1see also www.healthoutlook.nl
Dutch Health Outlook 2013
The Dutch Health Outlook is created under the supervision of Prof. dr. Fred van Eenennaam and Ir. Maarten Koomans. It is supported by the International Academic Advisory Council
-Academic partners--Developer-
“From Bench to Bed”
Monitoring Applied Research,
Innovation and Valorization
-Since 2013-
-Partners-
-The First Edition-
2see also www.healthoutlook.nl
Acknowledgement
Thanks to all participating hospitals and its data collectors.
Participating hospitals 2013
We would like to thank to all who made it possible. The help and insights of many (cluster) experts was essential in creating the
Dutch Health Outlook 2013. For all experts involved please refer to page(s) 98 and 99.
1 Albert Schweitzer ziekenhuis, Dordrecht
2 Amphia Ziekenhuis, Breda
3 Atrium Medisch Centrum, Heerlen
4 Canisius-Wilhelmina Ziekenhuis, Nijmegen
5 Catharina Ziekenhuis, Eindhoven
6 Deventer Ziekenhuis, Deventer
7 Gelre ziekenhuizen, Apeldoorn
8 HagaZiekenhuis, Den Haag
9 Isala klinieken, Zwolle
10 Jeroen Bosch Ziekenhuis, ‘s Hertogenbosch
11 Kennemer Gasthuis, Haarlem
12 Maasstad Ziekenhuis, Rotterdam
13 Martini Ziekenhuis, Groningen
14 Máxima Medisch Centrum, Eindhoven
15 Meander Medisch Centrum, Amersfoort
16 Medisch Centrum Alkmaar
17 Medisch Centrum Haaglanden, Den Haag
18 Medisch Centrum Leeuwarden
19 Medisch Spectrum Twente, Enschede
20 Onze Lieve Vrouwe Gasthuis, Amsterdam
21 Reinier de Graaf Groep, Delft
22 Rijnstate, Arnhem
23 Sint Franciscus Gasthuis, Rotterdam
24 Sint Lucas Andreas Ziekenhuis, Amsterdam
25 Spaarne Ziekenhuis, Hoofddorp
26 St. Antonius Ziekenhuis, Nieuwegein
27 St. Elisabeth Ziekenhuis, Tilburg
28 VieCuri Medisch Centrum, Venlo
3see also www.healthoutlook.nl
Summary (1/3)
The first Health Outlook aims to attract, and provide insights to applied research and its performance…
Attract applied research
Applied Research Hospitals* should attract applied research and need to be
aware of the importance of applied research to supporting, connecting and
improving the innovative Life Sciences & Health cluster, and their own
contribution to applied research.
Showcase the applied research performance
Applied Research Hospitals should showcase to the Netherlands, to their
industry and international clusters that the Dutch hospitals are performing well
on applied research.
Provide insights into the applied research
Applied Research Hospitals should provide insights in applied research since
this proves a valuable tool for all healthcare stakeholders, as individual
hospitals can use the results to compare and optimize their outcomes.
* From now on, applied research hospitals will be called “hospitals“. University Medical Centers (UMCs) are not included in this report.
This study was conducted on 16 out of 28 STZ hospitals. In this report the words “applied research hospitals” and “ (total) STZ hospitals” are used interchangeably.
Context
Providing
affordable
and high
quality care.
Health
Wealth
Aims
4see also www.healthoutlook.nl
Dutch Life Sciences & Health Outlook 2013:
Key Conclusions
Summary (2/3)
…by collecting and comparing data of 16 applied research hospitals, in order to build a database for the future
which will show progress, be comparable with international clusters…
• Applied research hospitals seem to vary heavily in
their ability to be relevant in applied research that
connects with industry and patients.
Size, level of expertise, support and connection with
industry and openness seem to matter.
• Hospitals that outperform collaborate above average
with the industry.
Outperformance on output: publications, innovation and
efficiency.
• Publishing and performing applied research are
clearly part of the core business of applied research
hospitals.
In particular clinical trials in phase 3 and medical devices.
For detailed data please see chapter 3
OUTPUT
No. of publications: 3057 publications cited
Lead time of clinical trials: 65 days
No. of
new products: 21*
new protocols: 144**
new guidelines: 159**
new treatments : 101**
SIZE
Size of clinical trials: 7745 patients*
Inflow of patients from
outside catchment area: 12 % admissions
10.4 % outpatient visits
INPUT
Industry investments: 630 research projects**
Hospital R&D investments: 10,8 m€**
Data
*Extrapolation based on number of publication cited. ** Extrapolation based on number of employees. For more information see chapter 4
5see also www.healthoutlook.nl
Summary (3/3)
… and stimulate and improve applied research by sharing (next) best practices in 4 overall themes.
C) Create visibility, a research culture and commitment
• BP 6: An education-driven organization will stimulate the preparation of protocols.
• BP 7: Involve specialists in quality management, and create commitment and (double) learning loops.
• BP 15: Invest in a research culture.
• BP 17: Create insight into costs and investments, to be able to allocate the right resources to the right activities.
A) Attract and invest in expertise and create internal structures
• BP 4: Stimulate an active policy and support the research committee and LTC (Local Ethics Committee) that enforces guidelines and business plans
to optimize research.
• BP 8: Obligate the recording (protocoleren) of research.
• BP 9: Register new protocols, treatments and guidelines adopted in a common, central database.
• BP 11: Stimulate and build research support structures.
• BP 13: Attract and invest in the expertise of the core staff members.
• BP 16: Coordinate research at a decentralized level too, to stimulate multicenter studies.
B) Invest in industry
• BP 1: Harmonize, discuss and share knowledge on events, to create leverage and enhance innovation.
• BP 3: Invest in a relationship with the industry.
• BP 5: Cooperate with industry and other partners, as universities and connect with their experts and professors.
• BP 12: Create visibility to industry partners, cluster location seems to matter.
D) Cooperate with other hospitals
• BP 2: Initiate, cooperate and participate in multidisciplinary studies to have access to knowledge.
• BP 10: Share best practices internally to increase knowledge: exchange of ideas may help the development of new products.
Key (next) Best Practices
The Key (next) Best Practices are based on: 1) best performing hospitals, 2) literature research, 3) advice from experts, 4) International Academic Advisory Council, 5) cluster
experiences by researches, 6) other industries. More detailed information about the Key (next) Best Practices can be found in chapter 4.
6see also www.healthoutlook.nl
Contents of the Dutch Health Outlook 2013
Key outcomes Dutch Health Outlook 2013
Executive summary 8
Background (Shaping – Defining – Measuring) 9
Data and conclusions 20
Next best practices 27
The Outlook 2013 has been compiled with the utmost care based upon available data in 2011. Readers are advised to contact the authors of the report to avoid potential misinterpretations of
the reported results. Authors welcome suggestions for improvement for the Outlook 2014 (please contact [email protected]) .
1
Guide to interpret data
A roadmap 32
Appendices
A. History, development and structure of the Health Outlook 67
B. About the involved partners 86
C. Bibliography 90
D. Consulted experts and organizations 97
Not included in this version but available for download at www.healthoutlook.nl
E. Key steering indicators 102
F. Monitoring Methodology – extended version 114
2
4
Monitoring
Key performance indicators (Definition – Measuring – Improving)
Output 38
Size 52
Input 59
3
7see also www.healthoutlook.nl
Should you like to make a decision based on:
_cons -.2098312 .3924445 -0.53 0.593 -.979094 .5594315 wcj 5.77e-07 3.49e-07 1.66 0.098 -1.06e-07 1.26e-06 dso6 .0098075 .3915849 0.03 0.980 -.7577703 .7773853 dso5 -.028818 .4020896 -0.07 0.943 -.8169869 .7593509 dso4 .0843082 .0983582 0.86 0.391 -.1084917 .2771082 dso3 .043337 .390496 0.11 0.912 -.7221063 .8087804 dso2 .0709971 .3904501 0.18 0.856 -.6943563 .8363505 dso1 .0771048 .3902956 0.20 0.843 -.6879458 .8421553 en18 -.027078 .0071182 -3.80 0.000 -.0410309 -.0131251 enf6 -.0081408 .014602 -0.56 0.577 -.0367635 .0204818 enf3 .0264903 .01663 1.59 0.111 -.0061076 .0590882 dip6 .0779941 .0245033 3.18 0.001 .0299632 .126025 dip5 .0796747 .0175065 4.55 0.000 .0453587 .1139906 dip4 .1522206 .0231657 6.57 0.000 .1068115 .1976296 dip3 .1814161 .0263996 6.87 0.000 .1296682 .2331641 dip1 .1824788 .0320881 5.69 0.000 .1195804 .2453773 hh .2240197 .0003729 600.79 0.000 .2232888 .2247506 expe2 -.000369 .0001039 -3.55 0.000 -.0005726 -.0001654 expe .0188156 .0041323 4.55 0.000 .0107154 .0269157 lw Coef. Std. Err. t P>|t| [95% Conf. Interval]
Total 213648.347 10888 19.6223684 Root MSE = .67525 Adj R-squared = 0.9768 Residual 4956.30251 10870 .455961593 R-squared = 0.9768 Model 208692.045 18 11594.0025 Prob > F = 0.0000 F( 18, 10870) =25427.59 Source SS df MS Number of obs = 10889
Applied research Improving Health Cluster
Measuring KPIs & KSIs Core business
Outperformance
See page no 15, 16, 22See page no 41, 44, 47, 50, 55, 58, 62, 65 See page no 11, 13, 14, 15
See page no 40, 43, 46, 49, 54, 57, 61, 64 See page no 39-65 See page no 22, 26, 40, 54
See page no 25, 28-30,
8see also www.healthoutlook.nl
Key outcomes Dutch Health Outlook 2013
© Rebke Klokke, Utrecht
Executive summary
• Background (Shaping – Defining – Measuring)
• Data & Key Conclusions
• Key best practices
1
9see also www.healthoutlook.nl
Need for a shift in productivity
In order to make the Dutch healthcare system sustainable, a shift is needed in its productivity frontier: optimizing
value per Euro spent…
DEFINING MEASURINGSHAPING
Sources: Blendon et al. (2004), Christensen et al. (2009), and a The Decision Group analysis (2010)
Current situation
Based upon: Porter (1996). What is Strategy? Harvard Business Review, November-December 1996: 59-78
Health Expenditure is outgrowing, resulting in a
pressure to cut costs and in the same time to
delivery better value to patients.
BACKGROUND
10see also www.healthoutlook.nl
Enhancing applied research, innovation and development
…by improving cooperation between the Life Science cluster and the Health cluster and enhancing at the same
time applied research, innovation and valorization.
Sources: Blendon et al. (2004), Christensen et al. (2009), and a The Decision Group analysis (2010)
Applied Research, Innovation and Valorization is the base of the five
recognized leverages of Christensen, to increase productivity.
DEFINING MEASURINGSHAPING
BACKGROUND
11see also www.healthoutlook.nl
A focus on the cross-over: Life Sciences & Health
On the cross-over of Life Science & Health (product supply market) the four main players each have
their own point of view on the current situation of cooperation.
Care & Cure
“In our hospital patient care is number 1, however a focus
on research and creating new treatments and products is
also necessary to increase patient value”.
Views on the cross-over
Industry
“We need the hospitals to run clinical trials on our new
products; speed, patient size and expertise of researchers
are critical success factors in our business.”
“Since we have a commercial point of view, trust is
sometimes difficult and hampers co-creation and product
development.”
Patients
“I would like to receive the best care
there is. New products and treatments
should be available on the market as
soon as possible. However, safety
and the added value should be
known.”
Insurers
“Of course, we would like to stimulate
cooperation, to create new ideas and
innovation. Our main concern is to get
people healthy as soon as possible”.
DEFINING MEASURINGSHAPING
BACKGROUND
12see also www.healthoutlook.nl
Monitoring the cross-over
The Health Outlook measures and monitors applied research, innovation, valorization and cooperation annually to
contribute to a successful and innovative Life Science & Health cluster.
Attract applied research
Applied Research Hospitals* should attract applied research and
need to be aware of the importance of applied research to
supporting, connecting and improving the innovative Life Sciences &
Health cluster, and their own contribution to applied research.
Showcase the applied research progress
Showcasing to the Netherlands, to its industry and international
clusters that the Dutch hospitals are performing well on applied
research.
Provide insights into the applied research
Getting insights in applied research proves a valuable tool for all
healthcare stakeholders, as individual hospitals can use the results to
compare and optimize their outcomes.
DEFINING MEASURINGSHAPING
BACKGROUND
13see also www.healthoutlook.nl
Definition of the Dutch Health Outlook 2013
The focus of the Dutch Life Sciences & Health Outlook 2013 is the performance of the innovative core of the
cluster of both the industry and part of the teaching and specialized care and cure providers.
Fundamental ResearchNGI, Hubrechts Institute
R&D
companies
Drugs and Medical
Device companies
(Pharma, Biotech,
Medical
Engineering)
Specialized Risk Capital
VC Firms, Angel Networks
Specialized Research
service providers
Contract
Manufacturing
Organizations,
Contract Research
Organizations
Clinical studies
Synthesis services
Specialized Business
Services
Banking, Accounting, Legal
Health Insurance
Laboratory, Clinical Testing
Laboratory
Equipment
Analysis Software
Diagnostic
Substances
Containers and
Packaging
Medical Equipment
Ophthalmic Goods
Educational InstitutionsUniversities
Cluster Organizations
Niaba, Nefarma,
Biofarmind, LSH
Chemical products
Bioelectronics,
Bioinformatics
Regulation
CCMO, METCs, FDA, EMA
Translational ResearchTiPharma, BMM, CTMM
Marketing & Sales
Reimbursement
Healthcare Insurance
Companies, VWS
Manufacturing
Distribution
Specialized
Research suppliers
Suppliers Value Chain Service Providers
The cluster map shows both
the value chain and the
supporting industries in the
Dutch LSH cluster. The
cluster map is in the process
of international recognition
Care and Cure
providers
Core Value Chain,
referred to top-sector
plan as innovative core.
Monitored with Life
Sciences Outlook.
16 out of 28 Top-clinical
hospitals are included in
the Health Outlook.
The Dutch Life Sciences Outlook 2013 was launched on 8th Feb 2013
The Dutch Health Outlook is launched on 14th June 2013
DEFINING MEASURINGSHAPING
BACKGROUND
14see also www.healthoutlook.nl
1 Albert Schweitzer ziekenhuis, Dordrecht
2 Amphia Ziekenhuis, Breda
3 Atrium Medisch Centrum, Heerlen
4 Canisius-Wilhelmina Ziekenhuis, Nijmegen
5 Catharina Ziekenhuis, Eindhoven
6 Deventer Ziekenhuis, Deventer
7 Gelre ziekenhuizen, Apeldoorn
8 HagaZiekenhuis, Den Haag
9 Isala klinieken, Zwolle
10 Jeroen Bosch Ziekenhuis, ‘s Hertogenbosch
11 Kennemer Gasthuis, Haarlem
12 Maasstad Ziekenhuis, Rotterdam
13 Martini Ziekenhuis, Groningen
14 Máxima Medisch Centrum, Eindhoven
15 Meander Medisch Centrum, Amersfoort
16 Medisch Centrum Alkmaar
17 Medisch Centrum Haaglanden, Den Haag
18 Medisch Centrum Leeuwarden
19 Medisch Spectrum Twente, Enschede
20 Onze Lieve Vrouwe Gasthuis, Amsterdam
21 Reinier de Graaf Groep, Delft
22 Rijnstate, Arnhem
23 Sint Franciscus Gasthuis, Rotterdam
24 Sint Lucas Andreas Ziekenhuis, Amsterdam
25 Spaarne Ziekenhuis, Hoofddorp
26 St. Antonius Ziekenhuis, Nieuwegein
27 St. Elisabeth Ziekenhuis, Tilburg
28 VieCuri Medisch Centrum, Venlo
The Dutch Healthcare system consists of
91 hospitals (without specialized centers);
including 8 University Medical Centers and
28 tertiary medical teaching hospitals
engaged in applied research.
The Care & Cure providers - Top-clinical hospitals
The Care & Cure providers include among others all Top-clinical hospitals of the Netherlands that
perform applied research.
In 2014, the definition
may broaden to:
1. More STZ hospitals
2. Specialty hospitals
and UMCs may be
included.
1Please note that a number of top-clinical hospitals provides patient care up to the highest level complexity of care.
2Please note that a schematic representation is given of hospital activities, i.e., general hospitals are not included in the group of top-clinical hospitals
Top-clinical hospitals (STZ)Academic hospital
Specialization
Qualit
y o
f care
* 16 out of 28 STZ hospitals are included
DEFINING MEASURINGSHAPING
BACKGROUND
15see also www.healthoutlook.nl
Applied Research Hospitals - Activities
The Health Outlook 2013 focuses on the value chain of the health cluster and its related activities to applied
research for the top medical teaching hospitals.
Applied research:
• Scientific publications, presentations
• Reporting on scientific activities (e.g. within annual reports)
• Complies to guidelines of Dutch Clinical Trial Foundation (DCTF) for applied scientific research
measured by the Health Outlook
DEFINING MEASURINGSHAPING
BACKGROUND
16see also www.healthoutlook.nl
Methodology to measure applied research
Literature Study - Monitoring Health International Advice on Clusters Pilot Study to Test Indicators
Support of Research Experts Roll out Study & Building the Database Review & Validation
We would like to thank all who made it possible. The help and insights of many (cluster) experts was essential in creating the
Dutch Health Outlook 2013. For all experts involved please refer to page(s) 98 and 99.
Together with experts, we developed a methodology to establish the first Health Outlook, monitoring applied
research.
DEFINING MEASURINGSHAPING
BACKGROUND
17see also www.healthoutlook.nl
Monitoring, Improving & Sharing Best Practices
9 Key Performance Indicators and 7 Key Steering Indicators have been developed to monitor and improve applied
research and to share (next) Best Practices.
Key
performance
indicators
Key
steering
indicators
ImprovingMonitoring
Best Practices
OUTPUT
• Number of publications cited
• Lead time of clinical trials
• Number of new products
• Number of new protocols, guidelines and
treatments
• Adoption rate of new products*
SIZE
• Size of clinical trials (number of patients
in trial)
• Inflow of patients from outside
catchment area
INPUT
• Industry investments
• Hospital R&D investments
• Number of best practices shared
among hospitals
• Costs of research projects
• Level of expertise
• Staff responsiveness
• Participation of staff in the
development, undertaking and use of
research
• Presence of research support offices
and transfer facilities in each hospital
• Cooperation relationships of hospital
research
* At this moment “adoption rate of new products” is not measured. Next year we aim to find and determine the right definition and to collect data on this specific performance indicator
Key Performance Indicators monitor the success of a cluster or set of organizations. Typically, performance indicators cannot be influenced directly by policy.
Key Steering Indicators can be influenced directly by policy makers. Typically, steering indicators are selected so as to have high impact on the success of a cluster or set of organizations.
DEFINING MEASURINGSHAPING
BACKGROUND
18see also www.healthoutlook.nl
Building and expanding the Health database
A new database was built to analyze data of the hospitals and based on a survey of which the answers were
carefully centralized.
Per hospital data
Data on Key Performance
and Key Steering Indicators
HagaZiekenhuis
St. Antonius Ziekenhuis
Rijnstate
Catharina Ziekenhuis
M.C. Haaglanden
Hospital by hospital checked database
Additional internal and external validity checks performed:
Hospital data from 16 individual hospitals
More than 500 respondents to survey employed within the 16 STZ hospitals taking part in this year’s Health Outlook
Function
Question / hospital
1.0 1.1 1.2 2.1.a 2.1.b 2.1.c 2.1.d 2.1.e 2.2.aneurolog Rijnstate ja nee c a a a a a
Rijnstate nee c a a a a a
kinderarts Rijnstate ja b c a a a a a
Rijnstate nee b a a a b a
internist-intensivist Rijnstate ja nee d a a a c a
kinderarts/medisch manager zorg Rijnstate nee c a a a a a
she arts Rijnstate nee b a a a a a
medish specialist Rijnstate nee b b a a a a
klinisch geriater MC Alkmaar ja ja b b a a a a
gynaecoloog MC Alkmaar ja nee b b a a a a
radioloog Rijnstate nee c a a b a a
anesthesioloog Rijnstate nee c a a b a a
SHE Rijnstate ja nee c a a b b a
chirurg Rijnstate ja ja b c a a b b a
radioloog Rijnstate ja ja b c a a b c a
internist Rijnstate ja nee c a a b a a
gynaecoloog Rijnstate ja nee c a a b a a
gynaecollog Zevenaar nee b a a b a a
longarts MC Alkmaar ja nee d a a b a a
arts onderzoeker MC Alkmaar ja ja c a a b a
Ziekenhuisapotheker MC Alkmaar ja nee c a a b a a
internist Rijnstate ja nee d b a b b a
patholoog Rijnstate nee c b a b a a
geriater Rijnstate ja nee b b a b a a
internist Rijnstate ja nee d b a b b a
anesthesioloog Rijnstate nee c b a b a a
internist-nefroloog MC Alkmaar ja c b a b c a
psycholoog MC Alkmaar ja nee b b a b a a
Hoofd Diëtetiek MC Alkmaar ja nee c b a b b a
MDL-arts Rijnstate ja nee d a b b a a
MDL-arts Rijnstate ja nee e b a c c a
orthopedish chirurg Rijnstate nee c b a a a
tandarts Rijnstate nee a a
kinderarts MC Alkmaar ja nee c a a a a b
arts-onderzoeker MC Alkmaar ja ja b b a a a a b
kinderarts Haga ja nee c c c a a b
radioloog MC Alkmaar ja nee c a a b b
MDL-arts Rijnstate ja nee d b b b b b
researchvpk Spaarne ja nee b a a c b
chirurg Rijnstate ja nee d a a a a c
anesthesioloog Rijnstate ja nee a d b b a b c
longarts Rijnstate ja ja c d d c a b c
dermatoloog Rijnstate ja nee d b a b c
orthopedish chirurg Rijnstate ja ja b b b a b b c
internist Rijnstate ja nee c b a b b c
chirurg Rijnstate ja ja a d b a b a c
internist-oncloog MC Alkmaar ja nee e b a b b c
researchverpleekundige MC Alkmaar ja nee b b a a a e
hoofd expertisecentrum Laboratorium voor KCHIMC Alkmaar ja nee c b a a b e
MKA-chirurg Rijnstate nee d b a b d e
longarts Haga ja ja b c b b a b
neurolog Rijnstate ja nee b b a c b
locatiemanager MC Alkmaar ja ja c c b a b c c
project leader clinical research Spaarne ja nee b a b a
anesthesioloog Rijnstate nee d b b a a a
neurolog Rijnstate nee a a
orthopedish chirurg Rijnstate ja nee c b a b c c
reumatolog Rijnstate ja ja b c b a a a
orthopedish chirurg Rijnstate ja c b a a b
Centralization of survey answers
Monitoring methodology to assess performance:
The methodology approach is based on the World
Economic Forum approach.
The nine key performance indicators are validated by
20+ hospital CEOs and management and medical staff.
The methodology is used to create international
standards within EU clusters.
The methodology has been checked by the International
Academic Advisory Council.
DEFINING MEASURINGSHAPING
BACKGROUND
19see also www.healthoutlook.nl
Experiences during data collection
Data collection itself results in building new infrastructures and gaining insight in the processes and procedures.
New ideas develop which improve the performance and the efficiency of applied research.
• Data registration, in general, is insufficient in hospitals, not only at
research offices but also at other supporting departments such as
Human Resources, Financial management and Health administration.
• Obtaining comparable data is difficult because the way of registration of
research projects differs between hospitals; how data is registered
differs between hospitals and which research projects are registered
differs as well between hospitals
• Hospitals have different local procedures, such as the local feasibility
procedure of the Board of Directors, with a different focus which leads to
different ways of registering data and thus, collecting data.
• The functionality of research offices is developing in a different way
between hospitals. Sharing best practices (such as a uniform way of
data collection of research projects) is desirable but there is also a need
for standardization.
Experiences
Bibi Blijham, Msc.
Data collector at 3 hospitals
Kwaliteitsmedewerker
Wetenschap
DEFINING MEASURINGSHAPING
BACKGROUND
20see also www.healthoutlook.nl
Data on the Life Sciences & Health Cluster 2013
OUTPUT
Revenue: 17.8 b€ (+0.6%)
Number of products: 122 (+10%)
SIZE
Number of companies: 343 (+4.3%)
Employment: 22.732 jobs (-6.7%)
INPUT
Public investments: 291 m€ (-2%)
Private investments raised: 1887 m€ (+574%)
Life Sciences cluster²Health cluster¹
*Extrapolation based on number of publication cited
** Extrapolation based on number of employees
OUTPUT
No. of publications: 3057 publications cited
Lead time of clinical trials: 65 days
No. of
new products: 21 *
new protocols: 144 **
new guidelines: 159 **
new treatments : 101 **
SIZE
Size of clinical trials: 7745 patients *
Inflow of patients from
outside catchment area: 12% admissions
10.4% outpatient visits
INPUT
Industry investments: 630 research projects **
Hospital R&D investments: 10,8 m€ **
DATA & KEY CONCLUSIONS
¹ For more info please see www.healthoutlook.nl
² For more info please see www.lifesciencesoutlook.com
21see also www.healthoutlook.nl
2
Key conclusions
Hospitals seem to vary heavily in their ability to be relevant in applied research
which connects with industry and patients. Ability depends on size, level of expertise, support and connection with industry and
openness.
Hospitals that outperform, collaborate more than average with industry.
Outperformance on output: publications, innovation and efficiency.
Publishing and performing applied research is clearly part of the core business
of hospitals.In particular clinical trials in phase 3 and medical devices.
3
1
DATA & KEY CONCLUSIONS
22see also www.healthoutlook.nl
0
5
10
15
20
25
30
35
40
No
of
rese
arch
pro
ject
s
Hospitals
No. of Industry Invested Projects
Position of
individual
hospitals
Hospital seems to vary heavily in their ability to be relevant in applied research
Variation in size, input and output is observed among the hospitals, showing differences in performance and
cooperation with industry.
Source: STZ & NFU (Red bars are Academic Medical Centers)
No. of publications cited
Examples of Key Performance Indicators, with high variation.
See chapter 3 for detailed information about KPI Industry Investments & Number of publications.
1
STZ individual hospitals
Mean n
orm
aliz
ed c
itatio
n s
core
DATA & KEY CONCLUSIONS
23see also www.healthoutlook.nl
Multiple affecting factors1
Factors such as size, level of expertise (number of professors, PhDs, GCP-certified), research support capacity,
connection with industry and openness to share best practices, seem to matter.
0 1000 2000 3000 4000 5000 6000
Employees
Ind
ivid
ual
ho
spit
als
Total employment
0 2 4 6 8
Professors
Ind
ivid
ual
ho
spit
als
No. of Professors
“As for the number of professors I dare to say that this is partly
the result of an active policy that we follow in cooperation with
academic institutions. Unlike many other hospitals, we focus
not only on cooperation with UMC's but also with other
academic institutions and disciplines.”
– Employee hospital
“Variation is a logic result of various factors. Some of these
factors, such as size, are not easy to influence. However,
openness to industry and other hospitals are more receptive
and can be steered.” – Researcher
See chapter 3 for detailed information about KPI Size of clinical trials & Level of expertise.
Example of 2 factors that influence variation
DATA & KEY CONCLUSIONS
24see also www.healthoutlook.nl
Performance of hospitals
The best performing hospitals measured by output: the number of publications, products, protocols, guidelines
and treatments (innovation) and lead time of clinical trials (efficiency)…
0 20 40 60 80 100 120 140No of days
Indiv
idu
al
Hospitals
Lead time of clinical trials
See chapter 3 for detailed information about KPI Lead time of clinical trials
2
DATA & KEY CONCLUSIONS
25see also www.healthoutlook.nl
Relationship performance & cooperation with industry
…collaborate more than average with industry based on industry invested research projects and staff
responsiveness to external partners (e.g. MKB* & Pharma).
*MKB stands for Midden en Klein bedrijven (Small and Medium-sized companies)
The graph shows a decreasing trend: hospitals with many
industry invested research projects have shorter lead times for
approval of clinical trials.
The graph shows an increasing trend: hospitals with many
industry invested research projects have a higher number of
publications.
2
DATA & KEY CONCLUSIONS
26see also www.healthoutlook.nl
Applied research is core business
Publishing and performing applied research is clearly part of the core business of hospitals. A total of
7445 patients are enrolled in clinical trials, with a total of 3057 citations.
Hospitals reported that for the year 2011, 90% of patients participating in clinical trials have been enrolled in Phase 3 (44%) and in Medical Devices trials (46%).
10%
44%
46%
Patients enrolled in clinical trials
PH2PH3M.D
3057
See chapter 3 for detailed information about KPI Number of Publications and Size of Clinical Trials.
3
7445
DATA & KEY CONCLUSIONS
27see also www.healthoutlook.nl
Research Support Offices
(roles and tasks)
• Training and educating personnel
• Negotiations with partners (industry
• METC & subsidy applications
• Data collection / project management
• Statistics
• Business development
• Support researches
• How to deal with rules and regulations
• How to set up a research line in their
own department.
(Next ) Best Practices - Expertise & Internal structures
Via various internal structures, such as research support offices and research committees the support can be
organized. A good database and information infrastructure facilitates decision making.
1
BEST PRACTICES
28see also www.healthoutlook.nl
(Next ) Best Practices - Relationships with Industry
Create a flywheel for applied research by investing in the relationships with industry. Participate in multi-
disciplinary studies and industry related events to share and have access to knowledge.
“A large number of specialists
and their departments have
developed a beautiful
structure, in which they have
become and remained a loyal
partner of the industry,
resulting in many clinical trials
and investments.” “Because of
these trials, a large part of
their own initiated studies can
be funded.”
Industry as a flywheel for research
Invest in attracting industry which in
turn will fund large projects. It is like a
circle, money earned can be
reinvested in applied research which
is attracting more industry
investments which in turn will fund
large projects…, etc.
2
BEST PRACTICES
29see also www.healthoutlook.nl
(Next ) Best Practices - Culture & Commitment
An ambitious culture and commitment is one of the internal keys of success. Research and innovation ideas
should be supported, shared and encouraged to create an optimal research environment.
“Everything starts with an ambition and a
specialist’ s guts and a norm that will be created.”
“Some departments have developed a mentality
with an imbued realization that if you want to
ensure specialized care (topreferente zorg) this
cannot be realized without the input of scientific
research.”
Next to patient care, the hospitals
have committed themselves to
perform applied scientific
research and stimulate health
care innovation.
3
© Rebke Klokke, Utrecht
BEST PRACTICES
30see also www.healthoutlook.nl
(Next ) Best Practices - Cooperate (Networks & Clusters)
Hospitals are more successful when they operate in a cluster with a strong local dynamic. Share best practices,
treatments, guidelines with partner hospitals to create leverage and enhancement of innovation.
“The outperforming departments also have a
specialist who is connected as a professor at a
university. As a result, research lines are created
with a continuous flow of PhD students and
publications.”
“We cooperate in many networks with universities,
IKZ (integral cancer south), and industry research
which also made research possible”
Source: STZ, Bibliometric analysis of STZ-hospitals
Red: STZ Hospitals Blue: University Hospitals: Green: Other universities Yellow: Others
Hospital structure
and strategy
4
BEST PRACTICES
31see also www.healthoutlook.nl
Health Outlook 2014: Learn, Share and Inspire
The Health Outlook aims to further improving. Learn from it, share it, get inspired and join the Life Sciences Outlook
2014 and Health Outlook 2014.
• include more hospitals
• include University Medical Centers
• address the international clusters
• improve KPIs and KSIs
11th Feb 2014 – Innovation for Health EventTo be determined
32see also www.healthoutlook.nl
Guide to read the data
A roadmap
2
© Rebke Klokke, Utrecht
33see also www.healthoutlook.nl
Monitoring & Improving – The Radar
The performance of the health cluster can be steered and improved by focusing on three themes: business
knowledge, cluster building and investment climate, each with their key steering indicators.
Dutch health cluster;
Key recommendations
Improving success of the health cluster and present
its international potential.
based on Key Steering Indicators
Improving
Dutch health cluster;
Cluster success
Measuring performance and progress
Dutch health cluster;
Key patient value concepts
Strategic assessment of progress
based on Key Performance Indicators
Monitoring
34see also www.healthoutlook.nl
Extrapolation
The Health Outlook 2013 aims to report the applied research of all hospitals. So far the data has been built using
the reports of 16 out of 28 hospitals.
* 61,3% and 43,41%. For detailed information about calculations and statistical tests please check ch. 4 on Monitoring Methodology
Not extrapolated
-No. of publication
-Lead time of clinical trials
-Inflow of patients from outside
catchment area
In some cases data is extrapolated across all hospitals. This is based on
extrapolation having as proxy, either the number of employees or number
of publications cited.
Example: there are 13 hospitals reporting the number of research
projects with industry. The sum of all reported projects is 301 and the
number of employment for those reporting hospitals is 47116. Total
employment with STZ hospitals is 93307. By applying
the Three Rule: equals 628 research projects for the STZ
hospitals.
The number of employees and or the number of publications cited
was/were taken as a proxy because the researchers found a correlation*
between the implied key performance indicators which had been
extrapolated and the number of Health Outlook employees.
Extrapolation based on number of
publications cited
- No. new products
- Size of clinical trials
Extrapolation based on number of
employees
- No. new protocols
- No. new guidelines
- No. new treatments
- Industry investments
- Hospital R&D investments
35see also www.healthoutlook.nl
Short management summaries
Every key performance indicator will have a short management summary: explanation on the rationale
(definitions), the results (measuring) and best practices (improving).
DEFINITION MEASURING IMPROVING
36see also www.healthoutlook.nl
Interpreting the graphs
For each indicator several scores are presented. Hospitals can compare their own results in their individual
hospital-specific Outlook.
The average, median, minimum and maximum value reported by hospitals is depicted, as well as the number of hospitals reporting (n). A separate graphindicates the total numbers for the Health Outlook hospitals and a total (extrapolated number) for all STZ hospitals.
KPI Information
On every slide the specific KPI or KSI isexplained.
*The Health Outlook is checked for validity by the International Academic Advisory Council. For more info please refer
to page 72.
Totals are obtained by extrapolation. In this edition; totals are based on all applied research hospitals minus the
University Medical Centers.
N = 15
630
37see also www.healthoutlook.nl
Monitoring
© TWU
Key performance indicators (Definition – Measuring – Improving)
3
© Rebke Klokke, Utrecht
38see also www.healthoutlook.nl
Key performance indicators - output
• Number of Publications
• Lead time of clinical trials
• No. of new protocols, treatments and
guidelines
• Number of products
EXTRA: short story on adoption rate of
new treatments
MEASURING IMPROVINGDEFINITION
OUTPUT© Rebke Klokke, Utrecht
39see also www.healthoutlook.nl
Number of publications cited
Definition
This indicator counts how many times a member hospital has been cited world wide, excluding local citations.
Proxy
Bibliometric analysis of STZ publications
Rationale
An higher number of citation indicates that an applied research hospital / or member of an applied research hospital is
more visible on the international research stage.
KPI - Number of publications cited
A higher number of publications cited indicates that a hospital or member of a hospital is more visible on the
international research stage. The Bibliometric analysis of STZ is used in the Health Outlook 2013.
MEASURING IMPROVINGDEFINITION
KPI – Number of publications cited
Number of publications cited from thehospital in one year.
40see also www.healthoutlook.nl
1320 13891631
18332035659 665
929968
1022
0
500
1000
1500
2000
2500
3000
3500
2007 2008 2009 2010 2011
No
of
cita
tio
ns
Total no of publications cited
Total STZ hospitals (n=28)
Health Outlook hospitals(n=16)
KPI - Number of publications cited
On average the number of citations of a hospital is 127 times a year. Compared to 2010, the total number of
citations increased by 9.14% (from 2801 to 3057) in 2011.
Source : The Decision Group and STZ database.
2054
KPI – Number of publications
Number of publications cited from the hospitalin one year.
1979
2560
2801
3057
61
127106
340
0
50
100
150
200
250
300
350
400
Minimum Average Median Maximum
No
of
qu
ota
tio
ns
No of publications cited
N=16
The Bibliometric analysis of STZ has been used. See for a detailed explanation Ch 4 Appendices - F. Monitoring Methodology – Extended version.
MEASURING IMPROVINGDEFINITION
41see also www.healthoutlook.nl
KPI - Number of publications cited
The high scoring hospitals perform more research projects with industry, indicating the importance of
cooperation.
Steering
The number of specialist that are first/main applicant at
LTC* (KSI5) and the number of participation to research-
events initiated by MKB (KSI 4) may be associated**
with the number of publications cited.
(Next) Best Practices
1. Harmonize, discuss and share knowledge on events,
to create leverage and enhance innovation.
“Some departments have developed a mentality with
an imbued realization that if you want to ensure
specialized care (topreferente zorg) this cannot be
realized without the input of scientific research.”
“These departments also have a specialist who is
connected as a professor at a university. As a result,
research lines are created with a continuous flow of
PhD students and publications.”
2. Initiate, cooperate and participate in multidisciplinary
studies to have access to knowledge.
3. Invest in a relationship with the industry: The best
scoring hospitals have more industry invested research
projects, showing a positive effect of industry on output
(i.e. publications).
.
See for a detailed explanation on correlations Ch. 4 Appendices page 82 and 83.
** The correlation coefficient with KSI 5 is 79,23% and with KSI 4 MKB is 39,48%.
*LTC stands for “Lokale Toetsingcommissie” which reads in English “Local Ethics Committee “
MEASURING IMPROVINGDEFINITION
42see also www.healthoutlook.nl
Definition Definition
Proxy
A sample of 10 studies within each hospital has been used to determine the lead time of clinical trials.
Rationale
To get an insight into the waiting time for approving of a clinical trial request by the board and until the first patient is enrolled
Proposal received
KPI - Lead time of clinical trials
To get an insight in efficiency, waiting time is measured: number of days from proposal received to local
feasibility.
The date on which the request for approval of each clinical
trial has been registered.
Local feasibility to
The starting date of a clinical trial, which is considered to be
the date that the board signs the proposal.
KPI – Lead time of clinical trials (Phase II and III for drugs and for medical devices)
Number of days from Proposal Received (regardless of completeness of proposal) to local feasibility (signature board of directors)
MEASURING IMPROVINGDEFINITION
43see also www.healthoutlook.nl
16
64
51
130
0
20
40
60
80
100
120
140
Minimum Average Median Maximum
No
of
day
s
Lead time
KPI - Lead time of clinical trials
A large variance in number of days from submission to approval is reported. The best performing hospital had a
lead time of 16 days.
KPI – Lead time of clinical trials (Phase II and III for drugs and for medical devices)
Number of days from Proposal Received(regardless of completeness of proposal) tolocal feasibility (signature board of directors)
N=15
The figures are based on an average among reporting hospitals. See for a detailed explanation Ch 4 Appendices - F.
Monitoring Methodology – Extended version.
- Source: The Decision Group database -
MEASURING IMPROVINGDEFINITION
44see also www.healthoutlook.nl
KPI - Lead time of clinical trials
In addition, performing more industry invested research projects has a positive relation on performance, in case of
efficiency: lead time of clinical trials.
Steering
The level of expertise (no of professors) (KSI 3) is
linked* with the lead time of clinical trials.
(Next) Best Practices
4. Stimulate an active policy and support the research
committee and LTC (Local Ethics Committee) that
enforces guidelines and business plans
to optimize research.
5. Cooperate with industry and other partners, as
universities and connect with their experts and
professors.
“Optimization of processes as lead time of clinical trials,
and in this case approval of proposals should be a
logical result of cooperation with partners, especially in
case these partners are profit-driven organizations like
big pharma.” – Prof. dr. Fred van Eenennaam – cluster
expert.
“As for the number of professors I dare to say that this is
partly the result of an active policy that we follow in
cooperation with academic institutions. Unlike many
other hospitals, we focus not only on cooperation with
UMC's but also with other academic institutions and
disciplines.” – Employee hospital* The correlation coefficient with KSI3 Professors is 12,91%.
See for a detailed explanation on correlations Ch. 4 Appendices on page 82 and 83.
MEASURING IMPROVINGDEFINITION
45see also www.healthoutlook.nl
New protocols and treatments
Definition
Proxy
Answers to survey* questions 3.1 to 3.4 are taken as a proxy for the number of new protocols, treatments and guidelines.
Rationale
New protocols and treatments are the result of applied research that lead to better patient outcomes.
KPI - No. of new protocols, treatments and guidelines
New protocols, treatments and guidelines are the result of applied research and innovation.
The plan for a course of medical treatment or for a scientific experiment.
KPI – Number of new protocols / treatments and guidelines
Number of new protocols and treatments
* For an overview of the question please see Ch4. Appendices on Monitoring Methodology – Extended version
MEASURING IMPROVINGDEFINITION
46see also www.healthoutlook.nl
KPI - No. of new protocols, treatments and guidelines
The respondents to the survey indicated they implemented a number of 96 protocols, 106 guidelines and 67
treatments.
KPI – Number of new protocols / treatments and guidelines
Number of new protocols and treatments(adopted at a national level, e.g., in guidelines)for which the hospital is the main applicant.**There is a positive linear correlation between no of new protocols, treatments and guidelines and no of citations. See for a
detailed explanation on correlations Ch4. Appendices on page 82 and 83.
96 106
67
0
20
40
60
80
100
120
140
160
180
Protocols Guidelines Treatments
# o
f p
roto
cols
/ g
uid
elin
es /
tre
atm
ents
Protocols / Guidelines / Treatments *
Total STZ hospitals (n=28)
Health Outlook Hospitals (n=13)
144
101
159
- Source: The Decision Group database -
*Underestimated due to self reporting. Next year improvements will be made to measure this indicator.
MEASURING IMPROVINGDEFINITION
47see also www.healthoutlook.nl
KPI - No. of new protocols, treatments and guidelines
Infrastructure to support research as well as participation in multicenter research studies increases the number of
new protocols and treatments.
Steering
The cost of research (KSI 2), the number of specialist
with application at LTC (KSI 5) and participation to
multicenter studies (KSI 7) shows a relationship* with the
number of new protocols, treatments and guidelines.
(Next) Best Practices
6. An education-driven organization will stimulate the
preparation of protocols.
7. Involve specialists in quality management, and create
commitment and (double) learning loops.
“Learning, training and research are a crucial part of our
hospital. All our specialists are a member of the quality
committee. This committee has a strong focus on
education. The enthusiasm of this committee will lead to
a culture whereby creating protocols of new ways of
working is stimulated.”
8. Obligate the recording (protocoleren) of research.
Done by one of the best performing hospitals.
9. Register new protocols, treatments and guidelines
adopted in a common, centrally database. At this
moment hospitals do not have a clear view.
See for a detailed explanation on correlations Ch4. Appendices on page 82 and 83.:
* The correlation coefficient with KSI 2 Cost of research is 38,56%.
MEASURING IMPROVINGDEFINITION
48see also www.healthoutlook.nl
Registered patents
Definition
Proxy
Answers to survey* question 3.1 of the survey are taken as a proxy for the number of products
Rationale
Patents awarded are the confirmation that the research process was found through novel features and support the process
of innovation and valorization.
KPI - Number of products
Patents awarded are the confirmation that the research process was found through novel features and support the
process of innovation and valorization.
A patent is the registered, exclusive right of an inventor to make, use, or sell an invention.
KPI – Number of new products
# registered patents for which the hospital is main applicant.
* For an overview of the question please see Ch 4 Appendices - F. Monitoring Methodology – Extended version.
MEASURING IMPROVINGDEFINITION
49see also www.healthoutlook.nl
11
0
2
4
6
8
10
12
14
16
18
2011
No
of
pat
ents
Total number of registered patents
Total STZ hospitals (n=28)
Health Outlook hospitals (n= 14)
0
1
2
3
4
5
6
7
8
No
of
pat
ents
Registered patents in 2011
KPI - Number of products
In 2011, Health Outlook hospitals reported to have registered 11 new patents. 7 of them were reported by the same
hospital. Two other hospitals registered two patents.
N=14
17
KPI – Number of new products
# registered patents for which the hospital is main applicant.
- Source: The Decision Group database -
*The total no of registered patents is based on question 3.1 of the survey. For detailed info please see Ch 4 Appendices - F.
Monitoring Methodology – Extended version.
Individual hospitals
MEASURING IMPROVINGDEFINITION
50see also www.healthoutlook.nl
KPI - Number of products
The number of new products might increase by enlarging high skilled labor force and incentivize staff to be more
open and cooperative with other hospitals.
Steering
The number of PhDs (KSI 3), participation to industry
initiated events (KSI 4) and multicenter investigator
initiated researches (KSI 7) are linked* with the number
of products.
(Next) Best Practices
10.Share best practices internally to increase knowledge:
exchange of ideas may help the development of new
products.
The STZ hospital which outperformed KPIs Number of
Products explained:
“Our culture is probably the key for success.
Collaboration and innovation are stimulated and
encouraged. At this moment we are rolling out an
internal policy which is based upon sharing best
practices. Hopefully, this policy will strengthen our
position”.
* The correlation coefficient with KSI 3 (PhD) is 11,14% , KSI 4 (industry initiated) 15,48% and
with KSI 7 (multicenter investigator initiated studies) is 19,36%.
.See for a detailed explanation on correlations Ch. 4 Appendices on page 82 and 83.
MEASURING IMPROVINGDEFINITION
51see also www.healthoutlook.nl
EXTRA: KPI - Adoption Rate of New Products
At this moment “adoption rate of new products” is not measured. Next year the aim is to find and determine the
right definition and to collect data on this specific performance indicator .
Marc Rinkes,
Manager Wetenschap & Kennis
Pieter Kievit,
Head of medical education and
research support
“Adoption rate of product innovation
At this moment, the said indicator does not provide a significant outcome in this first Health Outlook. The
indicator aims at finding the introduction rate and penetration grade primarily of new medicines. The
present data search did not turn out enough hits to support broader analysis. We expect that it will be a
mere question of time before the indicator will be supported by more adequate data registry.
It is probably more significant that present innovation in hospitals focuses mainly on therapy and treatment
rather than on product and technology innovation.
In an era dominated by an aging population and rising costs of healthcare, one would expect the scope on
healthcare innovation to be on medical, technical, process and social innovation. Membership of STZ
presupposes a certain size of the institution and number of patients they treat. Under these conditions it
seems attractive to realize and sustain local innovations resulting in lower costs of treatment and higher
(social) return on investments in terms of clinical outcome, patient satisfaction and quality of life.
Admittedly, this will have to be picked up by a whole new set of partners like MKB and HBO organizations
in a new variety of business case.
The hospitals that started in this way are confronted by both new and time-honored challenges, the difficult
acceptation of ‘foreign’ (not invented here) concepts being one of them. However, opening up for
innovative concepts that will increase the quality of care in feasible business cases will automatically invite
other innovators and their innovative concepts to present themselves.
Healthcare innovation appears to be in its infancy. Possibly, the current KPI 6 score’s most important signal
is: ‘Demanding attention’.” – Marc Rinkes & Pieter Kievit
MEASURING IMPROVINGDEFINITION
52see also www.healthoutlook.nl
Key performance indicators - Size
• Size of clinical trials (no of patients in
trial)
• Inflow of patients outside catchment
area
MEASURING IMPROVINGDEFINITION
Size© Rebke Klokke, Utrecht
53see also www.healthoutlook.nl
Ph2, Ph3 and Medical Devices clinical trials
Definition
Clinical trials performed by applied research hospitals in the Dutch Health cluster can be divided in two categories :
1. Drugs : a drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters
normal bodily functions
2. Medical Devices : Medical devices: “Medical device” means any instrument, apparatus, implement, machine,
appliance, implant, in vitro reagent or calibrator, software, material or other similar or related article, intended by the
manufacturer to be used, alone or in combination, for human beings for one or more of the specific purposes of (WHO).
Proxy
Total number of patients aimed to be enrolled in clinical trials over the entire period of these studies.
Rationale
The number of patients are representative for the size of the clinical trials assessed.
KPI - Size of clinical trials (no of patients in trial)
The number of patients are representative for the size of the clinical trials assessed.
KPI – Size of Clinical Trials ( number of patients in trial )
Total Number of target patients to be included in clinicaltrials, Phase II of III for Drugs or trials for medical devicesstarted during a year.
MEASURING IMPROVINGDEFINITION
54see also www.healthoutlook.nl
589
2067 2300
4956
296
10381155
2489
0
1000
2000
3000
4000
5000
6000
7000
8000
Ph 2 Ph 3 Medical Devices Total STZ hospitals
No
of
pat
ien
ts
Total - Size of clinical trials
Total STZ hospitals (n=28)
Health Outlook hospitals
KPI - Size of clinical trials (no of patients in trial)
Hospitals have a focus on phase 3 (2067 patients) and medical devices trials (2300 patients), compared to phase 2
(589 patients). Per total 7445 patients were enrolled in clinical trials.
KPI – Size of Clinical Trials ( number of patients in trial )
Total Number of target patients to be includedin clinical trials, Phase II of III for Drugs ortrials for medical devices started during a year.
N=14 N=14 N=13
885
31053455
7445
148 patients were enrolled in average in phase 3 clinical trials. 177 patients were enrolled in average in medical device trials.
See for a detailed overview Ch 4 Appendices - F. Monitoring Methodology – Extended version.
- Source: The Decision Group database -
MEASURING IMPROVINGDEFINITION
55see also www.healthoutlook.nl
KPI - Size of clinical trials (no of patients in trial)
A larger presence of research support activities will help hospitals to manage the patients in clinical trials.
Steering
Size of clinical trials and the presence of research
support offices (KSI 6) are associated*.
(Next) Best Practices
11.Stimulate and build research support structures:
Outperforming hospitals on size of clinical trials, have
more FTEs available to support research than other
hospitals. These hospitals have built more structures
to manage the large number of patients in trials.
12.Create visibility to industry partners, cluster location
seems to matter. A hospital suggested that large
phase 3 and medical devices studies are assigned
more often to hospitals located in one of the Dutch
Life Sciences sub clusters.
* The correlation coefficient with KSI 6 is 49.46%.
LS sub cluster
See for a detailed explanation on correlations Ch4. Appendices page 82 and 83.
MEASURING IMPROVINGDEFINITION
56see also www.healthoutlook.nl
Outside catchment area
KPI - Inflow of patients outside catchment area
If there is a high ratio of patients outside catchment area (inpatient and as well outpatient) then the hospital is
attractive.
Definition
The outer part of a specific geographic area for which a
particular institution is responsible.
Proxy
The patients reported at the hospital living outside the
geographic areas than the institution.
Rationale
If there is a high ratio of patients outside catchment area
then more attractive for the patients is that specific
institution.
Inpatient and outpatient
Definition
Inpatient : a patient who is admitted to a hospital
or clinic for treatment that requires at least one overnight
stay.
Outpatient: a patient who is admitted to a hospital or clinic
for treatment that does not require an overnight stay.
KPI – Inflow of patients from outside catchment area
Number of unique patients outside hospital catchment area that got care delivered when inpatient (admissions) and outpatient visits (vert.: opnames en 1ste polikliniek bezoeken).
Proxy
An overnight stay.
Rationale
To get a good insight in the complexity of pocedure that a
patient may undergo.
MEASURING IMPROVINGDEFINITION
57see also www.healthoutlook.nl
4,5%
12,0% 11,4%
29,8%
0%
5%
10%
15%
20%
25%
30%
35%
Minimum Average Median Maximum
% o
f p
atie
nts
ou
tsid
e ca
tch
men
t ar
ea
First admissions
3,9%
10,4% 9,7%
26,2%
0%
5%
10%
15%
20%
25%
30%
Minimum Average Median Maximum
% o
f vi
sits
ou
tsid
e ca
tch
men
t ar
ea
First outpatient visits
KPI - Inflow of patients outside catchment area
In 2011, the Health Outlook hospitals reported that on average 14.5 % of total admissions and 10,3% of outpatient
visits were from patients located outside the catchment area.
N=11
KPI – Inflow of patients from outside catchment area
Number of unique patients outside hospitalcatchment area that got care deliveredinpatient (admissions) and outpatient visits(vert.: opnames en 1ste polikliniek bezoeken)
N=11
The first position with the maximum number of first admissions and first outpatients visits outside catchment area is hold
by the same hospital. See for a detailed explanation Ch 4 Appendices - F. Monitoring Methodology – Extended version.
Source: The Decision Group database -
MEASURING IMPROVINGDEFINITION
58see also www.healthoutlook.nl
KPI - Inflow of patients outside catchment area
Expertise of employees might attract patients from outside catchment area to the hospital.
Steering
The level of expertise (KSI 3) is linked* with the inflow of
patients outside catchment area that are admitted for the
first time.
(Next) Best Practices
13.Attract and invest in the expertise of the core staff
members:
The expertise of the attractive hospitals, (inflow of
patients from outside catchment area) is higher
compared to average attractive hospitals.
Next to expertise, data shows a trend on size of
clinical trials and inflow of patients outside catchment
area. Further research has to validate the hypothesis
that inflow of patients with clinical trials may affect the
inflow of patients for admissions and outpatient visits.
* The correlation coefficient with KSI 3 PhD is 8,83%.and KSI Prof is 44,08%
See for a detailed explanation on correlations Ch. 4 Appendices on page 82 and 83.
MEASURING IMPROVINGDEFINITION
59see also www.healthoutlook.nl
Key performance indicators – Input
• Industry Investments
• Hospital investments
MEASURING IMPROVINGDEFINITION
INPUT© Rebke Klokke, Utrecht
60see also www.healthoutlook.nl
KPI – Industry Investments (in the core value chain)
Number of research projects with industry partners, (including self-initiated healthcare research with industry investment) started in a given year.
Core value chain of the Dutch health cluster
Definition of the core value chain
The Dutch Health cluster contains all top clinical and research hospital from the Netherlands, including all STZ hospitals
that perform applied research.
Proxy
The number of research projects commissioned by industry is taken as a proxy for industry investments.
Rationale
Industry investments give an approximation of the ability of hospitals to collaborate with industry in common projects.
KPI - Industry Investments
Industry investments give an approximation of the ability of hospitals to collaborate with industry in common
projects.
MEASURING IMPROVINGDEFINITION
61see also www.healthoutlook.nl
318
0
100
200
300
400
500
600
700
No
of
pro
ject
s
Total - Industry investments
Health Outlook hospitals (n=15) Total STZ hospitals (n= 28)
1
21 20
49
0
10
20
30
40
50
60
Minimum Average Median Maximum
No
of
pro
ject
s
Industry investments
KPI - Industry Investments
In 2011, the industry invested in, on average, 21 research projects per hospital with a maximum of 49 research
projects. In total 630 research projects within the hospitals were started.
N = 15
KPI – Industry Investments
Number of research projects with industrypartners, (including self-initiated healthcareresearch with industry investment) started in agiven year.
- Source: The Decision Group database -
630
There is a large variation among the reported industry investments. See for a detailed explanation Appendices on Monitoring
Methodology – extended version.
MEASURING IMPROVINGDEFINITION
62see also www.healthoutlook.nl
KPI - Industry Investments
Hospitals that are participating actively in multi center studies attract more industry investments. Furthermore,
ambitious specialists have a large impact on performance.
Steering
The participation in multicenter studies (KSI 7) seems to
influence* the industry investments.
(Next) Best Practices
15.Invest in a research culture. This generates an
exciting and vibrant learning community, reinforces
the links with industry, and contributes to high-
quality applied research.
The hospital which outperformed KPI Industry
Investments explained:
“Our specialists are very research minded. They
have a lot of ambition, and this influences other
specialists. A science-driven culture is growing. The
money they receive from the industry is often re-
invested in investigator research, which attracts
industry, a motor of innovation is created”.
16.Coordinate research at a decentralized level too, to
stimulate multicenter studies.
Another hospital clarified:
“Our main departments have own research
coordinators who facilitate in bringing in multicenter
studies.”
See for a detailed explanation on correlations Ch. 4 Appendices on page 82 and 83.
*The correlation coefficient with KSI 7 is 83.66%.
MEASURING IMPROVINGDEFINITION
63see also www.healthoutlook.nl
Money invested in applied research & innovation
Definition
Applied research is a form of systematic inquiry involving the practical application of science.
Proxy
Hospital budget and a sample of the 3 largest partnerships (maatschappen) for investment in applied research &
innovation apart from industry sponsored is taken as a proxy.
Rationale
Hospitals that invest in applied research & innovation are create a breeding ground for innovation.
KPI - Hospital investments applied research & innovation
Hospitals that invest in applied research & innovation create a breeding ground for innovation.
KPI – Hospital applied research & innovation
Money invested in applied research & innovation by the hospital in a given year.
MEASURING IMPROVINGDEFINITION
64see also www.healthoutlook.nl
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
1000000
Inve
stm
ents
in €
Ranking - Hospital investments
€ 10.000
€ 350.488€ 387.500
€ 904.500
€ 0
€ 100.000
€ 200.000
€ 300.000
€ 400.000
€ 500.000
€ 600.000
€ 700.000
€ 800.000
€ 900.000
€ 1.000.000
Minimum Average Median Maximum
Inve
stm
ents
in €
Hospital investments
KPI - Hospital investments applied research & innovation
The hospital investments applied research & innovation vary between the hospitals in 2011. There is a huge gap
between the minimum (invested €10k) and the maximum (invested €905k).
KPI – Hospital applied research & innovation
Money invested in applied research & innovation by the hospital in a given year.
N=10
- Source: The Decision Group database -
Different reporting sources were considered. See for a detailed explanation Appendices on Monitoring
Methodology – extended version: Individual hospitals
MEASURING IMPROVINGDEFINITION
65see also www.healthoutlook.nl
KPI - Hospital investments applied research & innovation
An explanation for the differences is based on the availability of internal data on investments.
Steering
The steering indicators level of expertise (KSI 3) and
participation to industry and health related events (KSI 4)
are associated* with Hospital investments.
* The correlation coefficient with KSI 3 (CGP) is 56.81% and with KSI 4 (participation to health related events is 60.50%
(Next) Best Practices
17.Create insight into costs and investments, to allocate
the right resources to the right activities.
See for a detailed explanation on correlations Appendices on page 82 and 83.
MEASURING IMPROVINGDEFINITION
66see also www.healthoutlook.nl
Appendices
A. History, development and structure of the Dutch Health Outlook
B. About the involved partners
C. Bibliography
D. Consulted experts and organizations
4
© Rebke Klokke, Utrecht
67see also www.healthoutlook.nl
Appendix A – History, development and structure of the Dutch Health Outlook
© Rebke Klokke, Utrecht
68see also www.healthoutlook.nl
Partners to create the Health Outlook 2013
STZ and The Decision Group proudly present the first edition of the yearly Outlook on the Dutch Health cluster.
The Outlook is commissioned by the ‘STZ-
ziekenhuizen’.
STZ stands for the Dutch association of
tertiary medical teaching hospitals. STZ
members can be seen as high care hospital
providers and top referral centers. STZ plays
an important role in applied medical research
having the aim to provide effective and
efficient care with focus on patient value.
Contacts:
Maarten Rook
www.stz-ziekenhuizen.nl
The Outlook is created in cooperation withthe Grenoble School of Management, School
of Public Health, part of The George
Washington University, Stockholm School of
Economics
The Outlook is created in cooperation with
consulting firm The Decision Group.
The Decision Group helps clients take better
strategic decisions, using methods such as
strategic dialogue and strategic alignment. The
creation of the Outlook is supervised by Prof. dr.
Fred van Eenennaam, and ir. Maarten Koomans
managing partners of The Decision Group.
Contacts:
Prof. dr. Fred van Eenennaam
Ir. Maarten Koomans,
Kim Bruheim, MSc.
Bogdan Toma, BA, BSc
+31(0)346-574942
www.thedecisiongroup.nl
Contact:
Prof. dr Fred van Eenennaam
69see also www.healthoutlook.nl
Background of the Health Outlook 2013 (1/2)
The Life Sciences Outlooks and the recent STZ publications have created the bases for the Health Outlook 2013…
Nyenrode LSH | Biotech Outlook 2010
Monitoring and improving
the red biotech cluster
The Nyenrode LSH | Biotech Outlook is created under supervision of prof. dr Fred van Eenennaam and Ir Maarten Koomans.
Draft – for High Profile Group review only – October 2009
70see also www.healthoutlook.nl
Background of the Health Outlook 2013 (2/2)
… which aims to register, monitor and report the outcomes (valorization) of research and cooperation with the
industry and applied research hospitals uniformly.
71see also www.healthoutlook.nl
Approach of the Health Outlook 2013 (1/2)
The Outlook builds on existing and available reports to leverage and improve on the current data position of the
health cluster.
Extensive and valuable cluster information is available through reports that 1) focus on specific cluster elements 2) are often one-time only publications.
Selection of key policy studies and reports on the Dutch biotech cluster
Innovation in Healthcare
Delivery Systems: A Conceptual
FrameworkThe Innovation
Journal: The Public Sector
Innovation Journal, Volume
15(1), 2010, Article
The Role of Integration into
External Informational
Environments, John R.
Kimberly, Journal of Health
and Social Behavior Vol. 19,
No. 4 (Dec., 1978),
Determinants of technological
innovation and its effect on
hospital performance, African
Journal of Business
Management Vol.5 (11), pp.
4314-4327, 4 June, 2011
ICT in Dutch Healthcare: An
International Perspective (2006)
Den Haag, Nederland
Health consumer powerhouse:
20012 EuroHealth Consumer
Index (2012)
WHO Draft Guidelines for
adverse event reporting and
Learning Systems (2005)
Denken, doen en delen: UMC’s als
regionale expertisecentra voor
onderwijs & opleiding (2007)
STZ expertisecentra in beeld.
(2011)
STZ-ziekenhuizen in het
Nederlandse
ziekenhuislandschap. (2011)
72see also www.healthoutlook.nl
Learn
ing loop L
earn
ing lo
op
Approach of the Health Outlook 2013 (2/2)
The needs of research and innovation that address the patient value in the Dutch Health cluster will be aligned by a
systematic yearly cluster dialogue, based on:
Creating Reporting Using
The Outlook uses insights from the strategic
dialog , where the key cluster challenges were
identified according to the needs of its
members.
The Outlook is the starting point for
cluster-wide strategic dialogues among
entrepreneurs and policy makers.
Improving business knowledge can have
large impact on the cluster success.
The Outlook is created with the hospitals,
using:
• A few sources with each hospital
• Dialogue sessions
• Round table discussions
The Outlook reports to hospitals &
entrepreneurs:
• Showing progress & performance of hospitals
• Communicating needs of hospitals to policy
makers
The Health Outlook is used for monitoring and
improving:
• The key policies have direct impact on the
success of the health cluster.
To make sure the actual needs are addressed To monitor progress systematically on the
overall cluster, key business impact areas and
key policies
To have a dialogue on improvements
Learning loopLearning loop Learning loop
73see also www.healthoutlook.nl
International Academic Advisory Council
The International Academic Advisory Council1, with the members providing advice on the development of the
Outlook, cluster policies and methodology development, is listed below.
Göran Lindqvist
Principal Associate at the Center for Strategy and
Competitiveness (CSC) at the Stockholm School of
Economics and Cluster Observatory project
manager. His research focuses on agglomerations,
clusters, cluster initiatives, and cluster policy.
Robert E. Burke
Professor at the George Washington University
Professor Burke is a medical sociologist and a
nationally known expert in long-term care, with
extensive experience in developing, evaluating and
implementing health care policy and managing
multidisciplinary professional staff.
Leonard H. Friedman
Professor at the George Washington University
Dr. Leonard Friedman is an expert on the
mechanisms of organizational change and strategic
decision-making in health service organizations.
Victoire de Margerie
Professor at Grenoble School of Management
Dr. de Margerie is specialized in strategy, technology
management and corporate governance and holds
various management and executive positions in
Germany, France and the USA in multinational
industrial groups. She holds numerous positions in
boards of listed companies.
Christian H.M. Ketels
Principal Associate Harvard Business School
Dr. Christian Ketels is a member of the Harvard
Business School faculty at Professor Michael E.
Porter’s Institute for Strategy and Competitiveness
and Director of The Competitiveness Institute (TCI), a
global network of professionals interested in
competitiveness and cluster development.
1The council meets twice a year with Prof. dr. Fred van Eenennaam as chair and Kim Bruheim, MSc. as secretary of the council.
Fred van Eenennaam
Professor of Strategy and Dynamics of Strategy
Professor Fred van Eenennaam is an expert on
corporate governance & strategy. He is also well
known for his expertise in the life sciences and
healthcare industry.
74see also www.healthoutlook.nl
Background on Monitoring methodology
The Monitoring methodology of the Outlook consists of: 1) choices, 2) definitions, and 3) measurement of the key
performance and steering indicators.
2) DEFINITIONS
Definitions of the key performance
and steering indicators
3) MEASURING
Data collection for the key
performance and steering indicators
The key performance and steering indicators
are selected to best reflect the success of
the Dutch health cluster:
The data collection methodology is set
up to provide accurate measurements:
MONITORING METHODOLOGY
1) CHOICES
Choice of the key performance
and steering indicators
The key performance and steering
indicators are defined to best reflect
the success of the Dutch health cluster:
© 2013 The Decision Group
DEFINITIONS MEASURINGCHOICES
75see also www.healthoutlook.nl
What were the design considerations?
The main goal of the design was to find a set of indicators that would help to improve the cluster success.
All choices made to select the key performance and steering indicators are based on the added value for the cluster.
Scope The scope of the Dutch Health Outlook is the Dutch Health cluster.
Aim The performance indicators monitor the success of a cluster or set of organizations. Typically,
performance indicators cannot be influenced directly by policy. Steering indicators can be influenced
directly by policy makers. Steering indicators are selected so as to have high impact on the
success of a cluster or set of organizations.
Focus The combined set of performance and steering indicators gives insight in the success of the
hospitals in the Dutch Health cluster.
Use To ensure that the performance indicators are practical for policy makers, a small controllable set of
performance indicators is selected which can be influenced and steered upon.
Health Cluster - High social interests in new healthcare products (performance indicator “Number of products”).
- Increased need for personalized medicine and cost reduction.
Validation The approach has been validated through a pilot program and the International Academic
Advisory Council that meets on a regular basis.
DEFINITIONS MEASURINGCHOICES
76see also www.healthoutlook.nl
Methodology development
An extensive three-step proces is followed, starting with the analysis of all hospital performance and steering
indicators extracted from key sources.
Analysis of sources to
extract a full list of
hospital performance
indicators
Step 1:
Select Key sources
Step 2
Extract all hospital
performance and steering
indicators
Step 3
Select key performance
indicators
Select key steering indicators
Selection of indicators
that monitor and
improve the
valorization and
cooperation of
hospitals with the
innovative industry
47 key sources with 85 key
documentsOutput
Action
Key sources: Best
practice hospitals,
healthcare policy
institutes ((e.g.,
Cleveland Clinic,
Centers for Medicare
and Medicaid Services
etc), healthcare
management journals
and universities
Selection of reports,
academic papers,
interviews on
monitoring and
improving hospital
performance
523 hospital performance
indicators
8 key performance indicators
7 key steering indicators
Key Sources All indicators Selection
DEFINITIONS MEASURINGCHOICES
77see also www.healthoutlook.nl
Step 1 - Zooming on the key sources
47 key sources are used that report in 85 key documents on monitoring and improving hospital performance.
Key Sources
Best practice hospitals Nederlandse Vereniging van Ziekenhuizen
Karolinska Hospital Healthcare management journalsSarasota Memorial Hospital Public Sector Innovation Journal
Mayo Clinic The Academy of Management Journal
Cleveland Clinic Journal of Health and Social Behavoir
Johns Hopkins Journal of Managerial Issues
Central Manchester University Hospital BeyeNetwork
Duke University Medical Center Healthcare management review
Childrens Hospital of Philadelphia African Journal of Business Management
National Taiwan University Hospital Gesundheitswesen
Universities Healthcare management review
Stanford University Healthcare policy institutesUniversity of York World Health Organization
Harvard Business School Australian Government
The George Washington University Centers for medicare and Medicaid Services (CMS, USA)
Bocconi University U.S. Department of Health and Human Services; Food and Drug Administration (FDA)
General hospital performance Agency for Healthcare Research and Quality (AHRQ; USA)
The Advisory Board Company National Board of Health and Welfare (Sweden)
Health Evidence Network National Health Service (NHS; UK)
ScienceDaily National Quality Forum (USA)
Clinical Connection Nederlandse Zorgauthoriteit (NZA)
Life Sciences Health (LSH) Het Rijskinstituut voor Volksgezondheid en Milieu (RIVM)
Dutch Clinical Trial Foundation Dutch Ministry of Health Welfare and Sports (VWS)
Dutch hospitals Inspectie voor de Gezondheidszorg (IGZ)
Vereniging Samenwerkende Topklinische opleidingsZiekenhuizen (STZ) Raad voor de Volksgezondheid en Zorg (RVZ)
Universitair Medische Centra (UMC's) Centrale Commissie Mensgebonden Onderzoek CCMO
Nederlandse Federatie Universitair Medische Centra (NFU)
DEFINITIONS MEASURINGCHOICES
78see also www.healthoutlook.nl
id
Monito
ring
/Impro
ving
Cat
egor
y
Nam
e of i
ndic
ator
Bes
t pra
ctic
e
hospita
ls
Hea
lthca
re
man
agem
ent jo
urnal
s
Hea
lthca
re p
olicy
inst
itute
sUniv
ersi
ties
Gen
eral h
ospita
l
perfo
rman
ce
Dutc
h hosp
itals
..
26 Monitoring Size Amount of IC beds 6
27 Monitoring Size Amount of papers published 15
28 Monitoring Size Amount of part-time specialists 12
29 Monitoring Size Amount of publications in top 1% segment 9,11, 13, 14
30 Monitoring Size Amount of topreferent patients 20
31 Monitoring Size Amount of translational research 13,29
32 Monitoring Size A-segment volume development 20
33 Monitoring Size A-segment volume development per type of care provider 20
34 Monitoring Size Availability of multidisciplinary infrastructure 2
35 Monitoring Size Availability of data 4
36 Monitoring size Availability of necessary departments 2
37 Monitoring Size Availability of necessary supporting specialties 2
38 Monitoring Size Availability of quality, expertise and key opinion leaders in clinical trial research 29
39 Monitoring Size Average population per hospital 6
40 Monitoring Size Average risk residents w ith pressure ulcers 14
41 Monitoring Size Avoidance of unnecessary care 3
42 Monitoring Size Brute force indicator (product of the total number of publications in a period, multiplied by the f ield-
normalized impact score (CPP/ FCSm)
15
43 Monitoring Size Care is offered by (sub)specialized experts in that area (approved by the association narrow
(sub)specialties)
2
44 Monitoring Size Care is proceeding according to tested protocols 2
45 Monitoring Size Central line bundle compliance 14
46 Monitoring Size Citation score 9,11,13,14, 15
47 Monitoring Size Clinical hospitalizations 6
48 Monitoring size Clinical trial phases covered 3 3
49 Monitoring Size Collaboration of CRO (Contract Research Organization) and pharmaceutical industry w ith hospitals and
hospital boards (to overcome collaboration bottlenecks)
29
50 Monitoring Size Contribution to the 20/10/5/2/1 % most frequently cited research papers w orldw ide 15
Step 2 - Zooming on all available indicators
523 performance and steering indicators are available.
1 Monitoring Input Budget by law A-segment 6
2 Monitoring Input Budget by law B-segment 6
3 Monitoring Input Budget of Medical faculty (ministry of education, culture and science) 10
4 Monitoring Input External grants/funding (for research) 7 7
5 Monitoring Input Free market competition health care budget (insurers) 10
6 Monitoring Input Health care budget (insurers) 10
7 Monitoring Input Healthcare budget (Ministry of Health, Welfare and Sport and health insurers) Including government
grant for tertiary care and innovation
27
8 Monitoring Input Hospital R&D investments 1
9 Monitoring Input Industry investments
10 Monitoring Input Research grants 7, 10 7
11 Monitoring Input Revenues: Ministry of Education, Culture and Science 27
12 Monitoring Input Rx subsidy % (The percentage of total prescription drug sales paid by subsidy) 18
13 Monitoring Input Third-party revenues: medical research council, charities, contract research 27
14 Monitoring Size Absentee rate 2
15 Monitoring Size Access times for outpatient clinics 3
16 Monitoring Size Accidental puncture or laceration 14
17 Monitoring Size Activeness of medical staff in their f ield or administrative and/or in the health care 2
18 Monitoring Size Amount of adverse events during the length of the research 16
19 Monitoring Size Amount of approved METC projects 9
20 Monitoring Size Amount of beds 6
21 Monitoring Size Amount of biomedical research 29
22 Monitoring Size Amount of citations per article 9
23 Monitoring Size Amount of citations per publication (excl. Self citations) 15
24 Monitoring Size Amount of citations per publication (inc. Self citations) 15
25 Monitoring Size Amount of Clinical research 13,29
id
Monito
ring
/Impro
ving
Cat
egor
y
Nam
e of i
ndic
ator
Bes
t pra
ctic
e
hospita
ls
Hea
lthca
re
man
agem
ent jo
urnal
s
Hea
lthca
re p
olicy
inst
itute
sUniv
ersi
ties
Gen
eral h
ospita
l
perfo
rman
ce
Dutc
h hosp
itals
..
DEFINITIONS MEASURINGCHOICES
79see also www.healthoutlook.nl
Step 3 - The selection of indicators
The key performance and steering indicators have been selected so that they can lie within the focus of the Life
Sciences and Health Outlook.
•79
© 2013 The Decision Group
1. Including clinical phase II,III and Medical Devices
2. Self-initiated healthcare research
3. Adoption of new products and treatments
Focus:
Focus of the Health Outlook
DEFINITIONS MEASURINGCHOICES
80see also www.healthoutlook.nl
Remarks
A few remarks about definitions and measuring should be made :
1. The researchers have opted not to include in the following pages a detailed overview on definitions and measuring of
KSIs. For those who might like to read the detailed definitions and measuring are welcome to check the extended
version of this Health Outlook available at www.healthoutlook.nl
2. The researchers thought it relevant to offer the definitions of KPIs in Chapter 3, before introducing the results scored
for each indicator. The measuring methodology used for each KPI is to be found in the extended version of the Health
Outlook.
3. The results of each KSI is provided in a different section called “Health Outlook extended”.
DEFINITIONS MEASURINGCHOICES
81see also www.healthoutlook.nl
Information about the survey
To measure the key performance indicators 8 & 9 and key steering indicators 1 & 4 a survey was sent. 593 people
from 14 hospitals have replied.
STZ & The Decision Group
Life Sciences & Health Outlook 2013Survey onderzoekers en medisch specialisten
Geachte heer, mevrouw,
Ons ziekenhuis doet namens de STZ topklinische ziekenhuizen mee aan het ontwikkelen van een Life Sciences & Health Outlook, in samenwerking met The Decision Group
Met behulp van de Outlook willen we meten en monitoren hoe we als STZ ziekenhuis presteren op het gebied van onderzoek en innovatie.
Graag maken we van uw expertise en knowhow gebruik om een aantal van de indicatoren die we met de STZ leden hebben opgesteld invulling te geven.
Momenteel voeren we een pilot uit. Hieruit kan ook blijken dat vragen minder goed aansluiten bij de informatie die we zoeken. Als u suggesties heeft horen we dat graag.
Het invullen van de vragen kost naar schatting ongeveer 10 minuten van uw tijd en levert zeer waardevolle input voor de Outlook.
We stellen het op prijs als u de ingevulde vragenlijst voor 1 februari zou kunnen toesturen aan Niels van Gorp: [email protected]
Bij voorbaat hartelijk dank voor uw bijdrage. We houden u graag op de hoogte van de ontwikkelingen rond de Life Sciences & Health Outlook.
Wilt u hier uw naam invullen?
Wat is uw functie?
Voor welk ziekenhuis werkt u?
1. Delen van best practices in onderzoek
Dit onderdeel gaat over de mate waarin u met onderzoekers van andere STZ ziekenhuizen best practices
deelt en adopteert in uw onderzoekspraktijk. (bijvoorbeeld Standard Operating Procedures)
De indicator sluit aan bij het speerpunt "coordination of research" van de STZ ziekenhuizen.
Antwoord:
1.0 Heeft u in 2011 medisch wetenschappelijk onderzoek (trials, productontwikkeling of anderszins)
uitgevoerd?
A) Ja
B)Nee (ga door naar vraag 2)
1.1 Komt het voor dat u onderzoeksprocedures aanpast (bijv beschreven in protocol)?
A) Ja
B)Nee (ga door naar vraag 2)
1.2 Hoe vaak deelde u in 2011 naar schatting zulke aanpassingen met collega's in andere ziekenhuizen?
A) niet (0 keer)
B) 1-2keer
C) 3-5 keer
D) 6-10 keer
E) >10 keer
2. Partnering met derden
Partnering met derden gaat over de mate waarin u met het bedrijfsleven (ondernemers in MKB,
farmaceutische industrie, anderen) contacten opbouwt en onderhoudt en samenwerkingen aangaat
2.1 Bijeenkomsten en symposia
a Hoe vaak nam u ongeveer deel aan congressen, symposia, science meets business en gelijksoortige
bijeenkomsten in 2011, waarbij de industrie of het bedrijfsleven vertegenwoordigd was?
A) niet (0 keer); Ga verder naar vraag 2.2
B) 1-2keer
C) 3-5 keer
D) 6-10 keer
E) meer dan 10 keer
b Hoeveel van die bijeenkomsten waren door de farmaceutische of medical devices industrie
geinitieerd?
A) geen enkele
B) 1-2
C) 3-5
D) 6-10
E) meer dan 10
c Hoeveel van deze bijeenkomsten waren er geinitieerd door het bedrijfsleven/MKB (anders dan
farmaceutische of medical devices industrie)?
A) geen
B) 1-2
C) 3-5
D) 6-10
E) meer dan 10
d Hoeveel bijeenkomsten waren door uw eigen ziekenhuis georganiseerd?
A) geen
B) 1-2
C) 3-5
D) 6-10
E) meer dan 10
e Hoeveel van dit soort bijeenkomsten heeft u in 2011 zelf (mede) georganiseerd ?
A) geen
B) 1
C) 2
D) 3
E) meer dan 3
2.2 Contact met industrie en MKB
a Hoe vaak heeft u in 2011 in het kader van uw onderzoek contacten gelegd met de industrie of de
industrie benaderd? (hoeveel verschillende partijen)
A) geen enkele keer
B) 1 keer
C) 2 keer
D) 3 keer
E) meer dan 3 keer
b Hoe vaak met het MKB?
A) geen enkele keer
B) 1 keer
C) 2 keer
D) 3 keer
E) meer dan 3 keer
2.4 Doelen van contact met bedrijfsleven
a Wat waren de doelen van uw contacten met industrie?
b Wat waren de doelen van uw contacten met MKB/overig bedrijfsleven?
3. Ontwikkeling van nieuwe producten, protocollen, richtlijnen, behandelingenDit onderdeel gaat over uw bijdrage aan innovaties; het ontwikkelen van nieuwe producten,
behandelingen, richtlijnen of protocollen.
Antwoord:
3.1 Patenten
a Heeft u in 2011 in het kader van uw onderzoek patent aangevraagd?
A) Ja en tevens toegewezen gekregen
B) Ja, maar nog niet toegewezen ga naar vraag 3.2
C)Nee, ga door naar vraag 3.2
b Hoeveel patenten heeft u geregistreerd?
3.2 Heeft u nieuwe protocollen opgesteld die in 2011 op (inter)nationaal niveau zijn geimplementeerd?
A) Ja (graag ook aantal vermelden)
B)Nee
3.3 Heeft u nieuwe richtlijnen opgesteld die in 2011 op (inter)nationaal niveau zijn gepubliceerd?
A) Ja (graag ook aantal vermelden)
B)Nee
3.3 Heeft u nieuwe behandelingen ontwikkeld die in 2011 op (inter)nationaal niveau zijn
geimplementeerd?
A) Ja (graag ook aantal vermelden)
B)Nee
Hartelijk dank voor uw deelname aan deze vragenlijst. Mocht u geinteresseerd zijn in de uitkomsten van het onderzoek, vult u dan graag even uw e-mail adres in, dan houden
we u op de hoogte. E-mail adres:
* Haga Ziekenhuis sent an own internal survey to measure the Key Performance Indicators: No of products and No of protocols, treatments and guidelines. The numbers of respondents
was 57.
*
DEFINITIONS MEASURINGCHOICES
82see also www.healthoutlook.nl
Information about correlations (1/2)
To compute the correlation between KPIs and KSIs the statistical software package STATA version 11 was used.
kpi9treatm~s 0.3287 0.5441 0.1891 -0.0690 -0.0534 0.2041 -0.0068 -0.1402 0.2224 0.4341 -0.1179 1.0000kpi9protoc~s 0.1217 0.1489 0.0320 0.4602 -0.0216 0.1670 0.1671 0.0361 -0.0034 0.2271 1.0000 kpi7 0.3257 0.5463 0.6811 0.0926 -0.3999 0.3321 0.7233 -0.0353 0.2834 1.0000kpi5_11_md~1 0.0221 -0.0340 0.4747 0.4255 0.1530 0.1271 0.3388 0.1223 1.0000kpi5~3_part1 0.0631 -0.3014 -0.1166 -0.3896 0.4471 0.1258 -0.1830 1.0000kpi4_11_ou~1 0.5180 0.5615 0.7626 0.2751 -0.1787 0.6379 1.0000kpi4_11_outp 0.9335 0.6586 0.3697 0.0481 0.3160 1.0000 kpi3_11_md 0.3057 0.0771 0.1621 0.1558 1.0000 kpi3_11_ph3 0.1374 0.0117 0.4342 1.0000 kpi3_11_ph2 0.3358 0.5500 1.0000kpi1_11_proj 0.6130 1.0000 ksi3_11_emp 1.0000 ksi3_~mp kpi1_1~j kpi3_1~2 kpi3_1~3 kpi3_1~d kpi4_1~p kpi4_1~1 ~3_part1 ~d_part1 kpi7 kpi9pr~s kpi9tr~s
Source: The Decision Group database – STATA print out.
The first column “ksi3_emp” indicates
employment and on each row the
performance indicator can be found.
The intersection between the
employment line and a specific key
performance indicator gives the
correlation coefficient.
For a series of a few KPIs i.e. KPI5,
KPI8 and KPI9 the relationship between
the above mentioned indicators and
KPI7 “Number of publications” has been
considered more appropriate to be used
when extrapolating.
kpi9treatm~s 0.4341 0.2224 -0.1508 -0.1179 -0.3536 1.0000kpi9guidel~s 0.0168 0.3983 -0.2665 -0.0833 1.0000kpi9protoc~s 0.2271 -0.0034 0.2132 1.0000 kpi8 0.1793 0.1017 1.0000kpi5_11_md~1 0.2834 1.0000 kpi7 1.0000 kpi7 ~d_part1 kpi8 kpi9pr~s kpi9gu~s kpi9tr~s
DEFINITIONS MEASURINGCHOICES
83see also www.healthoutlook.nl
Information about correlations (2/2)
For a series of KPIs and KSIs presented in chapter 4 the correlation coefficients are given. The table underneath
shows an overview of the given coefficients, based on STATA calculations.
Indicators KPI 7 KPI 5 KPI 9 KPI 4 KPI 1 KPI 2 KPI 3
KSI 4 Mkb 0,3948
KSI 4 Health 0,358 0,605
KSI 5 Spec 0,7923 0,3856
KSI 3 Prof 0,1291 0,4408
KSI 1 0,1932
KSI 2 0,365
KSI 3 PhD 0,0883
KSI 7 0,836
KSI 6 0,4946
KSI 3 GCP 0,5681
Source: The Decision Group database –.
DEFINITIONS MEASURINGCHOICES
84see also www.healthoutlook.nl
Communication
• Along the elaboration of the Health Outlook, there was a permanent and constructive communication
between the researchers of The Decision Group and hospital members / employees that participated in
this study.
• The individuals in charge of data-collection have discussed and harmonized data-collection procedures
and agreeing on sources for data.
Data validation (1/2)
Several steps have been taken to check the consistency of data…
Public sources
A web search has been performed to check the consistency of data reported for indicator “employment”.
The figures that were available publically corresponded with the ones reported.
Cooperation among data collectors
In some cases the data collators were the same individuals for multiple hospitals, e.g. the same
individuals gathered data from Medisch Centrum Alkmaar, Rijnstate, St. Elisabeth Ziekenhuis and
Medisch Centrum Leeuwarden. Hence, a consistency in data collection has been assured.
Pilot study
Before the set up of the Health Outlook 2013 a pilot study was launched. In this way the results could
be calibrated and definitions and indicators were adjusted .
Outlier Check
In a few cases, where researchers considered that the reported data may be an outlier, discussions were
carried out with the reporting hospital to assure that no reporting mistake had occurred.
DEFINITIONS MEASURINGCHOICES
85see also www.healthoutlook.nl
Data validation (2/2)
….. and its reliability through using STZ database and a survey.
STZ Database
The figures for number of publications cited are pulled together
centrally by STZ and are publicly available through its reports.
Survey
For a series of 2 performance indicators and 2 steering indicators a
survey was sent.
DEFINITIONS MEASURINGCHOICES
86see also www.healthoutlook.nl
Appendix B – About the involved partners
© Rebke Klokke, Utrecht
87see also www.healthoutlook.nl
The Life Sciences & Health - Focusing on patient value
The main objective of STZ is to capitalize on knowledge by stimulating the applied research with focus on patient
value.
The Outlook is commissioned by the ‘Life
Sciences & Health’ innovation program.
Contact: Willem de Laat, MD, PhD
Annemiek Verkamman
+31(0)71-3322033
www.lifescienceshealth.com
Driven by the cluster and empowered by
the Ministry of Economic Affairs, the LSH
program has the objective to improve the
life sciences innovation and investment
climate in the Netherlands. The Outlook
is part of the four-year work plan.
The Outlook is commissioned by the
‘STZ- ziekenhuizen’.
Contacts:
Maarten Rook
www.stz-ziekenhuizen.nl
STZ stands for the Dutch association of
tertiary medical teaching hospitals. STZ
members can be seen as high care
hospital providers and top referral centers.
STZ plays an important role in applied
medical research having the aim to
provide effective and efficient care with
focus on patient value.
88see also www.healthoutlook.nl
Value Based Healthcare Center Europe
Value Based Healthcare Center Europe works closely with Prof. Michael Porter from Harvard Business School on
the concepts of value-based healthcare with the goal of making better decision for patient value.
The Outlook is supported by Value Based Health
Care Center Europe
Contacts:
ir. Maarten Koomans
+31(0)346-574942
www.vbhc.nl
It is the vision and aim of the Value Based
Health Care – Center Europe to share key
practices, our experiences and knowledge on
Value Based Health Care to put Patient Value
at the core.
Value Based Health Care Center Europe
89see also www.healthoutlook.nl
About The Decision Group
The Decision Group is a niche strategy consulting firm founded in 1996 with a focus on the healthcare & life
sciences industry.
The Outlook is created in cooperation with
consulting firm The Decision Group.
Contacts:
Prof. dr. Fred van Eenennaam,
Ir. Maarten Koomans
Kim Bruheim, MSc.
Bogdan Toma, BA, BSc.
+31(0)346-574942
www.thedecisiongroup.nl
The Decision Group helps clients take better
strategic decisions, using methods such as
strategic dialogue and strategic alignment. The
creation of the Outlook is supervised by prof.
dr. Fred van Eenennaam & ir Maarten
Koomans, managing partner of The Decision
Group.
90see also www.healthoutlook.nl
Appendix C – Bibliography
© Rebke Klokke, Utrecht
91see also www.healthoutlook.nl
Key documents (1/6)
1. Chen, M. F. (2011). Interview Pharma Focus Reports.
2. Clinical Trials Management System (CTMS) . (n.d.). Retrieved 10 06, 2011, from Mayoresearch: http://mayoresearch.mayo.edu/mayo/research/clinical-trials-
management-system/
3. ctr clinical research. (n.d.). Retrieved 10 06, 2011, from Sarasota memorial health care system: http://home.smh.com/sections/services-procedures/clinical_trial-
research/ctr_clinical_research.html
4. Hopkins, J. (n.d.). Johns Hopkins Medicine Clinical Trials. Retrieved 10 06, 2011, from http://www.hopkinsmedicine.org/quality/patients/clinical_trials
5. Nederlandse Federatie van Universitair Medische Centra, Acute Zorg: Een beschrijving van het niet te plannen deel van de ziekenhuiszorg (2010), Utrecht, NL.
6. Nederlandse Federatie van Universitair Medische Centra, At a glance: Facts and figures for the Netherlands’ University Medical Centers (2009), Utrecht, NL.
7. Nederlandse Federatie van Universitair medische Centra, Bibliometric study on Dutch Academic Medical Centers 1998-2008 (2009), Utrecht, NL, p.6.
8. Nederlandse Federatie van Universitair Medische Centra, In één oogopslag: Feiten en cijfers over de Universitair Medische Centra 2009 (2009), Utrecht, NL.
9. Nederlandse Federatie van Universitair Medische Centra, Kwaliteitsborging van mensgebonden onderzoek (2010), Utrecht, NL, p.11-14.
10. Nederlandse Federatie van Universitair Medische Centra, Naar een goede waarde: Valorisatie in de Universitair Medische Centra van Nederland- Uitgangspunten
voor vorm en regelgeving (2009), Utrecht, NL, p13, p15
11. Nederlandse Federatie van Universitair Medische Centra, Onderzoek onderzocht: een bibliometrische analyse van het onderzoek van de universitair medische
centra (2004), Utrecht, NL
12. Nederlandse Federatie van Universitair Medische Centra, OOR-zaak en gevolg:Opleidingen in de zorg NFU-visiedocument (2005), Utrecht, NL, p. 3.
13. Nederlandse Federatie van Universitair Medische Centra, Patiëntveiligheid,de handen ineen (2006), Utrecht, NL.
14. Nederlandse Federatie van Universitair Medische Centra, Publieke functies van de UMC’s in een marktomgeving (2006), Den Haag, NL, p. 39
15. Nederlandse Federatie van Universitair Medische Centra, Report on the research management of the University medical centers in the Netherlands (2005), p
.13,15,16,17,23,28.
16. Nederlandse Federatie van Universitair Medische Centra, Tevredenheid gepeild (2005), Utrecht, NL
17. Nederlandse Federatie van Universitair Medische Centra, Trends in tevredenheid (2007/08) De tevredenheid van patiënten van de acht Universitair Medische
Centra (2008),Utrecht, NL.
18. Nederlandse Federatie van Universitair Medische Centra, Trends in tevredenheid (2003/2009):Samenvatting van het vierde onderzoek naar tevredenheid van
patiënten in Universitair Medische Centra (2010), Utrecht, NL.
Best practice hospitals
92see also www.healthoutlook.nl
Key documents (2/6)
19. Nederlandse Federatie van Universitair Medische Centra, UMC’s gespiegeld 2008: Resultaten van de basisset prestatie-indicatoren (2009),Utrecht, NL.
20. Nederlandse Federatie van Universitair Medische Centra, UMC’s gespiegeld 2009 (2010),Utrecht, NL.
21. Nederlandse Federatie van Universitair Medische Centra, UMC’s gespiegeld:Presentatie van de scores op de IGZ prestatie-indicatoren (2008),Utrecht, NL.
22. Nederlandse Federatie van Universitair Medische Centra, University Medical Centers in the Netherlands (2008), Utrecht, NL, p12, p39
23. Nederlandse Federatie van Universitair Medische Centra, Van vele markten thuis: de universitair medische centra in nederland Wat zijn ze, wat doen ze, wat
willen ze, Utrecht, NL, p42.
24. Nederlandse Federatie van Universitair Medische Centra, Wetenschap gewaardeerd (2008), Utrecht, NL, p.17
25. Nederlandse Federatie van Universitair Medische Centra, Wetenschap gewaardeerd (2009), Utrecht, NL, p.17.
26. Nederlandse Federatie van Universitair Medische Centra, Zaaien en oogsten: Een profi leringsnota over onderwijs en onderzoek in de umc’s(2010), Houten, NL,
p.25, p29, p30, p33, p40.
27. Nederlandse Federatie van Universitair Medische Centra, Zeldzaam Gewoon: Grensverleggende geneeskunde voor topreferente patiënten (2005), Utrecht.
28. Nederlandse Federatie van Universitair Medische CentraDenken, doen en delen: UMC’s als regionale expertisecentra voor onderwijs & opleiding (2007,), Utrecht,
NL, p. 3
29. Research & Clinical Trials - Cleveland Clinic, Clinical Connection. (n.d.). Retrieved 10 06, 2011, from Cleveland Clinic: www.clinicalconnection.com
30. Shaw C (2003) How can hospital performance be measured and monitored? Copenhagen, WHO Regional Office for Europe (Health Evidence Network report;
http://www.euro.who.int/document/e82975.pdf, accessed 29 August 2003)
31. Sibley, C. (2011). Our performance. Retrieved 10 06, 2011, from Central manchester university hospitals: http://www.cmft.nhs.uk/research-and-innovation/our-
performance.aspx
32. Tidd, J., Bessant, J., & Pavitt, K. (2005). Case_studies. Retrieved 11 14, 2011, from Managing innovation: http://www.managing-
innovation.com/case_studies/Karolinska%20Hospital.pdf
Best practice hospitals
33. Daniele Fabbri, Silvana Robone, The geography of hospital admission in a National Health Service with patient choice: evidence from Italy, University of York,
HEDG (Dec 2008)
34. Nicholas Bloom, Carol Propper, et al., The Impact of Competition on Management Quality: Evidence from Public Hospitals (Stanford University, Aug 2011)
Universities
93see also www.healthoutlook.nl
Key documents (3/6)
35. Research & Clinical Trials - Cleveland Clinic, Clinical Connection. (n.d.). Retrieved 10 06, 2011, from Cleveland Clinic: www.clinicalconnection.com
36. Rijswijk-Trompert, L. (2011). Stakeholder opinions on the position of the Netherlands in conducting clinical drug trials. Nederland: Life sciences health, umcg,
dutch clinical trial.
37. ScienceDaily, Hospitals That Participate In Clinical Trials May Provide Better Patient Care ( Mar. 25, 2008)
38. The Advisory Board Company, Clinical investments, How has hospital investment strategy evolved over time? (Aug 2011)
General hospital performance studies
39. De Vereniging Samenwerkende Topklinische Ziekenhuizen: 15 jaar STZ: Wat STZ-ziekenhuizen verbindt. (2011) Nederland, Utrecht.
40. De Vereniging Samenwerkende Topklinische Ziekenhuizen: Kengetallen Nederlandse Ziekenhuizen. (2009) Nederland, Utrecht.
41. De Vereniging Samenwerkende Topklinische Ziekenhuizen: STZ expertisecentra in beeld. (2011) Nederland, Utrecht.
42. De Vereniging Samenwerkende Topklinische Ziekenhuizen: STZ opnieuw in beeld. (2011) Nederland, Utrecht.
43. De Vereniging Samenwerkende Topklinische Ziekenhuizen: STZ Toelatings- en hervisitatiecriteria. (2011) Nederland, Utrecht.
44. De Vereniging Samenwerkende Topklinische Ziekenhuizen: STZ-ziekenhuizen in het Nederlandse ziekenhuislandschap. (2011) Nederland, Utrecht.
45. Leeuwen, van T. Noyons, E. Medina, C.C. Bibliometric analysis of STZ-hospitals. Leiden, Leiden University 2012
46. Nederlandse vereniging van ziekenhuizen. (2010). Retrieved 10 20, 2011, from ziekenhuis transparant:
http://www.ziekenhuizentransparant.nl/toon.php?hm=11006&sm=11979&id=762
Dutch hospitals
94see also www.healthoutlook.nl
Key documents (4/6)
47. Blendon, R., Schoe, C., DesRoches, C. M., Osborn, R., Zapert, K., & Raleigh, E. (2004). Confronting competing demands to improve quality: a five-country
hospital survey. Health Affairs, 23(5);119-35.
48. Christensen, C. M., Grossman, J. H., & Hwang, J. (2009). The innovator’s prescription, a disruptive solution for health care. McGraw-Hill; New York.
49. Greg Nelson, Implementing Metrics Management for Improving Clinical Trials Performance, BeyeNetwork/ThotWave Technologies
50. Hospital Adoption of Innovation: The Role of Integration into External Informational Environments, John R. Kimberly, Journal of Health and Social Behavior, Vol.
19, No. 4 (Dec., 1978), pp. 361-373
51. Interorganizational Links and Innovation: The Case of Hospital Services, James B. Goes and Seung Ho Park,The Academy of Management Journal, Vol. 40, No.
3 (Jun., 1997), pp. 673-696
52. Organizational Innovation: The Influence of Individual, Organizational, and Contextual Factors on Hospital Adoption of Technological and Administrative
Innovations, John R. Kimberly and Michael J. Evanisko, The Academy of Management Journal, Vol. 24, No. 4 (Dec., 1981), pp. 689-713
53. Porter, M. (1996). What is Strategy? Harvard Business Review, November-December 1996: 59-78
54. Rhay-Hung Weng, Jin-An Huang, et al, Determinants of technological innovation and its effect on hospital performance, African Journal of Business Management
Vol.5 (11), pp. 4314-4327, 4 June, 2011
55. Technological Adoption in Dynamic Environments: The Case of Not-for-Profit and For-Profit Hospitals, Journal article by James J. Hoffman, John G. Irwin, Lester
A. Digman; Journal of Managerial Issues, Vol. 8, 1996
56. Vera A, Salge TO, The impact of research and development on hospital performance - an empirical analysis in the English hospital sector, Gesundheitswesen
(Mar 2011)
57. Vera A, Salge TO,Hospital innovativeness and organizational performance: evidence from English public acute care. Health Care Manage Rev. 2009 Jan-
Mar;34(1):54-67.
58. Vincent K. Omachonu, Norman G. Einspruch, Innovation in Healthcare Delivery Systems: A Conceptual Framework The Innovation Journal: The Public Sector
Innovation Journal, Volume 15(1), 2010, Article 2.
Healthcare management journals
95see also www.healthoutlook.nl
Key documents (5/6)
59. Agency for Healthcare Research and Quality. Framework for Considering Study Designs for Future (2011), Rockville, United States, p.10,11.
60. Agency for Healthcare Research and Quality. Project Title: Comparative Effectiveness of Screening for Methicillin-Resistant Staphylococcus Aureus (MRSA)
(2011), Rockville, United States, Published online: www.effectivehealthcare.ahrq.gov
61. Agency for Healthcare Research and Quality. Project Title: Public Reporting as a Quality Improvement Strategy: A systematic review of the multiple pathways
public reporting may influence quality of health care (2011), Rockville, United States, Published online: www.effectivehealthcare.ahrq.gov
62. Australian government, Clinically competitive: boosting the business of clinical trials in Australia (2011)
63. Chief Scientist Office: Scottish Executive Health Department, Scottish exexutive health department research governance framework for health and community
care. p. 8/9
64. Ministry of Health Welfare and Sports: Here you work safely or you don’t work here at all (2004) Den Haag, Nederland.
65. National Quality Forum: Measurement Framework: Evaluating Efficiency Across Patient-Focused Episodes of Care (2009) Washington, DC, p.8
66. National Quality Forum: National voluntary consensus standards for patient safety measures, first report: a consensus report (2010) Washington, DC
67. National Quality Forum: The ABCs of Measurement, Washington, DC
68. Seow H, Snyder CF, Mularski RA, et al. A framework for assessing quality indicators for cancer care at the end of life. J Pain Symptom Manage 2009
Dec;38(6):903-12.p.13
69. Socialstyrelsen: Open Comparison and Assessment 2009– Cardiac Care, Ordförrådet AB.
70. Socialstyrelsen: Quality and Efficiency in Swedish Health Care Regional Comparisons (2010), Ordförrådet AB, p. 300
71. Socialstyrelsen: Quality and Efficiency in Swedish Health Care Regional Comparisons (2008), Ordförrådet AB.
72. Socialstyrelsen: Quality and Efficiency in Swedish Health Care Regional Comparisons (2009), Ordförrådet AB.
73. World Health Organization, Measuring hospital performance to improve the quality of care in Europe: a need for clarifying the concepts and defining the main
dimensions, Report on a WHO Workshop Barcelona, Spain, 10-11 January 2003
74. World Health Organization, The World Health Report 2000, Health Systems: improving performance (2000) Geneva, Switserland
Healthcare policy institutes
96see also www.healthoutlook.nl
Key documents (6/6)
75. Benthem, B. v. (2010, 09 14). Trend_in_prevalentie_van_ziekenhuisinfecties_in_Nederland_2007_2009. Retrieved 10 20, 2011, from Het Rijksinstituut voor
Volksgezondheid en Mileu
(RIVM):http://www.rivm.nl/Bibliotheek/Algemeen_Actueel/Uitgaven/Infectieziekten_Bulletin/Archief_jaargangen/Jaargang_21_2010/Nummers_jaargang_21/Septe
mber_2010/Inhoud_september_2010/Trend_in_prevalentie_van_ziekenhuisinfecties_in_Nederland_2007_2009
76. De Centrale Commissie Mensgebonden Onderzoek: Onderzoek met proefpersonen 2006 –2010, jaarverslag 2010, Den Haag, Nederland
77. Halbertsma, R. (2008). Kwaliteit van zorg & marktwerking: Een overzicht van de economische literatuur. Utrecht: Nederlandse zorgauthoriteit.
78. Inspectie voor de gezondheidszorg: Kwaliteitsindicatoren 2012 (2011) Utrecht, Nederland
79. Inspectie voor de gezondheidszorg: Veiligheidsindicatoren ziekenhuizen (2010) Utrecht, Nederland
80. Mansley, Mark. Health and safety indicators for institutional investors. United Kingdom: Health and safety executive, 2002.
http://www.hse.gov.uk/revitalising/csr.pdf.
81. Ministry of Health Welfare and Sports: Health consumer powerhouse: 2005 EuroHealth Consumer Index (2005)
82. Ministry of Health Welfare and Sports: ICT in Dutch Healthcare: An International Perspective (2006) Den Haag, Nederland.
83. Nederlandse Zorgautoriteit (NZA) : Marktscan Medisch specialistische zorg (2011) Utrecht, Nederland
84. Preventie, Ziekte & Zorg: medische technologie . (sd). Opgeroepen op 10 20, 2011, van Het rijksinstituut voor volksgezondheid en milieu:
Http://www.rivm.nl/Thema_s/Preventie_Ziekte_Zorg/Medische_technologie
85. Raad voor de volksgezondheid en zorg: Ruimte voor arbeids-besparende innovaties in de zorg door slimmer werken meer kwaliteit met minder mensen (2010)
Den Haag, Nederland.
86. Translating Clinical Trials into Practice, Robert M. Califf, MD, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina (July. 27,
2005)
87. WIP richtlijn handhygiene. (sd). Opgeroepen op 10 20, 2011, van Het Rijksinstituut voor Volksgezondheid en Mileu:
http://www.rivm.nl/Bibliotheek/Professioneel_Praktisch/Richtlijnen/Infectieziekten/WIP_Richtlijnen/Actuele_WIP_Richtlijnen/Ziekenhuizen/WIP_richtlijn_Handhygië
ne_ZKH
88. WIP-richtlijn Bloedcontact . (sd). Opgeroepen op 10 20, 2011, van het rijksinstituut voor volksgezondheid en milieu :
http://www.rivm.nl/Bibliotheek/Professioneel_Praktisch/Richtlijnen/Infectieziekten/WIP_Richtlijnen/Actuele_WIP_Richtlijnen/Ziekenhuizen/WIP_richtlijn_Bloedconta
ct_ZKH
89. World Health Organization, WHO Draft Guidelines for adverse event reporting and Learning Systems (2005) Geneva, Switserland
Healthcare policy institutes
97see also www.healthoutlook.nl
Appendix D – Consulted experts and organizations
© Rebke Klokke, Utrecht
98see also www.healthoutlook.nl
Consulted experts (1/2)
The help and insights of many cluster experts were essential in realizing the Dutch Health Outlook 2013.
First Name Last Name Position Organization
Bianca Baten Trial coördinator Rijnstate Ziekenhuis
Bart Berden Voorzitter raad van bestuur St. Elisabeth Ziekenhuis
Bibi Blijham Kwaliteitsmedewerker Wetenschap Medisch Centrum Alkmaar
Geke Blok
Coördinator medische vervolgopleidingen en
wetenschap Reinier de Graaf Groep
Frank Bosch 1. President, 2. Nederlandse Internisten Vereninging
2. Lid bestuur, 2. DCTF
3. MD PhD 3. Rijnstate Ziekenhuis
Bianca Boxma Research Coordinator Maasstad Ziekenhuis
Richard Brohet Head of Department Scientific Research Spaarne Ziekenhuis, Kennemer Gasthuis
Angelique Dierick Implementatiefellow Catharina Ziekenhuis
Joep Dille Manager R&D Isala Klinieken
Lea M Dijksman Coördinator wetenschapsbureau, epidemioloog Onze Lieve Vrouwe Gasthuis
Cecile Duindam Teamcoördinator Dialys St. Antonius Ziekenhuis Nieuwegein
Ingeborg Dusseldorp, van Hoofd Kennis- en Informatiecentrum Medisch Centrum Leeuwarden
Astrid
Duin-Outmaijjer,
vanWetenschapsfunctionaris
Meander Medisch Centrum
Willem Geerlings Voorzitter raad van bestuur Medisch Centrum Haaglanden
Norbert Groenewegen Directeur STZ
Niels Gorp, van Business Intelligence Business Specialist VGZ
Bernt Grimm Coördinator Research Leerhuis Atrium Medisch Centrum
Silke Groot, de Projectmedewerker van de Onderzoeksschool Sint Lucas Andreas Ziekenhuis
99see also www.healthoutlook.nl
Consulted experts (2/2)
The help and insights of many cluster experts were essential in realizing the Dutch Health Outlook 2013.
First Name Last Name Position Organization
Diana Grootendorst Coordinator wetenschap en senior epidemioloog MC Haaglanden
Mark Houdenhoven, van Lid raad van bestuur HagaZiekenhuis
Judith Hegeman Trialcoordinator / Projectmanager Rijnstate Ziekenhuis
Henk Hendrix Directeur Brabant Medical School St. Elisabeth Ziekenhuis
Ide Heyligers
Hoogleraar aan de Faculty of Health Medicine and Life
Sciences van de Universiteit van MaastrichtAtrium Medisch Centrum
Hedi Kan, van Directiesecretaresse STZ
Harrie Kemna Senior beleidsadviseur NVZ
Pieter Kievit Hoofd medische educatie en research support Medisch Centrum Alkmaar
Hedwig Neefs Seniorsenior beleidsadviseur opleiding en onderzoek STZ
Pieternel Pasker Science Officer Meander Medisch Centrum
Dana Ploeger Communicatie STZ
Marc Rinkes Manager Wetenschap en Kennis Rijnstate Ziekenhuis
Maarten Rook Voorzitter bestuur STZ
Martin Schipperus Stafbestuurder, hematoloog HagaZiekenhuis
Hedwig Slot Directeur Landsteiner Instituut (MCHaaglanden)
Henk Sluiter 1. Internist-nefroloog 1. Deventer Ziekenhuis
2. Opleidingscoordinator 2. Deventer Ziekenhuis
3. Bestuurslid 3. STZ
Willy Spaan Voorzitter raad van bestuur Jeroen Bosch Ziekenhuis
Peter Spronk Intensive care arts Gelre Ziekenhuis
Paul Nat, van der Senior Advisor to the Board of Directors St. Antonius Ziekenhuis
Reinier Veenhoven 1. Medisch manager 1. Linneaeusinstituut
2. Kinderarts 2. Spaarne Ziekenhuis
Inge Veltman Staffunctionaris wetenschapsbureau Jeroen Bosch Ziekenhuis
Rimke Vos Wetenschapscoördinator HagaZiekenhuis
Margot Wermeskerken, van Research Coordinator Onze Lieve Vrouwe Gasthuis
100see also www.healthoutlook.nl
Colophon
Developer
The Decision Group
Postbus 54
3620 AB Breukelen - the Netherlands
+31(0)346-574942
www.thedecisiongroup.nl
www.healthoutlook.nl*
Partner
Bureau STZ
Postbus 9696
3506 GR Utrecht - the Netherlands
+31(0)30-2739414
www.stz.nl
PhotographyRebke Klokke, Utrecht
www.arebkeoriginal.com
PrinterReflextra Printing & Design, Utrecht
www.reflextradesign.nl
© 2013 The Decision Group * For extra version of the Dutch Health Outlook 2013