Dunja Dreesens

16 ‘Guideline for Guidelines’, which stipulates 20 criteria for the development and implementation of clinical practice guidelines. The working group also more or less addressed shared decision- making; criterion 16 states that the guideline development project delivers products that are tuned to the needs of the healthcare professionals as well as patients, and which enhance the use of said guideline. Examples are: a patient version of the guideline, patient decision aids, patient materials to inform and educate, and other tools that promote self-management and shared decision-making by the professional and patient (6). The Working Group Guideline for Guidelines also adapted the existing Dutch ‘Haamstede’- definition of a CPG, stemming from 2004: “A CPG is a document with recommendations, advice and acting instructions to support the decision-making of healthcare professionals and patients, based on the results of scientific research and subsequent discussion and forming of opinion, aimed at making effective and efficient clinical care explicit.” (7). The members of the working group decided to align it more with the international consensus on what a CPG is, and updated the new definition using the one from Institute of Medicine (IoM) (2011). The new ‘Brummelen’- definition of a CPG was: “A CPG is a document with recommendations, aimed at improving the quality of care, based upon systematic summaries of scientific research and the assessment of pros and cons of the various care options, supplemented with the expertise and experience of healthcare professionals and patients.” (6). By doing so, the working group intended to shift the focus of CPGs from predominantly research evidence to include clinical practice and patient preferences as well. They decided to do this partly because a review of 62 CPGs commissioned by the Council showed that CPGs had low(er) AGREE-scores (Appraisal of Guidelines Research and Evaluation instrument) when less hard scientific evidence was available, as is often the case with input generated by patient involvement or other end users, and with topics related to organisation of care (8). Another bottleneck the Council recognized was a lack of consistency in the language and terminology being used regarding quality of care. The Council assembled a glossary of 1,000 words used in the quality of care discourse and added descriptions (9). Together with the participants of the Keizer Karel conference in 2009 100 from those 1,000 words were chosen as the most important ones (10) and both lists were published so that everybody working in care could get acquainted with these terms and definitions. The online glossary also provided the possibility to comment on the descriptions and add new words (11), as any language is dynamic; meanings change, words disappear and new ones are introduced. SDM was not mainstream in 2006, but since then it had picked up pace and in 2011 the international conference on SDM took place in the Netherlands: ‘Bridging the gap towards SDM: patient pull or clinician push?’. However, at the end of the ISDM-conference, the Dutch participants had to conclude that the Netherlands were not ready for nationwide implementation of shared decision-making. Before this was possible, concerted action was needed. For example, by educating professionals, further empowering of patients and making high quality decision support tools such as patient decision aids (PDAs) publicly accessible. At the end of 2012, it became clear that the Ministry of Health persevered in merging several councils and platforms dedicated to improving the quality of care. The Council for the Quality Chapter 1