An examination of the historical context of interprofessional collaboration in Dutch obstetrical care.

Collaboration between different groups of health care professionals is often rooted in a long and often difficult history. This history can exert a strong influence on how professionals collaborate and historical tensions can contribute to problems in contemporary practice. However, literature about interprofessional collaboration often ignores the historical underpinnings of collaboration. In this paper, the historical development of interprofessional collaboration between obstetricians and midwives within the setting of Dutch obstetrical care is explored using a review of Dutch and English literature for documents explicitly or implicitly describing the historical development of this collaboration. This literature delineates the establishment of professional boundaries and the formalization of the collaboration between the two professions. It also details the history of physician domination over the midwives both in midwifery practice and education and the relatively recent reversal of this situation. Moreover, the shift in collaborative partner from general practitioner to obstetrician and its effect on collaboration is examined. Insight into the historical foundations of Dutch maternity care collaboration may allow us to understand the origins, and thus formulate possible solutions, for contemporary problems within this collaboration.

A case study of haemoglobinopathy screening in the Netherlands: witnessing the past, lessons for the future.

OBJECTIVES: In 2007 neonatal screening (NNS) was expanded to include screening for sickle cell disease (SCD) and beta-thalassaemia. Up until that year no formal recommendations for haemoglobinopathy (carrier) screening existed in the Netherlands. Although it has been subject to debate in the past, preconceptional and prenatal haemoglobinopathy carrier screening are not part of routine healthcare in the Netherlands. This study aimed to explore the decision-making process of the past: why was the introduction of a screening programme for haemoglobinopathy considered to be untimely, and did ethnicity play a role given the history in other countries surrounding the introduction of haemoglobinopathy screening? DESIGN: A witness seminar was organised, inviting key figures to discuss the decision-making process concerning haemoglobinopathy screening in the Netherlands, thereby adding new perspectives on past events. The transcript was content-analysed. RESULTS: The subject of haemoglobinopathy screening first appeared in the 1970s. As opposed to a long history of neglect of African-American health in the United States, the heritage of the Second World War influenced the decision-making process in the Netherlands. As a consequence, registration of ethnicity surfaced as an impeding factor. However, overall, official Dutch screening policy was restrained regarding reproductive issues caused by fear of eugenics. In the 1990s haemoglobinopathy screening was found to be 'not opportune' due to low prevalence, lack of knowledge and fear of stigmatisation. Currently the registration of ethnicity remains on the political agenda, but still proves to be a sensitive subject. DISCUSSION: Carrier screening in general never appeared high on the policy agenda. Registration of ethnicity remains sensitive caused by the current political climate. Complexities related to carrier screening are a challenge in Dutch healthcare. Whether carrier screening will be considered a valuable complementary strategy in the Netherlands, depends partly on participation of representatives of high-risk groups in policy making.

[Uncertainties with starting new vaccinations: a comparison between polio and covid-19 vaccination]. / Onzekerheden bij invoering nieuwe vaccinaties.

In 1956 The Netherlands experienced a major outbreak of poliomyelitis with over 2200 patients. A vaccine was in reach, and it was used. Now, polio is nearly eradicated globally with vaccinations. In 2020 a similar situation occurred with COVID-19. Large-scale vaccinations form an essential tool to combat the epidemic. This article describes uncertainties to start both mass vaccination campaigns, and reflects on similarities and differences then and now.

[System disease or wear and tear?] / Slijtage of systeemaandoening?

The answer to the question which phenomena should be seen as a disease changes over the course of history. This article discusses, on the basis of the historical development of the concepts of arthritis and arthrosis, that the painful joint conditions that we now call 'arthrosis' have been viewed, and - importantly - treated, over the past 150 years, as both aging versus disease, and as systemic versus local. The specialists who were most involved - rheumatologists and orthopedic surgeons - followed different explanatory models and scenarios for treatment. Over the course of the 20th century, arthrosis emerged as an independent clinical entity, which some concluded may be the result of a normal aging process. This discussion leads to the idea that diseases do not have an essence separate from diagnostic and therapeutic practices.

"Strangers in the ER": Quality indicators and third party interference in Dutch emergency care.

RATIONALE, AIMS, AND OBJECTIVES: This paper examines a remarkable dispute between Dutch insurers, hospitals, doctors, and patients about a set of quality indicators. In 2013, private insurers planned to drastically reform Dutch emergency care using quality indicators they had formulated drawing from clinical guidelines, RCTs, and systematic reviews. Insurers' plans caused much debate in the field of emergency care. As quality indicators have come to play a more central role in health care governance, the questions what constitutes good evidence for them, how they ought to be used, and who controls them have become politically and morally charged. This paper is a case study of how a Dutch public knowledge institution, the National Health Care Institute, intervened in this dispute and how they addressed these questions. METHOD: We conducted ethnographic research into the knowledge work of the National Health Care Institute. Research entailed document analysis, participant observation, in-depth conversations, and formal interviews with 5 key-informants. RESULTS: The National Health Care Institute problematized not only the evidence supporting insurers' indicators, but also-and especially-the scope, purpose, and use of the indicators. Our analysis shows the institute's struggle to reconcile the technical rationality of quality indicators with their social and political implications in practice. The institute deconstructed quality indicators as national standards and, instead, promoted the use of indicators in dialogue with stakeholders and their local and contextual knowledge. CONCLUSIONS: Even if quality indicators are based on scientific evidence, they are not axiomatically good or useful. Both proponents and critics of Evidence-based Medicine always feared uncritical use of evidence by third parties. For non-medical parties who have no access to primary care processes, the type of standardized knowledge professed by Evidence-based Medicine provides the easiest way to gain insights into "what works" in clinical practice. This case study reminds us that using standardized knowledge for the management of health care quality requires the involvement of stakeholders for the development and implementation of indicators, and for the interpretation of their results.