Knowledge bank

2021

15 years of market forces in healthcare
In 2006 began the ambitious reform of the Dutch healthcare system based on principles of regulated competition or market forces. Can we now - 15 years on - consider those reforms a success? What has 15 years of market forces done to the accessibility, quality and affordability of our healthcare system? The book 'The market reform in Dutch health care; Results, lessons and prospects' provides a thorough review.
Download the book via this website.

2018

Betaalbare zorg (Affordable care)
The insights from the knowledge program 'Celsus, academy for affordable care' were compiled in the eponymous book 'Betaalbare zorg (Affordable Care)' edited by Patrick Jeurissen, Hans Maarse and Marit Tanke.

This core publication is part of a series of books on healthcare affordability that appeared simultaneously. The other titles in this series are also on this page
Available via SDU

Beleid en besturing in de zorg (Policy and management in health care)
Hans Maarse
Available via SDU

Vijftig jaar kostenbeheersing in de zorg (Fifty years of cost control in health care)
Part I: 1966-1995
Karel-Peter Companje, Ton Kappelhof, Robert Mouton and Patrick Jeurissen
Availablevia S DU - (Part II see 2021)

Waardevolle zorg, Kwaliteit en doelmatigheid voor verpleegkundigen (Valuable care, Quality and efficiency for nurses)
Henny van Lienden and Hiske Calsbeek
Available via Koninklijke van Gorcum

Current education requires nurses to be able to argue their own actions using theoretical principles and results of scientific research (evidence-based nursing). Effectief Verplegen provides students with the arguments for solving or making manageable a number of common nursing problems. This book elaborates nursing problems that can occur in many different patients/caregivers, focusing on somatics. As in Volume 2, these are self-contained nursing problems and interventions, such as malnutrition, pain, sleep problems, etc. The book opens with an introduction to ebp, followed by the nursing problems worked out. Each chapter forms a completed whole, which can be studied separately. The chapter structure follows a fixed pattern: each chapter begins with a brief introduction, followed by case histories and a description of the problem area, nursing diagnostics and nursing interventions, and concludes with a knowledge review and a literature review.

Editors: Prof. Dr. Th. van Achterberg, Dr. G.J.J.W. Bours, Drs. A.M. Eliens.
Publisher: Kavanah, Dwingeloo
ISBN: 9789057401244
Year of publication: 2012

This book discusses nursing problems that may occur in various patient categories and are located in the psychosocial domain. These nursing problems are clustered into a number of nursing problem areas (see below). The book opens with an introduction, which discusses the state of evidence-based nursing and explains the significance of some commonly used classification systems and the EAP formula.
The introduction is followed by the elaborated nursing problems: each chapter forms a rounded whole (problem area), which can be studied separately.
The chapter structure follows a fixed pattern: each chapter starts with a short introduction, followed by case histories and a description of respectively the problem area, nursing diagnostics and nursing interventions, after which it concludes with a knowledge review and a literature review.

Editors: Prof. Dr. Th. van Achterberg, Dr. G.J.J.W. Bours, Dr. A.M. Elien.
Publisher: Kavanah, Dwingeloo
ISBN: 9789057401176
Year of publication: 2011

Parts 1 and 2 in this series cover common nursing problems in somatic and psychosocial care. These are nursing problems that can occur in many different patients (general care).
Effectief Verplegen 3 and Effectief Verplegen 4 differ from this. Parts 3 and 4 highlight nursing problems in specific groups of patients or caregivers (complex care). By choosing target groups instead of nursing problems as an entry point, it becomes possible to describe the entire care of a group. The chapters therefore cover problems in every area of human functioning. When describing the nursing problems for a target group, the particular problems of the group in question were chosen. For general problems that may also occur in these groups, reference has been made to Parts 1 and 2 where possible (e.g., pressure ulcers in Part 1 or compliance in Part 2).
This book is provided with a personal access code that allows users to consult additional information (such as the latest insights, measurement tools and a knowledge test) at www.verpleegproblemen.nl.

Editors: Prof. Dr. Th. van Achterberg, Dr. G.J.J.W. Bours, Drs. A.M. Eliens.

Publisher: Kavanah, Dwingeloo
ISBN: 9789057401183
Year of publication: 2012

Effective communication is one of the most important competencies of the general practitioner. Yet this subfield sometimes remains underexposed in (continuing) education and is - wrongly - taken for granted. Optimal communication can make consultation and practice much more effective and enjoyable.

'Handboek effectieve communicatie in de huisartsenpraktijk'. Authors: Dielissen, P.W. / Jagt, E.J. van der / Timmerman, A.A. With contributions by W. Dekkers, S. Naber, P. Giesen (IQ Health).

Publisher: Prelum
ISBN:9789085621478
Year of publication: 2016

Implementation in healthcare is enjoying growing interest from science and practice. The book ‘Implementatie: Effectieve verbetering van de patiëntenzorg’ ('Implementation: Effective Improvement of Patient Care') edited by Michel Wensing and Richard Grol has for many years offered a practical and scientifically based overview of the knowledge in this field. It is widely used in education.

Recently, the eighth, revised edition was published, on which several scientists from the Radboudumc collaborated. The book covers clinical guidelines, implementation strategies, quality indicators, patient safety, patient empowerment, and process evaluation, among other topics. The new edition contains much new knowledge that has become available internationally in recent years.

Learn more at the BSL Web site.

The book Coaching Peer Learning in Healthcare by Marjo Maas and Anjo Markhorst was recently released. A Peer Learning (PL) Group is a group of professionals working together on professionalization, quality improvement and innovation. Central is learning from each other based on issues from practice or science. In this book, the authors focus primarily on coaching PL groups working toward good and responsible healthcare.

A critical reflection on current healthcare practice and the search together for alternative or new ways of doing things form the common thread. The authors of this book are experienced PL coaches in healthcare and trainers of PL coaches. They have compiled this book based on the available literature on learning and professionalization, their experience as trainers and their observational research using video recordings of PL sessions.

Coaching Peer Learning in Healthcare is intended for healthcare professionals who have experience with, or interest in, coaching professional learning groups. This book gives the (potential) coach tools to facilitate the process of Peer Learning and to act appropriately when it is necessary to adjust the process.

Marjo Maas is affiliated as senior lecturer at the Academy of Paramedical Studies of the HAN and as researcher at Radboudumc, IQ Health department. Anjo Markhorst is owner of Alinea Consult, organizational coach and researcher at Radboudumc, IQ Health department.

This book was created with support from the Stichting Keurmerk Fysiotherapie. Click here for more info:

 https://www.2010uitgevers.nl/product/het-coachen-van-peer-learning-in-de-gezondheidszorg/

New book, I Can See You. The healing power of empathy
The book with this title was recently released, edited by Prof. Dr. Maria van den Muijsenbergh and Dr. Hub Wollersheim. Dr. Wollersheim worked as a researcher and teacher at IQ Health until his retirement. At a time when polarization and individualism prevail, this book offers an essential look at the importance of empathy and humanity. It explores how declining empathy affects our relationships and social structures.
Through a series of essays by experts from various fields, including philosophy, medical science and technology, this book illuminates the multifaceted nature of empathy. It examines the impact of an empathetic attitude in the doctor-patient relationship, and how this translates to broader social and political issues.

Every year in healthcare, many valuable new insights, technologies, programs or best practices become available. Unfortunately, many of these innovations do not find their way into practice. Why is that? And how can effective improvement of patient care be achieved? In this - thoroughly revised - edition of Implementation: effectively improving patient care, you will find up-to-date information on implementing a variety of changes. The process of innovation in practice is carefully analyzed and discussed using a practical, step-by-step model. A large number of scientific findings and practical examples are presented to explain the model. In Implementation: effectively improving patient care, the emphasis is on improving the actions of physicians, paramedics and nurses and the teams in which they work. The patient is central to this effort. It is a practical book for healthcare providers, executives, quality officers, managers, policy makers and researchers involved in optimizing patient care in the Netherlands. Richard Grol is Emeritus Professor of Quality of Care at the Universities of Nijmegen and Maastricht, Michel Wensing is Professor of Implementation Science at Radboud University Nijmegen.

Editors: Richard Grol and Michel Wensing.
Publisher: Reed business, Amsterdam
ISBN: 9789035233966
Year of publication: 2011

Strategies for successfully updating and improving health care organizations of all kinds. 

Health care is always evolving and improving. However, the rapid speed of medical advancement can make the adoption of new technologies and practices a challenging process – particularly in large organizations and complex networks. Any projected impact upon quality and outcomes of care must be carefully evaluated so that changes may be implemented in the most efficacious and efficient manner possible.

Improving Patient Care equips professionals and policymakers with the knowledge required to successfully optimize health care practice. By integrating scientific evidence and practical experience, the text presents a cohesive and proven model for practice change and innovation, complete with analysis of innovation, target group and setting; selection and application of strategies; and evaluation of process, outcomes and costs.

This new third edition also includes:

• Newly written chapters on clinical performance feedback, patient engagement, patient safety, evaluation designs, and methods for process evaluation
• Increased emphasis on the role of contextual influences in implementation and improvement
• New research examples from across the world and updated scientific literature throughout

Designed to help promote safer and more efficient, patient-centered care and better outcomes, Improving Patient Care is an essential resource for healthcare providers, quality assessors, and students of health services research, health management, and health policy.

Editors: Michel Wensing, Richard Grol, Jeremy Grimshaw

More information can be found on the website of Wiley.

"Quality of care is determined by many factors, including the (personal and professional) qualities of professionals such as doctors and nurses. Those qualities include the personal qualities to be able to do your job ethically as a professional - virtues. This book includes a chapter on the virtues of doctors, the virtues of nurses and two "profiles" of healthcare professionals. One is Prof. Dr. Baziel van Engelen, a neurologist at the Radboudumc. The book combines two of IQ Health's research themes: 'professional development' and 'ethics.'"

According to virtue ethics, good action comes from attitudes you develop as you go through life, such as courage, justice and integrity. If you have character, you pursue such virtues. They make your own life and the lives of those around you good, even when you are at work.

'Those who are virtuous provide virtuosic custom.'

What virtues matter in professional practices such as education, healthcare, law and business, and how do you develop them? This book brings together answers to those questions and short interviews with professionals such as Robbert Dijkgraaf, Femke Cools and Jos de Blok. As an introduction, Paul van Tongeren wrote a brief history of virtue ethics.

Edited by Wouter Sanderse and Jos Kole
ISVW publishers NUR: 730 / ISBN: 978-94-91693-62-5

A new edition of the book Kwaliteit en veiligheid in patiëntenzorg (Quality and Safety in Patient Care) has been released. The book has now been made expressly suitable for nurses as well.
In health care education, increasing attention is being paid to quality improvement and the prevention of unsafety in patient care. The increased attention to quality of care is evident, for example, in the recent Framework Plan. The 2020 Framework Plan for Physician Education is based on the (updated) CanMEDS framework. Whereas in 2009 about half of the competencies were related to quality and safety, professional behavior and ethical moral thinking and acting, in 2020 this is more than three quarters. Moreover, many competencies are more explicitly elaborated toward patient safety, continuity of care, working on virtues and professional behavior, reflective capacity and lifelong learning, interprofessional collaboration, collaborative decision making and co-producing care. These topics are covered extensively in this textbook.
Quality and safety are such a high priority because of the important consequences for patients and society. But what exactly does it mean to provide quality and safe care in a transparent manner? What role does the healthcare organization play, and how can the physician, nurse or paramedic individually contribute to safe patient care? How are calamities prevented? But also: how to adequately deal with a mistake made and how to learn from it?
Quality and Safety in Patient Care clarifies what quality of care is and what are conditions for quality improvement. The various dimensions such as professional, organizational and patient-centered quality are discussed, as well as research on quality improvement and implementation in practice. Despite the pursuit of optimal patient care, incidents always continue to occur. A separate chapter is therefore devoted to how to deal with a calamity, keeping in mind patient, organization and one's own feelings and functioning. The possibilities of quality improvement are illustrated in this book with numerous examples from clinical practice.
Quality and Safety in Patient Care is written by leading Dutch quality researchers and improvers, -professionals and healthcare providers, who have already made many contributions to actual improvement of patient care. With this book they offer every (future) healthcare professional the knowledge and tools to pursue optimal patient care and to reflect on their own role in it.

Editors: Hub Wollersheim, Trudy van der Weijden, Cordula Wagner, Kees Ahaus, Jaap Hamming and Hester Vermeulen.

Quality of care is under pressure from high demand, complexity and high costs. The idea of 'appropriate care' helps address these issues. The updated edition of this book provides insight into theories (head), it encourages self-reflection (heart) and contains practical tips (hands). The book helps to deepen knowledge, and also to develop one's own view on quality of care. For (future) healthcare professionals who not only want to know what good care is, but also want to understand how they can really make a difference.

IQ Health colleagues Marlies Hulscher, Rosella Hermens, Hiske Calsbeek and Hester Vermeulen helped make this updated edition possible. The book can be ordered via:

BSL Shop | Kwaliteit en veiligheid in patiëntenzorg

On May 25, 2021, Kok Boekencentrum published the volume Leven met Euthanasie (Living with Euthanasia), by Theo Boer, Stef Groenewoud (health scientist and ethicist at IQ Health) and Wouter de Jonge. The book is a compilation of over forty stories of experience from people who are (or have been) involved in euthanasia in some way.
Approximately one in twenty deaths in the Netherlands involves euthanasia. In response to unplannable and unwanted suffering, people choose this planned death. But what does the "good death" mean for directly involved loved ones? How do they experience it? Living with Euthanasia provides an impressive, poignant look into the stories of 43 next of kin.

Medical Practice Variations © 2016

Editors: Johnson, Ana, Stukel, Thérèse A. (Eds.)

• Raises critical concerns about the quality, equity and efficiency of international health care resources  
• Raises critical concerns about the quality, equity and efficiency of international health care resources
• Synthesizes current research on variations in healthcare utilization, delivery and outcomes
• Outlines established concepts & frameworks involved in researching medical practice variations
• Examines systemic questions about healthcare spending, decision-making and service disparities

Medical Practice Variations Part of the series Health Services Research pp 113-122

Medical Practice Variations in Primary Care
Gert P. Westert Affiliated with Health Services Research, Scientific Institute for Quality of Healthcare (IQ Health), Radboud University Nijmegen Medical Centre Email author 

• Judith D. de Jong Affiliated with Health Care System and Governance, NIVEL (Netherlands Institute for Health Services Research)
• Philip da Silva Affiliated with NHS Right Care

In daily care, nurses, like other healthcare professionals, have many questions. What does a patient want to achieve? What are we going to work on? What are the effects of the care? Does treatment need to be adjusted?

The third, revised edition of the book Meten in de praktijk (Measuring in Practice) is now accessible to nurses. The book includes a roadmap for using measurement tools in health care.

Measuring clarifies and objectifies these issues. This benefits the healthcare professional, the patient and their loved ones, both in determining the diagnosis, predicting the course of recovery, and also jointly determining the goal and evaluating a treatment.

Hester Vermeulen, professor of nursing science at IQ Health, has been added to the editorial team. As a result, the nursing perspective is now well represented herein. Nurses regularly use measurement tools in all settings. Using a step-by-step plan, nurses can now also learn how to systematically and critically search for, select, and interpret the appropriate measurement instrument and integrate its outcomes into the treatment process.

So in this third edition, there is more focus on interpreting and using the results in the care process. In addition, it collaborates with the website https://meetinstrumentenzorg.nl/, making the measurement tools and user information freely available.

The book is now also accessible to nurses. Furthermore, it is intended for all healthcare professionals, students and teachers of healthcare courses in higher education. In addition, it is a useful guide for professionals and quality staff working in healthcare.

The editorial board members are Sandra Beurskens, Roland van Peppen, Raymond Swinkels, Hester Vermeulen and Harriët Wittink. The book can be ordered by: https://www.bsl.nl/shop/meten-in-de-praktijk-9789036824583.html

A new international book was released in 2020: "Occupational therapy for older people," in Dutch "Ergotherapie bij ouderen."  The book describes occupational therapy interventions with older people in primary care, intensive care, rehabilitation, nursing home, palliative care and future perspectives.
The editors of this book are IQ Health professor Maud Graff, Christian Pozzi, Alessandro Lanzoni and Alessandro Morandi. The book was published by Springer International Publishers, 2020.

Setting up clinical trials is a complicated business, and one of the more difficult questions is how many patients and centres to include in multi-centre trials.
Statistician Steven Teerensta from Radboud University Medical Center and Mirjam Moerbeek from Utrecht University have published the book 'Power Analysis of Trials with Multilevel Data' with Chapman and Hall  explaining exactly what the issues are and giving guidelines to researchers.

Nurses are critical to delivering quality care. By demonstrating leadership, they influence quality, safety, effectiveness and person-centeredness of care. After all, nurses influence key outcome measures such as reduced malnutrition, infection, pain, anxiety and increased participation, adherence and self-management.  Nurses influence their own development and professionalism as well as that of students and colleagues on their team or the organization.
The editors of this book, including three colleagues from Radboudumc, IQ Health, invite nurses to explore and make the topic of nursing leadership their own. In this book, they ask many questions in between, let them reflect on their own practice situations or give short assignments on leadership. Because leadership, like nursing, is a "practice," in other words, you have to do it, practice, learn and try.
This book is intended for all ambitious nurses who, in a variety of roles and functions, are engaged in the professionalization of their profession and serve as boosters. More specifically: nurses following a program to become nurse leaders, nurse advisory boards, nurse specialists in training, students in the final phase of undergraduate education.
Editors and authors: Hester Vermeulen, Monique van Dijk, Maud Heinen, Gerda Holleman, Anita Huis, Erwin Ista, Pieterbas Lalleman, Catharina van Oostveen and Marjolein Schouten.

Survey among GPs in 10 countries

The Dutch healthcare system is characterised by strong primary care. For most health problems, GP practices are the first place to turn for professional help. Specialist help usually requires a referral from a GP. This gives the GP the function of gatekeeper in healthcare. GP care is generalist medical care, accessible to all people close to home and thus fulfils a prominent place in healthcare. There are several challenges in healthcare, including an ageing population, rising healthcare costs and a more complex society and healthcare.

This report focuses on the quality of Dutch healthcare, as experienced by GPs in 2022. It focuses on, among other things, digitalisation, practice organisation, accessibility of care, coordination of care and care for chronic patients.

The results are from the 2022 Commonwealth Fund International Health Policy Survey (IHP 2022). Besides Dutch GPs, GPs from nine more Western countries participated. This provides a nuanced picture of the functioning of the Dutch healthcare system, as perceived by GPs. Every three years, this survey among GPs is repeated. In the intervening years, a similar study is conducted among citizens and the chronically ill.

The study was funded by the Commonwealth Fund, the Ministry of Health, Welfare and Sport, and IQ healthcare. The study was conducted with support from the Dutch General Practitioners Association.

Download the report

Is infection prevention covered in nursing courses? And if so: how? Anita Huis and Irma Maassen of IQ healthcare investigated this on behalf of GAIN (the Gelderland Care Network Infection Prevention). They did so following signals from various healthcare organisations that trainees are not always at home with the rules around infection prevention. The findings form the basis for a national project to give infection prevention a more prominent place in the curricula of mbo and hbo.

The study consisted of a survey and interviews. A total of 733 nurses-in-training from 37 educational institutions completed the questionnaire. Over 18% of the students reported that there was no focus on infection prevention within their education. More than a third of this group are lateral entrants or follow a shortened pathway. As infection prevention is mainly covered in the first year, non-regular students may miss out on the subject as a result. Anita and Irma also conducted interviews at 3 mbo and 3 hbo programmes.

Outcomes

Hand hygiene and personal hygiene are covered at most schools. Other topics scored only moderately. These include, for instance, antibiotic resistance and BRMOs or personal protective equipment. Topics that are really missed in the courses include attention to infectious diseases and approach behaviour.

Recommendations

The researchers make a number of recommendations in the report. More repetition in the curriculum is one of them. Other recommendations include: more depth and more attention to BRMOs.

National project

A national project will start soon to give infection prevention a more prominent place in education. All healthcare networks are cooperating in this. Anita and Irma's report forms the basis for the project. The aim is to formulate learning goals around infection prevention. These will then be submitted to the MBO Council and the Association of Universities of Applied Sciences.

Would you like to know more? Read the research report here.

Appropriate care has recently become the norm in the Netherlands. But appropriate care has existed much longer. As early as 1991, the Dunning Commission wrote about the need for choices in its report 'Choosing in Care'. In 2013, the American scientific societies presented their Choosing Wisely lists of examples of care in which doctors should exercise restraint. Dutch medical specialists followed with their 'Choosing Wisely'. But lists do not change care. That is why the Citrine Fund programme Doen of laten? launched an approach where healthcare professionals themselves were put in the lead to change healthcare. What did we achieve?

Open the desktop version
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Every year, the Netherlands participates in the Commonwealth Fund's International Health Policy (IHP) survey. Alternately, citizens, patients and GPs are surveyed in 11 Western countries. This makes it possible to compare the performance of the Dutch healthcare system with that of the 10 other participating countries. Researchers from IQ healthcare processed the results into reports.

This creates a differentiated picture of the functioning of the Dutch healthcare system, as perceived by the participants surveyed. With this monitoring, developments due to policy, but also other (external) factors, become visible and international comparisons are possible.

For the 2020 survey, citizens aged between 18 and 64 were interviewed on the themes. The focus was on the themes of participation - accessibility - care consumption - financial accessibility and costs and Functioning of the healthcare system. In 2021, these were citizens aged 65 and over with the themes of coordination and aftercare - Care wishes about end of life - (financial) accessibility and Corona crisis and social security.

At the time the 2020 survey was launched, the COVID-19 pandemic was presenting itself. In the 2020 edition, some questions were added to the survey on testing, treatment and consequences of COVID-19. In 2021, side effects of the corona crisis such as delayed care and effects on social security were collected.

The surveys show that on some aspects of care such as involvement in health and treatment decisions, social security and accessibility of care, the Netherlands scores very high compared to the other countries. On most other aspects of the IHP survey, the Netherlands scores average to good. As in previous editions, there remains room for improvement. Among others in the areas of lifestyle advice, coordination and aftercare and end-of-life care wishes. Also, as in previous years, aftercare and information transfer between the second and first line is a point of attention.

Both reports are available below:

Report IHP survey 2020

Report IHP survey 2021

The Healthcare and Youth Inspectorate (IGJ) monitors the quality of care provided by healthcare providers. Complex care, such as care for people in vulnerable situations, is increasingly organised in care networks. Cooperation is then needed to enable person-centred care. If only direct care is supervised, any problems in care networks remain underexposed, even though they affect direct care.

The inspectorate has therefore started developing supervision of care in care networks from the patient/client perspective and is now also working on supervision of collaborating organisations. Supervising cooperating parties (regional healthcare networks) is more complex than supervising individual healthcare providers.

Erasmus School Health Policy & Management (Erasmus University Rotterdam) and IQ healthcare (Radboudumc) were asked to provide building blocks for the further development of supervision of healthcare networks. To this end, the functioning of cooperation in care networks and initial experiences with the supervision of cooperation were investigated. The assignment focused on care networks for people in vulnerable situations. The building blocks produced are widely applicable in supervision. In the report, the researchers present 14 recommendations with which the inspectorate can further develop supervision of care networks.

Researchers Dr Jozé Braspenning and PhD student Rabab Chrifou were involved in the development of this report from IQ healthcare.

Read the report here.

This report is part of the Programming Study Development of Quality Standards 2019-2022. The aim of the study, set up by IQ healthcare in collaboration with NIVEL and Utrecht University of Applied Sciences, was to develop an agenda of activities to implement existing and future quality standards. Sub-goals here were: to provide an overview of quality standards where implementation activities are needed, an overview of implementation activities for future district nursing quality standards and to make recommendations to embed implementation in the quality cycle.

Several methods were used to unravel the implementation issues. First, an analysis from an implementation perspective of the results of the first two sub-studies (de Groot & Francke, 2021, Zuidema et al., 2021). Second, a further analysis of the topic of Advance Care Planning that was suggested from the field based on a request from the V&V Panel as a topic for the development of a new quality standard for district nursing. Third, an analysis of developments within V&VN regarding quality standards. This resulted in a number of core recommendations in addition to an overview of existing quality standards that may already answer some of the questions from practice but are not yet focused on district nursing. The core recommendations focus on 1) prioritisation based on the need from the field, 2) a pilot implementation as a regular part of the development process, 3) implementation-support tools summarised for practice, 4) a format for a dissemination plan, and 5) organising a system that monitors and/or evaluates the knowledge and use of quality standards at an aggregate level.

Partners involved

• IQ health, Radboudumc Nijmegen: Maud Heinen, Anita Huis and Hester Vermeulen
• Nivel, Utrecht: Anneke Francke, Kim de Groot
• University of Applied Sciences, Utrecht: Rixt Zuidema, Nienke Bleijenberg

Read the report here and view the infographic here.

To future-proof long-term care for the elderly in the Netherlands, the government must develop a realistic long-term vision, in dialogue with all stakeholders, as a precondition for stable public support. This is the main conclusion from the working paper 'Sustainable care for the elderly - Lessons and experiences from other countries' published today by the Scientific Council for Government Policy (WRR).

The country study was conducted by researchers from Leyden Academy on Vitality and Ageing, IQ Health Radboudumc and Erasmus School of Health Policy & Management (ESHPM), and forms a background study to the ongoing WRR advisory project Sustainable Care.

View the report here.

IQ Health was commissioned by the NTS Foundation to conduct a scientific study on the validity and reliability of the Dutch Triage Standard (NTS) in adults. In a nationwide study, 41 cases with real and common health complaints were assessed by 102 experienced triagists from the 3 partners in the emergency care chain: GP out-of-hours surgery (HAP), the Ambulance Dispatch Centre (MKA) and the Emergency Department (ED).

View the report here.

For people with a cochlear implant (CI), listening to music and enjoying music is a challenge. From her own experience, pianist Joke Veltman developed a training course that can bring music enjoyment back into the lives of people with cochlear implants. The report "Project Musi-CI ZonMw Project 'For Each Other!'" describes the further development of this training.

Open the report

New ways of working at the Beatrix Hospital in Gorinchem and hospital Bernhoven in Uden have improved the efficiency of care. The hospitals set up their organisations in such a way that the quality of care for the patient is more of a priority and that they are less focused on the number of treatments. Care providers' initiatives are given more space, there is more cooperation with GPs and organisational changes have been made. Also, agreements are no longer made with the insurer per treatment, but fixed amounts have been agreed for five years. This is according to the just-published evaluation of the new ways of working by the Netherlands Bureau for Economic Policy Analysis (CPB), IQ Health and the Dutch Healthcare Authority (NZa).

The hospitals each had their own strategy that suited their situation. In Bernhoven, for instance, all medical specialists went into salaried employment and in the Beatrix Hospital, a different distribution model for financing medical specialists was introduced. In Bernhoven, in addition, an organisational change was implemented in which the hospital was organised according to four types of care provision: acute care, diagnosis and indication, interventional care lines and chronic care.

The changes at both hospitals were made possible by five-year contractual agreements with the region's main health insurers (VGZ and CZ). This provided financial stability and reduced the incentive to treat as many patients as possible, and gave the hospitals room to make major organisational changes. Important for the outcome was the launch of over 50 initiatives from the shop floor to improve quality, as well as good cooperation with GPs and health insurers and the removal of unwanted incentives to treat among medical specialists.

Three years after implementation, treatment volume (the value of DBC treatments) decreased by 13% at Bernhoven and 7% at Beatrix Hospital, compared to other hospitals. This decrease came about through both less and less intensive treatment. For instance, both hospitals saw a stronger shift from inpatient care to day treatment and more care was done by GPs in the region than at comparable hospitals.

There is little evidence of negative effects. The study shows that there has been no shift of patients to other hospitals in the region. The quality of care at both hospitals did not change on average, according to the study.

More efficient care is an important first step towards lower healthcare spending. After all, it offers room for hospitals to (eventually) reduce healthcare spending and for health insurers to lower healthcare premiums for policyholders. However, a longer-term evaluation is needed to determine whether the change programmes will lead to lasting financial savings.

For more information:

View the report here.
Authors: Simone van Dulmen, Niek Stadhouders, Gert Westert, Erik Wackers, Patrick Jeurissen

Read the three parties' joint policy brief: Evaluation of Beatrix Hospital and Bernhoven programmes, CPB Policy Brief. CPB/IQHealth/NZa. (2020).

Read more in the background paper on the CPB and NZa study: CPB/NZa. (2020). Case study Beatrix hospital and Bernhoven.

Primary care is not failing due to a lack of goodwill

Recent qualitative research conducted within three Dutch healthcare regions by IQ Health as part of the Primary Care Learning and Improvement Network (LeVEL) shows that primary care does not lack a willingness to collaborate. Between November 2025 and March 2026, the study interviewed 21 healthcare and welfare professionals about the day-to-day practice of regional collaboration, the bottlenecks they experience in this regard, and the conditions they believe are necessary to organise primary care in a future-proof manner.

The central message of the report is that collaboration in primary care does not falter due to a lack of motivation among professionals, but primarily due to organisational, governance and funding issues.

Analysis of the interviews revealed that collaboration in primary care can be understood as a complex, adaptive process arising from daily interactions at the system, network and professional levels. Five themes were identified that can support the move towards better collaboration: (1) Interprofessional dynamics and social network structure, (2) Governance links and power relations, (3) Sense of urgency, (4) Structural funding, (5) The role of LeVEL as a support network.

With these findings, the report directly addresses current issues surrounding access to care and regional collaboration, as described in the Primary Care Vision 2030 (Ministry of Health, Welfare and Sport and primary care stakeholders). The instinct in policy-making is often to seek ‘the’ solution or ‘the’ organisational model for primary care. This research, however, shows that collaboration is difficult to capture in a single blueprint.
Effective collaboration develops locally, step by step, based on trust, clear roles, designated contact persons and the opportunity to learn from one another. This process requires less emphasis on new consultation structures and more attention to sustainable enabling conditions: time, organisational capacity, knowledge-sharing and appropriate funding.

The Primary Care Learning and Improvement Network (LeVEL) aims to strengthen primary care by establishing a learning healthcare system in which local, regional and national levels are interconnected. The project is funded by ZonMw. Further information about LeVEL can be found at: https://level.1sociaaldomein.nl

Rudi Steenbruggen, Marjo Maas, Ron van Heerde, Annick Bakker, Simone van Dulmen, Philip van der Wees, namens het LeVEL consortium. Naar sterke regionale samenwerking in de eerste lijn: inzichten uit de praktijk. IQ Health, Radboudumc, Nijmegen, juni 2026.

Read the report here (in Dutch only)

71% of oncology nurses would like to be authorised to prescribe medication. However, oncology nurses are currently unable to obtain this authorisation because the pharmacotherapy module is no longer offered as part of their training.

V&VN commissioned a study into the implementation of medication prescribing authority for nurses. Here are some findings from the report, compiled by Maud Heinen, Rosa Mennes and Juliette Cruijsberg of IQ Health, with involvement from Hester Vermeulen and Philip van der Wees:

➡️ 509 oncology nurses took part in the questionnaire

➡️ Only 5% stated that they actually had prescribing authority

➡️ 71% of oncology nurses without prescribing authority wish to obtain this authority

Many oncology nurses see this as an opportunity to apply their expertise in a more targeted way, to provide patients with appropriate care more quickly, and to reduce unnecessary steps in the care process.

V&VN is working with stakeholders to explore what is needed and feasible to ensure appropriate training and the necessary regulatory changes. The research shows that there is a significant need for this in practice.

 Read here the report and here the full news article on the website (in Dutch only): Voorschrijfbevoegdheid werkt, maar is nog niet vanzelfsprekend | V&VN

This report provides insight into which factors nurses, carers and nursing specialists (V&V) experience when (de)implementing quality standards and which strategies lead to successful application of recommendations from quality standards by V&V. The recommendations from this study should contribute to optimal application of quality standards in V&V professional practice and education.

Partners involved

• Dr E. Ista, ErasmusMC,
• Dr L. van Bodegom-Vos, LUMC
• Prof. Dr M. van Dijk, ErasmusMC,
• Dr M. Heinen, Radboudumc, IQ healthcare
• Dr A. Huis, Radboudumc, IQ healthcare
• Dr. A. Persoon, UKON
• Prof. H. Vermeulen, Radboudumc, IQ healthcare

Download the entire final report WINK V&V: What Is Needed for Implementation of Quality Standards for Nurses, Caregivers & Nursing Specialists?

Publications published from this study:

Implementation strategies used to implement nursing guidelines in daily practice: A systematic review.
Denise Spoon, Tessa Rietbergen, Anita Huis, Maud Heinen, Monique van Dijk, Leti van Bodegom-Vos, Erwin Ista.

Effects of de-implementation strategies aimed at reducing low-value nursing procedures: a systematic review and metaanalysis.
Tessa Rietbergen, Denise Spoon, Anja H. Brunsveld-Reinders, Jan W. Schoones, Anita Huis, Maud Heinen,
Anke Persoon, Monique van Dijk, Hester Vermeulen, Erwin Ista and Leti van Bodegom-Vos

This bottleneck analysis investigated how family and client participation is currently implemented and what bottlenecks are experienced by clients, relatives and (district) nurses, caregivers and nursing specialists.

Bottleneck analysis family participation in district nursing care - Family and client participation: what makes it difficult and how can it be improved?
Drs Elise van Belle, Drs Benjamin Wendt, Dr Anita Huis, Dr Maud Heinen, Drs Mariëlle Blankestijn, Dr Alette de Jong, Dr Lilian Vloet, Prof Hester Vermeulen, Prof Sandra Zwakhalen.