An EU approach to health system performance assessment: Building trust and learning from each other.

EU countries have recently joined forces to carry out common work on health systems performance assessment (HSPA). After the signature of the Tallinn Charter in 2008, a small group of countries brought the issue of HSPA on the EU agenda; this led the European commission and member states to set up an expert group on HSPA in 2014. This group started by facilitating the exchange of best practices and lessons learnt, with an eye to avoiding duplications with activities of international organisations. While progressing on its work, the group broadened its scope: it stepped into concrete work on policy priorities such as the assessment of quality of care, integrated care and primary care. It also moved into the organisation of country-tailored events and of advocacy activities. We identify three main strength factors of the EU expert group on HSPA. First, it is built through a bottom-up participatory approach, which promotes a sense of ownership by the members. Second, it developed a flexible and pragmatic attitude, which makes it able to constantly adapt to emerging needs and priorities. Finally, the group positioned itself in a niche that was still to be exploited: the identification of ways to translate HSPA findings into effective policy making.

Obtaining full contact for measuring polydimethylsiloxane mechanical properties with flat punch nanoindentation.

Procedure to establish full contact between the sample and the 1 mm diameter cylindrical flat punch tip to measure polydimethylsiloxane (PDMS) mechanical properties using the Hysitron TriboIndenter is described. This procedure differs from the standard automated indentation because each indent has to be performed manually after establishing full contact with the sample surface. Incomplete contact happens because of the sample tilt with respect to the flat punch surface and results in incorrect elastic modulus values.•Automated indentation results in incorrect values of the elastic modulus due to initial incomplete contact between the flat punch and the PDMS sample surface, caused by the tilt, and using the unloading slope, which is affected by viscoelastic soft polymer deformation.•Correct procedure requires establishing the full contact between the tip and the sample. This is achieved by moving the tip into the sample in 1-2 µm increments, up to 40-80 µm maximum combined displacement, until the loading stiffness no longer increases.•The elastic modulus is calculated from the loading stiffness and the diameter of the flat punch, instead of the unloading stiffness, which is larger due to viscoelastic unloading. After establishing the full contact, other mechanical testing can be conducted.