Knowledge bank

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?

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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.

To support nurses and caregivers with signaling and prevention of healthcare-associated infections, a new guideline has recently been issued. This guideline was developed by Dr. Anita Huis (senior researcher IQ Health) and her colleague Nynke Bos (junior researcher at IQ Health). The goal is for a team to gain insight into how it handles infection prevention measures and what can be improved. The guideline, implementation guide and hygiene chart can be found on the V&VN site.
Read more on the V&VN website.

The Maturity Matrix is a method for evaluating the level of development in a general practice. During the administration, each practice staff member is asked to complete the list individually and independently.

A consultant then leads a discussion to reach agreement among the practice staff. A discussion then takes place about improvement priorities and plans in the practice.

The international version of the Maturity Matrix was developed between 2005 and 2007 by the European association for quality in general practice (EquiP) and IQ Health in a partnership with Cardiff University.

See also:
Elwyn G et al . Facilitating organizational development using a group-based formative assessment and benchmarking method: design and implementation of the International Family Practice Maturity Matrix. Qual Saf Health Care. 2010;19(6):e48.

For more information, please contact Jolanda van Haren.

The IQ consensus tool supports groups in reaching consensus. It is based on the Modified RAND Delphi Method and combines the measures highest tertile, median, and score on top-3 to arrive at a score "selection," "discussion," or "no selection.

The tool consists of several components:

• An (online) questionnaire, in which respondents must score on a 9-point Likert scale and indicate a top-3 and can add any comments;
• An Access program in which all relevant data can be entered;
• A summary of the scoring results, indicating for each indicator whether the indicator scores "selection," "discussion," or "no selection. This document can serve for discussion.
• An overview of the comments per indicator.
• An overview of the scores per individual respondent.

For more information, please contact Drs. Janine Liefers.

The bottleneck questionnaire is a tool for identifying bottlenecks for change. The questionnaire can be used in both improvement projects and research.
From the application of the questionnaire described in the book 'Room for Change? Bottlenecks and opportunities for improvement in patient care' described in the book 'Space for change? This variation further underscores the importance of good bottleneck analysis in improving patient care.

The world is changing. A movement is visible in which the starting point is not the care system of the care provider, but the context of the patient as a person. Patients are also increasingly able to access tools that allow them to direct the care process from their intention.

The personal care net is an example of this. MijnZorgnet is owned by the Radboudumc and managed by IQ Health. It is an Internet place owned by the patient where there is the possibility to store, share and discuss information about your health.

The information can include diaries written by the patient, uploaded files of medical information and modular third-party applications such as forms, decision aids for shared decision-making and questionnaires. Patients can invite people they consider relevant to their health to join their personal care network. These could include family doctors, medical specialists and physical therapists, as well as family members or friends. Members of a care team have access to the personal data and can communicate about it. All activities in the personal care net are logged. In this way, the patient can see who has visited and when.

Identification and authentication on MijnZorgnet is via DigiD for patients and BIG validation for healthcare providers. After creating a profile, patients can set up their personal care net and get started.

For more information, please contact Prof. Jan Kremer.

The Excel application POINT 1.0 (Presentation of the Opportunity Costs of Introduction of New (Medical) Technologies 1.0) was developed as part of the project "Verdringseffecten binnen het Nederlandse zorgstelsel", commissioned by Zorginstituut Nederland. This project investigated the loss of value when introducing new healthcare interventions. Empirical research calculated how much producing a QALY in hospital care costs and how these opportunity costs were distributed across hospital care 2. This was calculated using an econometric model that relates changes in health outcomes to changes in hospital spending for the years 2012 to 2014.

POINT 1.0 uses the results of this report to visualize displacement effects at a glance. Filling in a limited set of data on a new medical technology shows whether the innovation is cost-effective, and if not, what the price reduction would have to be for the innovation to be cost-effective. The necessary data should all be available by default with a pharmacoeconomic file as submitted to ZIN. Medical technologies that have not taken that path but where a Dutch cost-effectiveness analysis is available usually also have the necessary information. In addition to the total displacement, the loss of value is also shown per disease state. This manual shows how the Excel application works and which parameters can be set or input.

Open POINT 1.0
Go to the user manual of POINT 1.0
Go to the final report on which POINT 1.0 is based
An illustration using the case study Orkambi

This questionnaire is designed to evaluate the process of interprofessional collaboration.
The questionnaire was developed by IQ Health in cooperation with Hogeschool Zuyd (Wim Goossens & Jerome van Dongen). The ReflectionScan (RISS-2020) can be used for both existing and newly formed teams.

Download Reflectiescan (RISS-2020)

Informal care is often very satisfying, but it can also be demanding at times. Informal caregivers who provide intensive care for long periods of time are at risk of becoming overburdened. It is important for caregivers, nurses and nursing specialists to be able to act in time to identify, prevent or alleviate overburdening.

IQ Health, in cooperation with the University Medical Center (UMC) Utrecht and the Hogeschool van Arnhem en Nijmegen (HAN), has developed a guideline on Informal Care. By using the guideline, young, working and elderly informal caregivers will be recognized earlier and (threatening) overburdening will be detected earlier. Informal caregivers will feel more heard and empowered in dealing with the care for their loved one.

The guideline was developed by Dr. Maud Heinen, Dr. José Peeters, Dr. Nicole Vullings, Prof. Dr. Hester Vermeulen and Prof. Dr. Maud Graff.

• The guideline can be found on the website of V&VN
• Read an additional introduction to ithere
• Report practice test guideline Informal care
• Infographic Informal caregiver
• Infographic Care professional

Nationwide, the call ''Pay a little attention to each other'' is heard in this time of the coronavirus. Togetherness and caring are not only desirable and necessary in situations of crisis.

For (care) questions and needs of residents, strong neighborhood networks are vital. The project "A strong neighborhood network: citizens, professionals and education SAMEN!" has resulted in an online toolbox. Citizens and professionals are given tools to build, organize and perpetuate a strong neighborhood network.

This toolbox came out of the project 'A strong neighborhood network: citizens, professionals and education SAMEN! In this project 2 living labs and 5 practical projects are involved.

This is a cooperation project between KOH, HAN University of Applied Sciences (lectorate Organization of Care and Services) and Radboudumc (departments IQ Health and Primary Care). The research was funded by the Ministry of Health, Welfare and Sport.

See website: Successful collaboration in neighborhood networks

Read also 'Collaborating with citizens. How to do it'.

This is a questionnaire for measuring team climate. This questionnaire is based on a theory of team climate and consists of 4 dimensions ('Experienced safety for participation', 'Support for innovation', 'Vision' and 'Task orientation') and 13 subscales.

IQ Health has translated and validated the TCI for the Dutch situation.
IQ Health can provide support in administering the questionnaire and prepare a report.

For more information, please visit www.teamclimateinventory.nl

Contact person: Jolanda van Haren