking van WhatsApp-buurtpreventiegroepen te verbeteren. Dit resultaten laten zien dat dit niet eenvoudig is: het vereist de nodige tijd en aandacht. Bij de inzet van WhatsApp-buurtpreventie is volgens de auteurs voorzichtigheid geboden, omdat effecten ook averechts kunnen zijn. Het experiment laat bijvoorbeeld ook zien dat in vergelijking met niet-deelnemers, deelnemers een negatievere perceptie van de veiligheid hadden

Samen met de gemeente Rotterdam deed het lectoraat een experiment. Het doel was om de werking van WhatsApp-buurtpreventiegroepen te verbeteren. Dit resultaten laten zien dat dit niet eenvoudig is: het vereist de nodige tijd en aandacht. Bij de inzet van WhatsApp-buurtpreventie is volgens de auteurs voorzichtigheid geboden, omdat effecten ook averechts kunnen zijn. Het experiment laat bijvoorbeeld ook zien dat in vergelijking met niet-deelnemers, deelnemers een negatievere perceptie van de veiligheid hadden

Videosamenvatting over het onderzoek dat door Erike Essen (Hogeschool van Amsterdam) en Jimmy Maan (Avans Hogeschool) is uitgevoerd aan de hand van praktijkcasussen en waarover zij een artikel publiceerden en het Tijdschrift voor veiligheid.

Dit artikel voor Tijdschrift voor Veiligheid behandelt de invloed van digitale buurtpreventie op criminaliteit. Het vaak veronderstelde positieve effect op het aantal aanhoudingen laat zich niet zien. Toch is het aannemelijk dat digitale buurtpreventie criminaliteit vermindert. Door middel van sociale controle wordt de gelegenheid voor criminaliteit beperkt en worden criminele handelingen verstoord. Dit blijkt uit recente literatuur en bevindingen uit eigen onderzoek: een ‘realist evaluation’ waarin professionals en deelnemers van digitale buurtpreventiegroepen in Rotterdam is gevraagd naar hun perceptie van de werkzaamheid van dit middel. Relevant voor het werkveld: in het artikel geven we aanknopingspunten waarmee de werkzaamheid kan worden vergroot.

De rol van het personeel in penitentiaire inrichtingen (PI) is de laatste decennia drastisch gewijzigd. Waar voorheen het waarborgen van veiligheid voorop stond, is er gaandeweg – mede door een veranderende populatie – meer aandacht gekomen voor zorgaspecten in het werk van inrichtingswerkers. Werken met aandacht voor zowel zorg als veiligheid noemen we hybride werken. Om met coaching en scholing goed aan te sluiten op hybride werken is het belangrijk te weten hoe penitentiair inrichtingswerkers (piw’ers en zbiw’ers) denken over hun werk en over de omgang met gedetineerden. In deze rapportage worden de resultaten van dit onderzoek, de opvattingen van piw’ers en zbiw’ers, in kaart gebracht.

Week tegen Pesten Van 26 tot en met 30 september is het de Week tegen Pesten, met als thema: Grapje! Moet toch kunnen?! Wanneer iets nog ‘grappig’ is, en wanneer het ‘pesten’ wordt, daar denkt iedereen verschillend over. Dat maakt het oplossen van pesten moeilijk, zeker als je dat samen met anderen wilt doen. Voor een goede samenwerking is het daarom belangrijk dat je op één lijn komt met de ander. Dat doe je door met elkaar te praten, maar vooral ook door goed naar elkaar te luisteren. Dat bleek uit recent onderzoek van Rosanne Spruijt (e.r.spruijt@pl.hanze.nl), promovenda aan de Hanzehogeschool Groningen en Rijksuniversiteit Groningen. Bespreek bijvoorbeeld met elkaar: •Wat weten jullie over de situatie en hoe denken jullie erover? •Wat zou kunnen helpen, en welke rol is daarbij voor jezelf en de ander weggelegd? •Wanneer en hoe houden jullie elkaar op de hoogte van de aanpak en de uitkomst? Over de aanpak van pesten lees je meer in de informatiekrant ‘Samen tegen Pesten’!

De rol van het personeel in penitentiaire inrichtingen (PI) is de laatste decennia drastisch gewijzigd. Waar voorheen het waarborgen van veiligheid voorop stond, is er gaandeweg – mede door een veranderende populatie – meer aandacht gekomen voor zorgaspecten in het werk van inrichtingswerkers. Werken met aandacht voor zowel zorg als veiligheid noemen we hybride werken. Om met coaching en scholing goed aan te sluiten op hybride werken is het belangrijk te weten hoe penitentiair inrichtingswerkers (piw’ers en zbiw’ers) denken over hun werk en over de omgang met gedetineerden. In deze rapportage worden de resultaten van dit onderzoek, de opvattingen van piw’ers en zbiw’ers, in kaart gebracht.

This dissertation examines the development and implementation of a new care model in Dutch forensic psychiatry called Forensic High and Intensive Care (FHIC). FHIC aims to foster the transition from control-based care to contact-based care in forensic psychiatry. A new care model in acute psychiatry, High and Intensive Care (HIC), serves as an example. By analogy, Forensic High and Intensive Care (FHIC) has been developed for forensic psychiatry. However, the question is how the HIC model can be translated to forensic psychiatry. To gain insight into this, three research questions have been formulated: A. What can be learned from complex situations at HIC wards? B. What are the characteristics of FHIC and how can implementation be measured? C. How can FHIC be implemented? Chapter 2 presents a study of difficult situations in HIC wards to see what can be learned regarding the development of FHIC. At HIC wards, care professionals sometimes encounter difficult situations. Interviews and a focus group were organized with care professionals from HIC wards. Taking into account the situation, and not focusing only on the patient, can be helpful in the detection of (early) signals or even prevent aggression. Chapter 3 describes the development and core elements of FHIC. The model was developed in expert meetings, using the results of scientific research and experiences from practice. The FHIC model consists of various interventions to reduce coercive measures and increase safety by working on the basis of contact. There are five core elements; care ethics, stepped care, the premise that a crisis is relational, safety in contact and peer expertise. Chapter 4 describes a mixed methods study validating the FHIC monitor. The FHIC monitor is a model fidelity scale of the FHIC model. Audits by trained FHIC care professionals provided the basis for the assessment of the measurement properties of the instrument. After revisions and adjustments, the FHIC monitor proved to be a useful tool to measure the implementation of the FHIC model and to support institutions in the implementation process. Chapter 5 presents a study of two Communities of Practices (CoPs), one for HIC and one for FHIC. The CoPs for HIC and FHIC consist of auditors, project leaders and care professionals working with HIC and FHIC, respectively. Based on qualitative research, various lessons were formulated for the development of CoPs and perceived effects were identified. The audits served as an important vehicle to activate the CoPs and stimulated the implementation of HIC and FHIC. Chapter 6 shows that working on the basis of contact can result in moral questions and dilemmas. A specific form of clinical ethics support is moral case deliberation (MCD). The chapter describes a MCD in a forensic psychiatric clinic about the relationship between contact and safety. MCD can also contribute to a change in culture. Chapter 7 concludes with the general discussion and conclusion. The research in this thesis confirms that FHIC is a promising development. Many forensic healthcare institutions are in the process of implementing FHIC and this process contributes to the intended transition to contact-based care. The thesis also shows that the implementation of FHIC is not easy because it requires a transition at the level of culture, structure, and practices within a complex care practice. Three lessons were formulated for initiatives aimed at shifting from control to contact-based care in complex care practices: 1) pay attention to complexity, 2) use reflection for dealing with complexity, and 3) foster collaboration in complex care. For future research it is recommended to gain more insight into the further implementation of FHIC and the effects of FHIC on (perceived) safety.

This dissertation examines the development and implementation of a new care model in Dutch forensic psychiatry called Forensic High and Intensive Care (FHIC). FHIC aims to foster the transition from control-based care to contact-based care in forensic psychiatry. A new care model in acute psychiatry, High and Intensive Care (HIC), serves as an example. By analogy, Forensic High and Intensive Care (FHIC) has been developed for forensic psychiatry. However, the question is how the HIC model can be translated to forensic psychiatry. To gain insight into this, three research questions have been formulated: A. What can be learned from complex situations at HIC wards? B. What are the characteristics of FHIC and how can implementation be measured? C. How can FHIC be implemented? Chapter 2 presents a study of difficult situations in HIC wards to see what can be learned regarding the development of FHIC. At HIC wards, care professionals sometimes encounter difficult situations. Interviews and a focus group were organized with care professionals from HIC wards. Taking into account the situation, and not focusing only on the patient, can be helpful in the detection of (early) signals or even prevent aggression. Chapter 3 describes the development and core elements of FHIC. The model was developed in expert meetings, using the results of scientific research and experiences from practice. The FHIC model consists of various interventions to reduce coercive measures and increase safety by working on the basis of contact. There are five core elements; care ethics, stepped care, the premise that a crisis is relational, safety in contact and peer expertise. Chapter 4 describes a mixed methods study validating the FHIC monitor. The FHIC monitor is a model fidelity scale of the FHIC model. Audits by trained FHIC care professionals provided the basis for the assessment of the measurement properties of the instrument. After revisions and adjustments, the FHIC monitor proved to be a useful tool to measure the implementation of the FHIC model and to support institutions in the implementation process. Chapter 5 presents a study of two Communities of Practices (CoPs), one for HIC and one for FHIC. The CoPs for HIC and FHIC consist of auditors, project leaders and care professionals working with HIC and FHIC, respectively. Based on qualitative research, various lessons were formulated for the development of CoPs and perceived effects were identified. The audits served as an important vehicle to activate the CoPs and stimulated the implementation of HIC and FHIC. Chapter 6 shows that working on the basis of contact can result in moral questions and dilemmas. A specific form of clinical ethics support is moral case deliberation (MCD). The chapter describes a MCD in a forensic psychiatric clinic about the relationship between contact and safety. MCD can also contribute to a change in culture. Chapter 7 concludes with the general discussion and conclusion. The research in this thesis confirms that FHIC is a promising development. Many forensic healthcare institutions are in the process of implementing FHIC and this process contributes to the intended transition to contact-based care. The thesis also shows that the implementation of FHIC is not easy because it requires a transition at the level of culture, structure, and practices within a complex care practice. Three lessons were formulated for initiatives aimed at shifting from control to contact-based care in complex care practices: 1) pay attention to complexity, 2) use reflection for dealing with complexity, and 3) foster collaboration in complex care. For future research it is recommended to gain more insight into the further implementation of FHIC and the effects of FHIC on (perceived) safety.

This dissertation examines the development and implementation of a new care model in Dutch forensic psychiatry called Forensic High and Intensive Care (FHIC). FHIC aims to foster the transition from control-based care to contact-based care in forensic psychiatry. A new care model in acute psychiatry, High and Intensive Care (HIC), serves as an example. By analogy, Forensic High and Intensive Care (FHIC) has been developed for forensic psychiatry. However, the question is how the HIC model can be translated to forensic psychiatry. To gain insight into this, three research questions have been formulated: A. What can be learned from complex situations at HIC wards? B. What are the characteristics of FHIC and how can implementation be measured? C. How can FHIC be implemented? Chapter 2 presents a study of difficult situations in HIC wards to see what can be learned regarding the development of FHIC. At HIC wards, care professionals sometimes encounter difficult situations. Interviews and a focus group were organized with care professionals from HIC wards. Taking into account the situation, and not focusing only on the patient, can be helpful in the detection of (early) signals or even prevent aggression. Chapter 3 describes the development and core elements of FHIC. The model was developed in expert meetings, using the results of scientific research and experiences from practice. The FHIC model consists of various interventions to reduce coercive measures and increase safety by working on the basis of contact. There are five core elements; care ethics, stepped care, the premise that a crisis is relational, safety in contact and peer expertise. Chapter 4 describes a mixed methods study validating the FHIC monitor. The FHIC monitor is a model fidelity scale of the FHIC model. Audits by trained FHIC care professionals provided the basis for the assessment of the measurement properties of the instrument. After revisions and adjustments, the FHIC monitor proved to be a useful tool to measure the implementation of the FHIC model and to support institutions in the implementation process. Chapter 5 presents a study of two Communities of Practices (CoPs), one for HIC and one for FHIC. The CoPs for HIC and FHIC consist of auditors, project leaders and care professionals working with HIC and FHIC, respectively. Based on qualitative research, various lessons were formulated for the development of CoPs and perceived effects were identified. The audits served as an important vehicle to activate the CoPs and stimulated the implementation of HIC and FHIC. Chapter 6 shows that working on the basis of contact can result in moral questions and dilemmas. A specific form of clinical ethics support is moral case deliberation (MCD). The chapter describes a MCD in a forensic psychiatric clinic about the relationship between contact and safety. MCD can also contribute to a change in culture. Chapter 7 concludes with the general discussion and conclusion. The research in this thesis confirms that FHIC is a promising development. Many forensic healthcare institutions are in the process of implementing FHIC and this process contributes to the intended transition to contact-based care. The thesis also shows that the implementation of FHIC is not easy because it requires a transition at the level of culture, structure, and practices within a complex care practice. Three lessons were formulated for initiatives aimed at shifting from control to contact-based care in complex care practices: 1) pay attention to complexity, 2) use reflection for dealing with complexity, and 3) foster collaboration in complex care. For future research it is recommended to gain more insight into the further implementation of FHIC and the effects of FHIC on (perceived) safety.