Vienna — Department of Science and Technology Studies AT The Department of Science and Technology Studies at the University of Vienna aims to foster critical reflexive debate concerning the developments of science, technology and society with scientists and students from all disciplines, but also with wider publics. Originally embedded within the Department of Philosophy and Social Studies of Science since , it was founded as an independent department within the Faculty of Social Sciences in That it is neither theoretical possible nor generally desirable to operate with predetermined conceptions of the relation between humans and technologies, and their respective characteristics, is pivotal for works within this field.
The complex intermingling of technological artefacts and human beings must be analysed empirically in concrete situations.
International STS departments
Reflecting on the epistemic, social, and historical dimensions of science and technology requires long-term and interdisciplinary research. Scholars with a background in sociology, philosophy and history, among other disciplines, collaborate at IWT. Actor-Network Theory proposed an alternative to the debate between realism — knowledge as a reflection of an outside reality — and constructivism — knowledge as the product of human activities -, a debate in which the latter was accused by the former of relativism knowledge being seen as nothing more than the expression of a certain state of society at a certain point in time.
By examining the actual production of reality and knowledge from a resolutely pragmatist point of view, this new approach made it possible to revive the debate on new terms. The research conducted at Spiral fundamentally pertains to a global reflection on governance in a context of scientific uncertainty and dynamics of technological innovation. Spiral is an academic research department that is characterized by a strong interdisciplinary approach. The process was described as a complex interplay of top-down and bottom-up processes between the government agency and the regional healthcare organizations.
The guideline model implies an active strategy for raising awareness by involving stakeholders during the development of the guidelines. This was done through involvement of health professional organizations and via dialogue with healthcare decision-makers. The aim was to gain support from healthcare professional actors and thereby increase the chances for positive reception among target audiences.
We are working through the health professional organizations. NBHW offered funding to seven health professional organizations to launch implementation projects and to researchers, aiming to increase knowledge of how the guidelines could be adopted.
The uptake of the policy was described as complex and slow, but as a potentially promising process. Barriers to adoption were inflexibility of the documentation systems and negative attitudes among parts of the health professional groups. No national performance-based grants were disbursed; instead, the regional authorities developed their own financial incentives.
A core management group at the NBHW coordinated the implementation. They analyzed information to identify the support needed. Possible solutions were sought and developed together with stakeholders and actors in healthcare. NBHW also formed a reference group with representatives from national stakeholders e. This was based on the idea that the professions and the healthcare decision-makers are best suited to judge the needs for and barriers to implementing the guidelines. Quality indicators for the guidelines were implemented in the patient record systems, and the aim was to connect these indicators to the annual national quality measurements and a national quality registry in the future.
The guidelines include a model to measure policy and implementation outcomes. The outcome measurement will show the proportion of patients who received a specific recommendation and the results. The results will be public and openly compared. However, the reporting of indicators encountered barriers in the medical record systems, and there were still ongoing development in June The need to improve care for older people was well acknowledged among all stakeholders, along with an awareness that evidence-based practices were not being applied systematically.
Previous improvement initiatives had been difficult to evaluate, and there were large local variations in the quality and coordination of care for older people. Several related policies in health and social care including performance-based grants were being implemented by the government and SALAR. A policy resonating these interests was developed in in negotiations between the government and SALAR. Initially, we [SALAR] did not like the conditional requirement about documentation of a management system for systematic quality work.
Now they are more aware of their decision-making structures, what regulations apply and what templates they should use… So I guess there have been some positive effects.
The ambition was to formulate a coherent policy comprising a few important improvement areas and to stick to these for the whole period while successively increasing the requirements for the performance-based grants. This did not follow a structured or pre-defined process. In the first two agreements, both parties used their own experiences as well as their political and social values to negotiate the content. An expert at NBHW described this:. The choice of improvement areas eligible for performance-based grants was made through some kind of consensus procedure, by a small group of experts from the organizations involved.
GESIS: Overview of Comparative Surveys Worldwide
We tried to identify the main problems from a more value-based point of view and then we had to narrow down the list due to availability of data. SALAR, which was responsible for the administration of national quality registries, identified relevant registries e. National quality registries contain patient-level data regarding diagnoses, treatments, and outcomes.
The use of the registries involved systematic assessments with validated instruments, evidence-based interventions, and follow-ups. In , the government introduced a more structured strategy for sourcing information. A problem investigation was conducted to serve as a basis for a more comprehensive agreement in the negotiations. Information was gathered through study visits, hearings, and interviews with stakeholders.
A broad literature search was also conducted, mainly involving reports from national agencies. Synthesized information from several sources was used. A pragmatic approach was used in the negotiations about the areas eligible for performance-based grants preventive care, palliative care, dementia care, pharmacological treatment, and coordination of care. Knowledge and arguments were assessed regarding the perceived significance for improving care, scientific evidence, and the availability of suitable indicators.
SALAR was the main actor, responsible for engaging regional and local authorities, coordinating and supporting the implementation by organizing activities, and compiling and reporting on the results. The strategy also included capacity-building and establishing regional support structures i. The assessment resulted in specific capacity-building strategies, such as funding for support structures and conditional requirements for obtaining performance-based grants. SALAR had the formal responsibility to increase awareness, and strategic communication was given high priority.
Initially, great emphasis was put on reaching out quickly with information. SALAR invited regional and local stakeholders to conferences and also used their established networks to disseminate the policy. The government and SALAR collaborated to raise awareness among target audiences and other groups, such as retiree organizations, for instance by conducting joint visits to all regions.
The national performance-based grants provided a strong incentive for political and higher management levels to adopt the policy. No governmental authority can do that.
Benefits of evidence-based practices were used as arguments to spur on adoption among professionals. The core value of the policy, i. This was described as a strategic choice, since the need to improve older people care was the feature that all stakeholders strongly agreed upon. Facilitative strategies were used extensively, with the focus on establishing regional support structures for the policy. Improvement coaches were hired in each region and SALAR supported the coaches via regular network meetings and a web-based interactive platform for sharing experiences and information.
Collaborative teams of managers were formed in each region to drive the implementation from a managerial point of view. A program was initiated to inspire the teams to put action plans into practice. SALAR created arenas for education and sharing experiences for the management teams. A web-based portal presenting indicators was developed, which made it possible to openly and continuously monitor the development.
Numerous educational events were organized, and efforts were made to coordinate the activities with other ongoing policies to streamline the implementation.
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SALAR also participated in local and regional activities across the country. The quality registry actors played an important role. They provided support to the improvement coaches and users at the local level. After the implementation, the disbursement of performance-based grants stopped, the project team at SALAR dissolved, and responsibility for continued implementation rested with the regional and local authorities.
SALAR arranged for the maintenance of the web-based tools, and the quality registries continue to support their users. Measurement of some of the indicators continues as parts of the annual national quality measurements. Monitoring and feedback were central aspects of the policy. Indicators and target levels for performance-based grants were developed and refined over time for each improvement area.
Initially, the monitoring focused on activities, but measures concerning outputs and outcomes were introduced successively. The web portal for outcome data enabled stakeholders to continuously view and compare results and to use the information for planning and systematic improvement work. In both cases, policymakers gathered information through their networks to assess the capacity to implement. Assessments showed that the target groups lacked the capacity to act on the policy without support and thus actions were taken to strengthen the capacity.
The implementation strategies in the cases were also similar: dissemination through existing channels, interactive educational activities, and creating arenas for support and sharing experiences between regional and local implementers. As for policy outcomes, indicators were identified for monitoring, feedback, and comparison of results in both cases. The cases differed regarding how the actors were involved in developing the policy, the extent to which the phases in the process overlapped and the rigor of methods for searching and assessing evidence.
There were also differences in core values, which influenced the choices regarding dissemination and implementation strategies for more information about the similarities and differences, see Additional file 3. The two policies differed greatly regarding how evidence was used, how the policies were formulated, and the extent to which the policy phases overlapped.
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Similarities were an emphasis on capacity assessment and modification of activities based on the assessment and a highly active implementation approach relying on networks of stakeholders. We also suggest some further development to the model based on new categories that emerged in the analysis Fig. These findings are discussed below, and implications for practice and research are suggested. One of the main findings concerned how evidence was used in the formulation of the policies. What was regarded as evidence and how this knowledge was used depended heavily on the nature of the policy.
The guidelines in Case 1 share the characteristics of a practice policy as presented by Black [ 23 ]. Practice policies are described as rather linear and rationalist processes for sourcing and using scientific evidence. The nature of the policy in Case 2 represents a combination of service and governance policies, implying a weaker relation between scientific evidence and the policy [ 23 ]. In Case 1, there was a central policy core belief shared by the principal actors that high-quality scientific evidence is the key to creating value for the patients.
This case can be seen as an optimal model for developing evidence-based policy, in terms of using a systematic and transparent decision-making process using the best available research evidence [ 24 , 25 ]. In Case 2, a central policy core belief was that knowledge that has been proven to work in practical settings is necessary in order to create value for the patients.
A broad definition of evidence, including both scientific and practical knowledge such as expert opinions, values, and traditions [ 8 ] were used. The use of evidence in Case 2 is in line with prior studies suggesting that policymakers tend to interpret and use evidence in a broad sense [ 7 ].
The goal was to use a scientifically sound evidence base, even though this was done indirectly and in rather non-systematic ways. Thus, the policy in Case 2 was characterized by a pragmatic approach with regard to the policy content rather than strictly scientific as in Case 1.