Dunja Dreesens

39 struggling with definition issues: ’It is not possible to use one definition to cover all circumstances. Similarly, the word ‘standards’ is employed in a variety of ways across Europe […]. The words also have very different meanings in the local contexts of national higher education systems.’ (136) Strengths and limitations Because we made the choice to include tools even though their definition or description was not fully complete – incompleteness was deemed an interesting result by itself – it could mean that somebody else might decide differently on the inclusion or exclusion of the tools that we found. The aim of the review was to show that there were many tool types available in the Netherlands for knowledge transfer and decision-making. Although another person might have chosen different organisations or different tools, we feel that the outcome would have been roughly the same. Because of the national policy perspective, we limited the scoping review to tool types being developed by national agencies. Including locally developed, internationally developed tool types and tool types developed by commercial organisations probably would have generated an even larger range of available tool types, but we would not have been able to look into these tool types in detail as we did in this approach. Conclusions In the Netherlands, but also in other countries, there is a myriad of tool types available to healthcare professionals (and patients). Tools that are developed to facilitate, ensure knowledge translation, and to provide healthcare professionals with support whilst making decisions. But because the tool types are not defined clearly and precise, misunderstanding about their use and purpose can arise. As can miscomprehension between disciplines and domains. We also might be duplicating efforts, and wasting (public) means when developing these tool types. Also, because the dependencies or interconnectedness between some of the tool types is poorly indicated as well. And we still add new ones before we have established that the old ones do not work. By doing so, we seem to be creating, despite our best intentions, a tool overload instead of solving the information overload. Recommendations As existing tool types do not seem to deliver the results for which they are intended or do not live up to the full expectations of their target users, one response is to develop new ones (107, 141). We should ask, however, if this is the right response, or whether we need to take a closer look at the tools already available and how they are being used, need adaptation, as well as paying attention to improving (in providing) the definition of these tool types and their intended use. We have shown that there exists a myriad of tool types, most of which are poorly defined and unclear as well as to their mutual relations. This abundance of tool types might affect their usefulness raising the important question how to deal with all these tools, their different formats and sometimes their contradictory contents. The review underpins what parties have been advocating for a number of years now (88): a trimming down of the number of tool types or terms used and a clear(er) definition of tools. We recommend that parties on either a national or Chapter 2