Dunja Dreesens

58 aforementioned working group, to attempt to reach consensus on the remaining tools. The group reconvened in June 2016, again discussing the tools and their interrelations. In 2018, the Federation of Medical Specialists, an umbrella organisation of 32 medical specialist societies acknowledged the importance of having a limited set of tool types and agreed on a list with five tool types and their definitions [29]. Furthermore, organisations and agencies in the mental healthcare and nursing have tried to elaborate on our work by aiming to reach agreement on care terminology used by both parties. Finally, the Dutch Federation of Patient Organisations, an umbrella organisation of more than 200 patient organisations, has endorsed the core set and started using its definitions. Conclusions and implications for practice For successful implementation, it is necessary that the parties involved use and stick to the core set of tool types. It requires discipline and resisting the temptation to design new tools, regardless trends in health policy (108). Imbedding clearly defined tools in knowledge translation strategies, combining them with other KT interventions or integrating them in the KT-cycle, might contribute to their implementation as well (147, 164, 165). So far, organisations have made steps in using the core set and reducing the number of tool types to be funded and developed but collaboration could be improved. This is of increasing relevance as healthcare services are becoming more multidisciplinary and patients are getting more involved in policy making. A shared taxonomy at a national level and a clear governance structure with defined tasks and roles of different stakeholders within the healthcare system will help reducing confusion and duplication of efforts. In addition, formal and informal networks nationally and internationally can contribute to raise awareness and understanding. Repeating the Delphi in an international context, for instance within the Guidelines International Network, including more than 100 organisational members in 30 countries across the world, or the International Society for Evidence Based Health Care (EBHC), might be a worthwhile exercise. As language is dynamic, and meanings and use of the tool types might change over time, the tool types and their definitions need to be reviewed periodically. The challenge is to balance between the need to keep definitions over time and to keep up-to-date with new knowledge and research findings. Acknowledgements - All the experts who participated in the survey and the Delphi rounds. - Synmind, especially Fred Balhuizen and Caroline de Roos, for providing the web-based platform for the Delphi study, as well as their support and expertise. - Arnoud van den Eerenbeemt for editing the definitions of the tools so that they were written in proper Dutch. - Jannes van Everdingen from the NVDV Dutch Society of Dermatology and Venerology and the National Health Care Institute for his expertise and participation in the project group. Chapter 3