The Netherlands - Lessons from the Dutch healthcare system

Citation

(2007), "The Netherlands - Lessons from the Dutch healthcare system", Leadership in Health Services, Vol. 20 No. 2. https://doi.org/10.1108/lhs.2007.21120bab.004

The Netherlands - Lessons from the Dutch healthcare system

The Netherlands

Lessons from the Dutch healthcare system

Keywords: Healthcare improvement, Performance management, Healthcare outcomes

Creating the best healthcare system possible at an affordable cost is the goal of every policymaker. While no system is perfect, a new report shows the Netherlands has initiated several reforms in the areas of primary care, emergency care, and quality improvement that allow it to achieve very high performance.

For a long time, the Dutch have made primary care central to their overall healthcare system. Family doctors work with nurses, nurse practitioners, midwives, physiotherapists, and pharmacists to deliver high-quality, efficient care. All patients must register with a primary care practice, and family physicians act as gatekeepers to hospital and specialist care, ensuring 95 percent of problems presented in primary care are handled there. As well, nearly all primary care practices use electronic medical records, and many are starting to use computer software to identify and manage patients who have or are at risk of developing a chronic condition.

Also, after-hours and emergency care has been reorganized in the Netherlands. Patients are assigned to a regional primary care co-operative, which employs nurses as the first point of contact. In an emergency after hours, patients call the co-operative nurse and ask for triage advice on how to handle the problem. Family doctors follow up by telephone, in walk-in centres, or in patients’ homes, if necessary. Patients are also able to visit an emergency room directly, though about 85 percent choose to call the nurse at the primary care co-operative first.

Quality improvement has become a key part of Dutch healthcare culture:

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  Clinical practice guidelines were developed – more than 80 for primary care alone. Practitioner adherence is continuously evaluated and found to be strong; a mean of 75 percent of all actions and decisions taken in the sample followed the guidelines in 2002.

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  Local collaboratives, comprised of eight to 12 professionals from various disciplines, meet regularly to discuss clinical guidelines and performance, exchange best practices, and plan for change.

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  Specially trained nurses and doctors do peer visits to primary care practices, offering training and education, feedback, materials, and other support to ensure the clinical guidelines are followed. In one prevention intervention, the percentage of women getting Pap smears rose from 45 to 70 percent after the peer visits.

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  Specialist teams working in hospitals are evaluated on a regular basis.

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  Hospitals collect and publicly report on 20 performance indicators, including death rates after a heart attack or stroke, wound infections, and medication errors.

Policy makers in other countries are urged to take several lessons from the Dutch reforms, including the need to focus on primary care; integrate and provide long-term support for change interventions; educate and support healthcare professionals on the need for evaluation and quality improvement; and study the quality improvement initiatives themselves to ensure they are efficient and effective.