Dunja Dreesens

131 still is described as such in the document “Toetsingskader’ (Quality assessment framework) (302), however in recent years the term has been used for a tool type in its own right (303- 305). This begs the question if these new tool types, are actually new tools or similar tool types with new names. This was illustrated by a study by De Bleser et al carried out in 2006 regarding the tool type ‘clinical pathway’; they found 84 different definitions (70). These findings are reminiscent of Walshe’s characterization of developments in the quality improvement (QI) domain. He described how a similar set of quality improvement ideas and methods are presented repeatedly under different names and terminologies, and called it pseudo innovation. He ‘blamed’ the human tendency to be allured by the new and improved. And healthcare is not immune to it either. When embracing new ideas (or tool types in this case) we should ask ourselves are they really new and are they really an improvement. Constantly introducing ‘new’ tool types is in contradiction with Deming’s first principle of quality management: the need for constancy of purpose (108). The uptake and use of tools in health care is usually poor (42, 148). Although the amount of tool types has not been the (main) focus of tool implementation research, it could be a factor just as it is suspected in QI. And perhaps the “serial ‘pumping and dumping’ of” a myriad of tools during the last decades has – instead of sustained and continuing improvement – led to some waste of effort and resources as it did in the quality improvement domain (108). If we want to help healthcare professionals and patients with making sense of all the knowledge available to them, we should not inundate them with tools. And we need to be more vigilant about their definitions and implementation. More discipline by and collaboration between stakeholders is necessary for sustainability of the core set. The Netherlands do not have an organisation such as NICE (The National Institute for Health and Care Excellence) that could take the lead in orchestrating this. Tool developers in the Netherlands are organised per healthcare domain, serving their own rank and file (e.g. The Dutch College of General Practitioners (NHG) for general practitioners, the Knowledge Institute of Medical Specialists, Akwa for mental health care, TNO for youth health care, and Vilans for long term care). Moreover, they are considered peers amongst one another. One organisation taking the lead to bind them more together regarding the (maintenance of and adherence to the) tool set, would be considered presumptuous. The National Health Care Institute could be considered, as it is an independent body, and taking its goals on quality and affordability of health care (system) into account (306). So far, the institute has been regarded with some suspicion and considered a ‘bogeyman’ by some parties because of unwanted interference when it comes to who is responsible for the quality of health care. The funding of these tool developing and quality improvement organisations however is being centralised at ZonMw, the Netherlands Organisation for Health Research and Development. For the time being separate funding programmes are still in place, but in time ZonMw – in collaboration with the parties involved – might bring them closer together in developing and maintaining tools (i.e. following the agreed rules for tools), including sticking to the established core set of tool types (307). Chapter 7