Page 18 - Reduction of coercive measures

Chapter 1
and complex forms of care fail to meet the needs of people with disabilities. Complex care often brings risks, for example the risk of injury as a result of severe challenging behavior. If other attempts to prevent or limit this behavior have failed, coercive measures are used to limit the risks of this behavior against.
The need to reduce coercive measures is clear and various initiatives have been taken to reduce coercive measures. The main focus is on safe and sustainable control of risky behavior in the form of the implementation of alternatives to coercive measures (Van Wouwe & Van der Weerd, 2015). The introduction of alternative methods for risk control can be accompanied by organization-wide programs that focus on the elimination of coercive measures. In the Netherlands several initiatives were started and implemented during the past decennium aimed at reducing the use of specific forms of coercive measures, such as a bed belt used for mechanical restraint during times of unrest (Denktank Complexe Zorg, 2012; Romijn & Frederiks, 2012). In addition, organizations are encouraged by the Health Care Inspectorate and the sector association (in Dutch: Vereniging Gehandicaptenzorg Nederland (VGN) to develop and implement policies that reduce the use of coercive measures (Romijn & Frederiks, 2012). However, the phasing out of coercive measures does not yet take place structurally and consistently. Implementation of new working methods in health care that attempt to change the ways in which organizations or teams have adapted to internal or external threats will meet resistance (May, 2013). If coercive measures would be banned at the organization level, care staff and clients are bound to experience insecurity. Support staff, professionals, and residents and their representatives need to know whether it is safe to abandon coercive measures that were put in place to ensure safety (Luiselli, 2009; Williams, 2009). In addition to the safety aspect, it is well known that innovations in healthcare practice are complex and extensive because they almost always consist of changes in several interrelated behaviors of several people working together (May, 2013). Behavior and actions of healthcare employees arise and continue to exist in interaction between these persons. The more complex a process of change is, the more thinking, control, and coordination of different parts of the organization it requires.
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