Dunja Dreesens

37 extinct, while the ones that fit best survive. Alternatively, one could put it into more economic terms, as the Dutch healthcare system has undergone a shift from government regulated to a market regulated construct. As a result, organisations apply strategies of differentiation and diversification to advance themselves and to try to distinguish their products from those of other organisations (106). The National Health Care Institute recently introduced the ‘care tree’ tool (107). This is in effect a digital flow chart, but such a name would not attract the attention desired by the institute (108). The DCGP (Dutch College of General Practitioners) already applied this marketing technique a long time ago by calling its guidelines ‘standards’. This implies that when their guidelines are developed according to their strict, predetermined criteria, they are entitled to be called ‘standards’. Consequently, DCGP Standard could be considered the ‘brand name’ for their guidelines. As mentioned above, the description of a tool was not always immediately clear. This does not necessarily mean that there is no understanding of the tools within or outside the organisation. For example, the DCPG Standards have already been in use for almost thirty years. The DCPG Standard and its meaning might therefore be considered to be common knowledge in healthcare practice. The tool types of the Dutch Health and Youth Care Inspectorate (IGJ) proved to be an ambiguous case. The Inspectorate mentioned seven tool types on its site but no definitions were provided. In general, the Inspectorate refers to these tool types as ‘field norms’, as they are preferably developed by the healthcare field. One of the tasks of the Health Care Inspectorate is monitoring; when it detects an inadequacy, it will call upon the relevant healthcare organisations to address this problem, for example by developing a tool. A clear explanation of these tools would therefore have been expected; in failing to provide these, the expectations of the Inspectorate remain unclear. Some parties, including the Health and Youth Care Inspectorate itself, might say that in this manner it grants organisations room to manoeuvre and decide for themselves which tool is appropriate. At the same time, the Inspectorate fosters expectations of the tool in question and its use for monitoring and enforcement, which congruent with the purposes of the healthcare organisations developing the tool, and whether this organisation employs a clear definition of the tool or not. We decided to include the general term ‘field norm’ as it can refer to all tool types developed and used by healthcare organisations. The example mentioned above underlines the importance of clear and precise definitions of tools. Norma Lang phrased it boldly in 1992: ‘If we cannot name it, we cannot control it, practice it, teach it, finance it, or put in into practice’ (109-112). Another reason for this might be that health care is multidisciplinary, although the real meaning of ‘multidisciplinary’ seems to become apparent and sink in only now. Apart from different kinds of healthcare professionals, patients are added to the healthcare equation, while insurers, government agencies are also (getting) involved (113, 114). Maybe these do not all play a pivotal role in the decision-making process between patient and clinician, but they do use the tools. To better understand each other it is therefore necessary to use and speak the same language (115). As Ubel states in his book ‘Critical decisions’: ’For any pair of people to communicate effectively, it helps enormously if they share a common language.’ (116). At the moment, we Chapter 2