[Supervising quality of care through the patients' eyes; a different approach to inspection is required]. / Toezien op zorgkwaliteit door de ogen van patiënten.

The Netherlands Health and Youth Care Inspectorate (IGJ) wants to take the patient's perspective into account more often in its supervision of quality of care. The inspectorate already has some insight into this perspective via patients' reports; patients report complaints with the aim of preventing recurrence of the problem. However, the inspectorate does not further investigate the vast majority of these complaints and, furthermore, complaints with a clinical aspect are investigated far more often than organisational or communicational problems. Patients reports do not necessarily concern damage caused by deviation from professional guidelines, and if the IGJ really wants to look at quality of care from the patient's perspective then it should take the image presented by the patient more seriously. The patient's perspective suggests that it is important for the IGJ to pay more attention to organisational and communicational factors and other aspects of healthcare, along with medical professional standards.

Complaint handling in healthcare: expectation gaps between physicians and the public; results of a survey study.

BACKGROUND: Patients who submit complaints about the healthcare they have received are often dissatisfied with the response to their complaints. This is usually attributed to the failure of physicians to respond adequately to what complainants want, e.g. an apology or an explanation. However, expectations of complaint handling among the public may colour how they evaluate the way their own complaint is handled. This descriptive study assesses expectations of complaint handling in healthcare among the public and physicians. Negative public expectations and the gap between these expectations and those of physicians may explain patients' dissatisfaction with complaints procedures. METHODS: We held two surveys; one among physicians, using a panel of 3366 physicians (response rate 57 %, containing all kinds of physicians like GP's, medical specialist and physicians working in a nursing home) and one among the public, using the Dutch Healthcare Consumer Panel (n = 1422, response rate 68 %). We asked both panels identical questions about their expectations of how complaints are handled in healthcare. Differences in expectation scores between the public and the physicians were tested using non-parametric tests. RESULTS: The public have negative expectations about how complaints are handled. Physician's expectations are far more positive, demonstrating large expectation gaps between physicians and the public. CONCLUSIONS: The large expectation gap between the public and physicians means that when they meet because of complaint, they are likely to start off with opposite expectations of the situation. This is no favourable condition for a positive outcome of a complaints procedure. The negative public preconceptions about the way their complaint will be handled will prove hard to change during the process of complaints handling. People tend to see what they thought would happen, almost inevitably leading to a negative judgement about how their complaint was handled.

Stronger, but not (yet) an equal. The use of quality improvement instruments and strategies by patient organisations in the Netherlands.

This article deals with the questions what the benefits and limitations are of the instruments and strategies that patient organisations use to influence quality of care. The advocacy of patients' interests has become more important for patient organisations in recent years, which is partly due to Dutch health care policy reform. Thirty state funded quality improvement projects run by patient organisations between 2009 and 2012 have been analysed. The quality improvement instruments developed and used in these projects are concerned with: standardization and standard setting (What is good care?); consultation, comparison and checking (What is the state of the care given?); and negotiating and advising (How can quality of care be improved?). The choice for these instruments is partly based on patient organisations' strategies of scientization, valuing institutionalized methods and valuing good relationships. We see that the development and use of these quality improvement instruments do strengthen patient organisation and therefore have internal identity and organisational effects. However, the external effects patient organisations can have by using these instruments and strategies is limited or at least insecure by lack of economic capital after the development phase and lack of negotiating power. The external effects of these instruments and strategies depend largely on a patient organisation's network and the willingness, degree of openness and policy of other stakeholders to cooperate. Therefore, these forms of patient participation remain vulnerable.

Understanding health care providers' reluctance to adopt a national electronic patient record: an empirical and legal analysis.

BACKGROUND: Several countries are implementing a national electronic patient record (n-EPR). Despite the assumed positive effects of n-EPRs on the efficiency, continuity, safety and quality of care, their overall adoption remains low and meets resistance from involved parties. The implementation of the Dutch n-EPR also raised considerable controversy, which eventually caused the Dutch government to stop its contribution to the national infrastructure. AIM: To explain Dutch health care providers' reluctance in adopting the n-EPR, we investigated their perceptions of problems associated with the n-EPR and their legal position regarding then-EPR. We hereby aim to provide suggestions about approaches that could promote successful implementation. METHODS: The study consisted of two parts. The empirical part of the study was conducted in three health care settings: acute care, diabetes care, and ambulatory mental health care. Two health care organisations were included per setting. Between January and June 2010, 17 stakeholders working in these organisations were interviewed to investigate health care providers' perceptions of problems associated with the n-EPR. In the legal part of the study, legal documents were analysed to study health care providers' legal position regarding the n-EPR and any associated problems. RESULTS: The respondents expressed concerns about the confidentiality and safety of information exchange and the reliability and quality of patient data in the n-EPR, and indicated that their liability in case of medical errors was not sufficiently clear. The perceived problems could partly be attributed to legal uncertainties. CONCLUSIONS: It is recommended to start the implementation of an n-EPR in limited geographical areas. This will allow health care providers to experience benefits of electronic information exchange before being asked to participate in information exchange at a larger scale. The problems that health care providers perceive in the n-EPR should be minimised. Legislation underlying the n-EPR should provide sufficient clarity about health care professionals' responsibilities and liabilities.

Key factors influencing the implementation success of a home telecare application.

RATIONALE: The introduction of home telecare in healthcare organizations has shown mixed results in practice. The aim of this study is to arrive at a set of key factors that can be used in further implementation of video communication. We argue that key factors are mainly found in the organizational climate for home telecare implementation, the characteristics of the implementation strategy and the available technology. METHODS: Interviews were conducted in three care organizations with 27 respondents of different levels within and outside the organization. Implementation determinants, based on earlier research, were used as a categorization framework for the interviews. RESULTS: We found that most prominent factors influencing implementation outcomes relate to the stability of the technical and the external environment and the alignment of organization, goals and implementation strategy. CONCLUSION: Because of the experimental nature of implementing video communication, attention to telecare influencers has been inconsistent and disorganized but it is becoming increasingly important. According to the respondents, a champion-led roll-out is imperative for implementation in order to advance to the next stage in home telecare and to organize services for substitution of care.

Explaining differences between hospitals in number of organ donors.

The shortage of donor organs calls for a careful examination of all improvement options. In this study, 80 Dutch hospitals were compared. They provided 868 donors in a 5-year period, constituting 91% of all donors in that period in The Netherlands. Multilevel regression analysis was used to explain the differences between hospitals. Potential explanatory variables were hospital-specific mortality statistics, donor policy and structural hospital characteristics. Of all donors, 81% came from one quarter of the hospitals, mainly larger hospitals. A strong relationship was found between the number of donors and hospital-specific mortality statistics. Hospitals with a neurosurgery department had additional donors. Seven hospitals systematically underperformed over a period of 5 years. If these hospitals were to increase their donor efficiency to their expected value, it would lead to an increase of 10% in the number of donors. Most donors are found in large hospitals, implying that resources to improve donor-recruitment should be channelled to larger hospitals. This study presents an efficient strategy toward a benchmark for hospitals of their organ donation rates. Some larger hospitals performed less well than others. This suggests that there is still room for improvement. There is no evidence for large undiscovered and unused pools of donor organs.

Public trust in Dutch health care.

This article describes the development of a valid and reliable instrument to measure different dimensions of public trust in health care in the Netherlands. This instrument is needed because the concept was not well developed, or operationalized in earlier research. The new instrument will be used in a research project to monitor trust and to predict behaviour of people such as consulting "alternative practitioners". The idea for the research was suggested by economic research into public trust. In the study, a phased design was used to overcome the operationalization problem. In the first phase, a qualitative study was conducted; and, in the second, a quantitative study. In the first phase, more than 100 people were interviewed to gain insight into the issues they associated with trust. Eight categories of issues that were derived from the interviews were assumed to be possible dimensions of trust. On the basis of these eight categories and the interviews, a questionnaire was developed that was used in the second phase. In this phase, the questionnaire was sent to 1500 members of a consumer panel; the response was 70 percent. The analysis reveals that six of the eight possible dimensions appear in factor analysis. These dimensions are trust in: the patient-focus of health care providers; macro policies level will have no consequences for patients; expertise of health care providers; quality of care; information supply and communication by care providers and the quality of cooperation. The reliability of most scales is higher than 0.8. The validity of the dimensions is assessed by determining the correlation between the scales on the one hand, and people's experience and a general mark they would assign on the other. We conclude that public trust is a multi-dimensional concept, including not only issues that relate to the patient-doctor relationship, but also issues that relate to health care institutions. The instrument appears to be reliable and valid.

Prevalence of back pain and characteristics of the physical workload of community nurses.

A research project is described that analyses the back pain prevalence and physical working conditions of community nurses. The purpose was to compare the position of nurses working in institutional care with the specific situation of nurses working in the private homes of their patients. The results of a questionnaire showed that the back pain prevalence was relatively high as compared to other occupations and also when compared to other health care sectors. The home care organization is influenced not only by sick leave due to back pain, but also its efficiency is hampered by nurses with back pain who continue to work. It appeared that the total sick leave incidence due to musculoskeletal disorders other than back pain exceeds that due to back pain alone. The physical exposure level not only consisted of frequent and heavy lifting and transferring of patients but also a substantial static workload was present. The onset of back pain seems to result from a gradual build up of overload reaching its maximum. A preventive approach should take these differential loading factors into account. The consequences for preventive interventions are discussed resulting in recommendations towards a (participatory) ergonomic approach. This material forms the baseline of a controlled prospective trial in home care.

Quality of care and patient satisfaction: a review of measuring instruments.

Surveying the literature on the assessment of quality of care from the patient's perspective, the concept has often been operationalized as patient satisfaction. Patient satisfaction has been a widely investigated subject in health care research, and dozens of measuring instruments were developed during the past decade. Quality of care from the patient's perspective, however, has been investigated only very recently, and only a few measuring instruments have explicitly been developed for the assessment of quality of care from the patient's perspective. The authors consider patient satisfaction as an indicator of quality of care from the patient's perspective. This review is concerned with the question of whether any reliable and valid instruments have been developed to measure quality of care from the patient's perspective.

Changes in food choices of recently diagnosed insulin-dependent diabetic patients.

Current food use and habitual food use prior to the diagnosis of diabetes were measured using a food frequency questionnaire in a group of recently diagnosed insulin-dependent diabetic patients. Patients (51 m, 29 f) were between the ages of 20 and 40 years and had been diagnosed as insulin-dependent diabetics less than 6 months prior to the study. The results show that patients after the diagnosis of diabetes reduce their consumption of foods and beverages with high sugar content, of snacks and of foods from the dairy and meat group with high fat content, and incorporate foods with low fat content into their pattern of food consumption. Some of the changes have been less favourable from a nutritional perspective such as the increased consumption of diabetic specialty foods, the reduced consumption of pulses, and the lower overall food variety. In conclusion, patients are able to change their food use after the diagnosis of the insulin-dependent diabetes; however the extent to which patients will change their food choices on a long-term basis remains to be determined.