Dunja Dreesens

15 General introduction My first introduction to clinical practice guidelines was in 2006. During my studies at Erasmus School of Health Policy & Management (Rotterdam), I had to write a critical reflection paper on the subject. Later that same year, I switched jobs and started as programme manager with ZonMw, the Netherlands Organisation for Health Research and Development. One of the programmes I was responsible for was the so-called KKCZ-programme (Kennisbeleid, Kwaliteit Curatieve Zorg (Knowledge management, Quality Curative Care)) which was chaired by professor Ton Casparie. He was responsible for bringing the quality (management) movement and clinical practice guidelines to the Netherlands. The KKCZ-programme entailed the development of multidisciplinary clinical practice guidelines while also introducing innovative elements as patient involvement, taking into account the social and labour participation by patients, as well cost effectiveness of the recommendation. Up until then clinical practice guidelines, further referred to by the acronym CPG, were mainly characterized by a monodisciplinary approach and patient participation was virtually non-existent. The Dutch Ministry of Health, wellbeing and sports thought it important that CPGs should reflect the ever- increasing multidisciplinary setting of (health) care (delivery) and the added value of patient involvement. In addition, the Ministry of Social Affairs and Employment felt that CPGs should regard health from a broader perspective than just curative care aspects (2, 3). Therefore, both ministries commissioned and funded this guideline programme. Adding patient involvement and the effect of health care on labour and social participation to clinical practice guidelines, turned out for me to be an early introduction to patient engagement, and maybe even shared decision-making (SDM). However, the concept of shared decision- making and its abbreviation SDM were not mainstream in the Netherlands yet. As a follow-up, the Ministry of Health installed the Council for the Quality of Care in 2009. This was an advisory board to the Minister of Health for which I was – together with Jannes van Everdingen – executive secretary. The task of the Council for the Quality of Care was to: - Enter on the agenda bottlenecks concerning clinical practice guideline development and implementation; - Support healthcare professional associations by providing guidance in CPG development and developing procedures to solve the bottlenecks mentioned above; - Encourage healthcare professional associations in dealing with these bottlenecks (4). One of the bottlenecks was that the development of CPGs in the Netherlands was being left to the own accord of the parties involved. Besides the agreement that guideline development should be evidence-based (5), there was no nationwide consensus on the criteria which had to be met when developing clinical practice guidelines. To tackle this, the Working Group Guideline for Guidelines was formed by the Council. Members of the working group were representatives from the various care domains, such as long term care, public health, primary and secondary care, as well as experts on guideline development and implementation. Some of the represented domains were forerunners in CPG development, such as the Dutch College of General Practitioners and the medical specialists. The main legacy of the working group is the Chapter 1