Competitive Tendering Research Articles

Continuity and Change in Construction Procurement

This short history describes the evolution of procurement in the building and construction industry, from the early modern system of craft production in the seventeenth and eighteenth centuries to the emergence of the general contractor and the professions with modern methods of procurement in the nineteenth century. Procurement here is the commissioning or purchasing of buildings and structures, and any associated supplies and services required, by a client that pays for the work. A historical review is useful because there is a surprising, and often not well-recognized, continuity in the methods used and problems found. While ideas like competitive tendering, enforceable contracts, subcontracting and measurement of costs with a bill of quantities are now widespread and common, this was not the case 200 years ago and these innovations came with the industrial revolution that began in England in the eighteenth century. In other countries, especially the US and elsewhere in Europe, the details of their history of procurement are different, but the methods of tendering, contracting and the professions that emerged in England around the turn of the eighteenth century became the basis of the modern system of construction procurement.

A Case Study of a Negotiated Tender within a Small-to-Medium Construction Contractor: Modelling Project Cost Variance

This research explores the failure of competitively tendered projects in the UK construction industry to procure the most suited contractor(s) to conduct the works. Such work may have equal relevance for other developed nations globally. This research seeks to teach clients and their representatives that “lowest price” does not mean “best value”, by presenting a case study of a successfully negotiated tender undertaken by a small-to-medium enterprise (SME) contractor; SME studies are relatively scant in academic literature. By applying the “lessons learnt” principle, this study seeks to improve future practice through the development of a novel alternative procurement option (i.e., negotiation). A mixed philosophical stance combining interpretivism and pragmatism was used—interpretivism to critically review literature in order to form the basis of inductive research to discuss negotiation as a viable procurement route, and pragmatism to analyse perceptions of tendering and procurement. The methods used follow a three-stage waterfall process including: (1) literature review and pilot study; (2) quantitative analysis of case study data; and (3) qualitative data collection via a focus group. Our research underscores the need to advise clients and their representatives of the importance of understanding the scope of works allowed within a tender submission before discounting it based solely on price. In addition, we highlight the failings of competitive tendering, which results in increased costs and project duration once the works commence on site. These findings provide new contemporary insight into procurement and tendering in the construction industry, with emphasis on SME contractors, existing relationships, and open-book negotiation. This research illustrates the adverse effects of early cost estimates produced without first securing a true understanding of project buildability and programming. Our work concludes with a novel insight into an alternative procurement option that involves early SME contractor involvement in an open-book environment, without the need for a third-party cost control.

Modeling a Multi-Criteria Decision Support System for Prequalification Assessment of Construction Contractors using CRITIC and EDAS Models

Contractor prequalification assessment in the construction industry is an essential part of the project development process because contractors play a pivotal role in the extension of projects and resources. The main objective of the present study is comprised prequalification assessment for classifying contractors by applied the EDAS method for recognizing the contractors' potential before competitive tendering and obtaining bids. First, an inclusive, detailed list of 56 sub-factors under 5 main factors for project prequalification was compiled following a thorough literature review, and review of contractors by experts of Bandar Imam Khomeini municipality who already have done projects with contractors. Second, used the CRITIC method for obtained the weighing and importance of each factor. Third, classified the contractors by applied the EDAS system for recognizing the contractors' potential before competitive tendering and obtaining bids. Finally, the prequalification assessment process was developed to obtaining the rank of each contractor and help the stakeholders to select the right contractors. The effectiveness of the present approach was tested by applying it to a case study of the prequalification assessment of four construction companies' in Bandar Imam Khomeini municipality, Khuzestan, Iran. It is worth mentioning that the prequalification assessment by the proposed approach is approved by the project stakeholders and is consistent with their expectations. It can be concluded that based on relevant ranking and weighing of companies that procedure can be extended to the same studies in this regard, and the contribution of the present study is to propose a support system for prequalification and identification of contractors' ability, before assigning projects to companies for success in projects.

Assessing and Measuring: On Quality in Development-led Archaeology

The concept of quality has become the subject of inten- sive discussion in almost all aspects of society in recent years and development-led archaeology is no exception. Results showing a lack of quality have been observed both in countries which choose to use systems based on competitive tendering and in those where development- led archaeology is conducted solely by official institu- tions. In this article the authors discuss the essential elements for achieving good quality in development- led archaeology as required by the Swedish Heritage Act. They also discuss how Swedish development-led archaeology can be enhanced and what is needed to achieve and maintain quality.

Supplier satisfaction with public sector competitive tendering processes

Purpose This paper aims to explore the supplier perspective on competitive tendering processes and build on an increasing and developing interest in supplier satisfaction with public sector procurement activities. Design/methodology/approach Qualitative data was collected from 20 interviews with a variety of suppliers to the UK public sector, which was then analysed using Nvivo and a series of empirically supported propositions developed. Findings The findings are combined into an integrated supplier satisfaction model, which explains how a multi-layered set of expectations (past and ideal) and quality dimensions (fairness, ambiguity, unnecessary information, tender focus, relationship irrelevance, unresponsiveness, outcome success) lead to dissatisfaction. This paper also establishes the implications of these judgments (non-response, poor quality and relationship impact) and that they are impacted by comparison to alternatives. Practical implications Supplier dissatisfaction can have serious ramifications for public sector buying organisations by reducing the pool of applicants, creating relationship barriers and a disconnect between the tender and the eventual services provided. This paper gives empirically derived advice to managers and policymakers on how to avoid these issues. Social implications Ensuring that as wide a pool of possible suppliers can respond to tender requests, means that the services that are provided by the public sector can make the most effective and efficient use of available resources. In addition, small to medium-sized enterprises may be encouraged to overcome their feelings of dissatisfaction and respond more frequently and readily to tender requests. Originality/value This paper contributes to the field of public sector procurement and in particular that which looks at increasing supplier satisfaction, by developing a supplier satisfaction model based on supplier generated data, which uses disconfirmation theory to explain the dynamics of how individuals make judgments by comparing perceptions of performance with a multi-layered set of expectations. This paper identifies service quality dimensions that influence satisfaction judgments and the implications of these judgments.

Supreme emergencies and public accountability: the case of procurement in the UK during the Covid-19 pandemic

PurposeThe aim of this paper is to examine the changed nature of public accountability during a supreme emergency and explore how legal and auditing mechanisms have come to the fore, concluding that misappropriation of public monies is not an inevitable outcome.Design/methodology/approachThe paper explores an illustrative example, the UK government's procurement of personal protective equipment during the early stages of the Covid-19 pandemic.FindingsIn circumstances of a supreme emergency where parliamentary scrutiny and competitive contract tendering are suspended, other forms of public accountability come to the fore, with civil society actors becoming more evident.Research limitations/implicationsThe paper relies on illustrative examples based on the Westminster model of government. The study advanced the notion of deferred accountability and identifies areas for further study, potentially in different jurisdictions.Social implicationsThe paper highlights the need for a variety of active and engaged civil society actors.Originality/valueThe paper contributes an empirical case to how an account of government behaviour is established. The paper also contributes to a deeper understanding of the nature and role of legal and government audit accountability mechanisms.

Off-Patent Biologicals and Biosimilars Tendering in Europe-A Proposal towards More Sustainable Practices.

Background: In Europe, off-patent biologicals and biosimilars are largely procured by means of tender procedures. The organization and design of tenders may play a key role in the evolving biosimilar market, and currently, it is not fully elucidated how tenders for off-patent biologicals and biosimilars are designed and if approaches are aligned with sustaining market competition and societal savings for healthcare systems over the long term. This study aims to (i) explore the design and implementation of tender procedures for off-patent biologicals and biosimilars in Europe, (ii) identify learnings for sustainable tender approaches from purchasers and suppliers, and (iii) formulate recommendations in support of competitive and sustainable tender practices in the off-patent biologicals market. Methods: A mixed methods design was applied. A quantitative web-survey was conducted with hospital pharmacists and purchasers (N = 60, of which 47 completed the survey in full), and qualitative expert-interviews with purchasers and suppliers (N = 28) were carried out. Results: The web survey results showed that the organization and design of tenders for off-patent biologicals and biosimilars, and the experience of hospital pharmacists and purchasers with this, considerably varies on several elements across European countries. From the qualitative interviews, signals emerged across the board that some of the current tender approaches might negatively affect market dynamics for off-patent biologicals and biosimilars. The focus on generating short-term savings and existence of originator favouring tender practices were identified as elements that may limit timely competition from and market opportunity for biosimilar suppliers. The need to optimize tender processes, considering a more long-term strategic and sustainable view, was expressed. In addition, challenges appear to exist with differentiating between products beyond price, showing the need and opportunity to guide stakeholders with the (appropriate) inclusion of award criteria beyond price. Due to the variety in tender organization in Europe, a ‘one size fits all’ tendering framework is not possible. However, on an overarching level, it was argued that tender procedures must aim to (i) ensure market plurality and (ii) include award criteria beyond price (warranted that criteria are objectively and transparently defined, scored and competitively rewarded). Depending on the market (maturity), additional actions may be needed. Conclusions: Findings suggest the need to adjust tender procedures for off-patent biologicals and biosimilars, considering a more long-term strategic and market sustainable view. Five main avenues for optimization were identified: (i) safeguarding a transparent, equal opportunity setting for all suppliers with an appropriate use of award criteria; (ii) fostering a timely opening of tender procedures, ensuring on-set competition; (iii) ensuring and stimulating adherence to laws on public procurement; (iv) securing an efficient process, improving plannability and ensuring timely product supply and (v) safeguarding long-term sustainable competition by stimulating market plurality.

A comparison of structural features and vulnerability between government and nongovernment alcohol and other drug (AOD) treatment providers

ObjectiveBoth public (government-run), and not-for-profit (nongovernment) service providers provide alcohol and other drug (AOD) treatment services. Research has rarely studied the structural features of these providers, such as workforce characteristics, procurement arrangements, and funding security. The study reported here sought to document and analyze the differences between these two AOD treatment provider types in Australia. MethodsThe study administered an online survey instrument targeted at managers of AOD treatment sites. The survey comprised three sections: (1) the service (e.g., treatment types); (2) workforce (e.g., total number of staff); and (3) funding and procurement arrangements (e.g., contract length). The study completed a total of 207 site surveys. The studied compared government and nongovernment services on structural features that may create a more or less sustainable or vulnerable service (funding arrangements, payment mechanisms, and contract length). ResultsGovernment providers were more likely to provide medically oriented treatment types such as withdrawal management and pharmacotherapy, whereas nongovernment organization (NGO) providers were more likely to offer rehabilitation. Consistent with this, government services were more likely to employ medical professionals and nurses, indicative of a more medically oriented workforce, while NGO services were more likely to employ AOD workers, youth workers, peer workers, and counselors. Our data illustrate that NGO services were more likely to be subject to competitive tendering and to have shorter contract lengths, compared with government services, and overall to be more structurally vulnerable. ConclusionDespite the reliance on NGOs to provide the majority of specialist care (71% of all treatment episodes in Australia), these services are more vulnerable than their government counterparts. To ensure that a comprehensive suite of treatment services is available, procurement arrangements that support stability and security in nongovernment service providers and government service providers are essential.

In Focus: Tender procurement sparks row

Croydon LOC has complained of unfair treatment during a competitive tender process.

A Narrative Approach to Corporate Relations: The Historical Background on Telenor’s Success

This article examines the development of buyer-supplier relations in the telecom sector. The literature on telecoms in Scandinavia has been dominated by the narrative praising the trusting and collaborative relations between Telia, the Swedish public telephone operator (PTO), and Ericsson, the equipment supplier. The Norwegian PTO, Telenor, diverted from this path and was a pioneer in preferring competitive tenders and arm’s length relations with its suppliers starting in the 1970s. The article argues that Telenor’s history and nationality had a significant impact on its business strategy. In addition, the article examines why some business narratives persist while others remain unknown. One finding is that shareholder-friendly narratives have a handicap because they focus on self-interest and money, and not societal values.

Assessing the cost of competitive tendering in Ghana using transaction cost theory

PurposeThe purpose of this study was to determine the transaction cost (TC) contractors incur when tendering for a project as well as establish a correlation between the TC of tender and tender amount of projects procured through the national competitive bidding procurement method.Design/methodology/approachThe research draws extensively documentary analysis, observation and interviews to collect cost data on 14 different tenders submitted by a D1/K1 contractor. Using TC theory, the data are analyzed and the actual cost is determined. Further, Spearman rank correlation is employed to establish a relationship between tender price (TP) and the cost of tender by the aid of Statistical Package for Social Sciences.FindingsThe research developed a tender preparation conceptual framework highlighting the components of TC in competitive tendering in Ghana and also revealed that, apart from the emotional and psychological costs, contractors in Ghana incur approximately Gh₵ 4,625 (US$ 925)–Gh₵ 2,520 (US$ 504) to prepare and submit a competitive tender. In relation to the tender figure, the TC of tender in Ghana ranges from 0.05% to 0.65% and an average of 0.33%. Also, there is an inverse correlation between TP and the percentage cost of tender.Research limitations/implicationsThe research relied on 14 competitive tenders and also limited to public sector works. Findings from the study should therefore be applied with caution.Originality/valueThis study is the only known research that has focused on assessing the TC of public sector competitive tendering from a contractor's perspective and within a developing sub-Saharan African context.

An Overview on Pharmaceutical Tendering Process

Objectives: World Health Organization (WHO) has implemented the Pharmaceutical tendering process for procuring the high-quality medicines from different firms to meet the needs of the countries which are having drug shortages. Materials and Methods: The main aim of the WHO is to get the quality products at low price which can be affordable by the patient. WHO constantly giving chance to different firms based on their qualification for tendering process. The pharmaceutical companies are inspected by WHO members to check whether the company is adhering with Good Manufacturing Practices (GMP) regulations and Quality Management system (QMS) requirements. Results: The WHO allows only prequalified pharmaceutical company for the tendering process (Restricted tender). By this process WHO allows the company which produces quality drugs at the affordable cost and complying with the all WHO regulations. Comparing the restricted to open tender, the direct procurement and competitive negotiations tender methods are little disadvantageous as the drugs are taken from highly reputed or single manufacturer which causes the price of the drug to be higher. In the open tender and restricted tender, the WHO can get the manufacturers who supply drug products at low prices.

State-of-the-Art of Mini Grids for Rural Electrification in West Africa

The current electrification status in West African countries presents rural electrification rates below 40%, national grid losses above 39% with frequent disruptions, and electricity prices averaging $0.35/kWh, up to national values of $0.66/kWh. With this, off-grid systems have gained great attention during the last decade as energy solutions; especially solar home systems (SHS) and mini grids. Nowadays, 385 mini grids with a power of near 30 MW are operating in West Africa, with 95% based on PV. Since 2019, result-based tenders with international aid funding—more effective than previous competitive tenders—seek to install at least 317 new mini grids in Togo, 250 in Nigeria, 100 in Burkina Faso, and two in Mali. Besides, the market for mini-grid energy access start-ups grew from $19 million in 2013 to $339 million in 2018. Despite this recent development in West Africa, research and data for mini grids in this region is scarce, and it is mostly approached from the technological side, with a striking lack of information regarding the social impact. This work tries to describe the present status of research and current operating installations, as well as the main challenges for future development of off grid mini grids in West Africa, which pose as the missing link between SHS and grid extension.

Antecedents of Opportunism on Integrity in Competitive Tendering

Opportunism negatively impacts relational exchange tenets in public procurement such as trust, compliance, professional values and ethics. It is manifested in behaviours such as stealing, cheating, dishonesty, and withholding information when executing competitive tendering. The problems of competitive tendering and its implications on public sector procurement have been identified as not only enormous but complex now that there is serious needs on the part of various government servants to provide poor services with little funds. However, integrity translates degree of reliability of public procurement practitioners, as bidders and all other stakeholders need to have assurance that they can rely on any information disseminated by the procurement entity, formally or informally. This study is endeavor to reach a more comprehensive understanding of the relationship between integrity on opportunism dimensions, with a special focus on behavioural aspects in public sector. Primary data were collected through self administered questionnaire to public procurement practitioners and regulators in Tanzania’s Local Government Authorities of Singida and Dodoma Regions. Data were analysed through preliminary analysis, descriptive analysis and multiple regression analysis to examine effects of Integrity on Opportunism in Competitive Tendering. It is evidenced that integrity practices in competitive tendering are statistically significant and negatively correlated to opportunism. The findings will help public procurement practitioners and regulators in Local Government Authorities to take necessary steps to improve integrity so as to reduce opportunistic behaviours in competitive tendering. In overall, higher integrity is associated with higher level of competitive tendering performance.

The influence of dissensus on governmentality during competitive tendering: A longitudinal field study

This paper investigates the ways in which dissensus has influenced governmentality during a longitudinal process of competitive tendering of public services. Data are from a field study conducted in the field of public care for the elderly from 2007 to 2015 in Finland. Public elderly care in Finland is under the responsibility of each municipality. Municipalities have local autonomy; including municipal taxation right. In addition to municipal tax revenues, the central government finances each municipality on a per capita basis annually. Every municipality is run by democratically elected local politicians. The elected politicians have the power to appoint leading public managers in charge of each public service sector. Findings showed that political dissensus arose from a lack of appropriate policies of governing for performance during a new and international competitive tendering process. Managerial dissensus arose from a low-level professional experience and a lack of appropriate technologies to deal with highly advanced profit-making companies competing for entry and expansion into a prestigious public elderly care market. In consequence, costs of outsourced services continued to increase. As time passed, however, political and managerial dissensus improved the process of governing for performance; key decision-makers took reactive measures to limit procurement risks in future competitive tendering processes. The potential contribution is to show the relevance of dissensus when it motivates public managers and political decision-makers to improve specific programs, techniques, and strategies used to manage public services

Comparing Regulatory Designs for the Transmission of Offshore Wind Energy

Offshore wind plays an ever-increasing role for the global transition to renewable energy. For offshore wind energy to be successful, cost-effective transport of the produced electricity to shore is necessary. The development and operation of the offshore transmission asset is costly and regulated differently across the globe. In most countries, the TSO is responsible for the transmission and develops and operates the asset separately from the offshore wind farm. Other countries have established a competitive tender with integrated development of the offshore wind farm and the transmission asset. However, there is so far no empirical analysis of the economic benefits of different regulatory designs regarding the offshore transmission assets. In this paper, we collect a unique data set on offshore transmission assets that compares empirical cost and quality of offshore transmission assets in two countries with different regulatory regimes for the first time. With project level data we can control for geographical as well as technical difference to assess which regulatory design might lead to lower economic costs for the offshore transmission asset. Comparing the cost in the two leading countries for offshore wind energy, we find that a competitive regime leads to lower transmission cost and similar transmission availability.

Thromboembolic Events and Thrombosis With Thrombocytopenia After COVID-19 Infection and Vaccination in Catalonia, Spain

Background: Thromboembolism and thrombocytopenia have emerged as potential adverse events associated with vaccines against SARS-CoV-2. We compared rates of thromboembolism and thrombocytopenia following vaccination with BNT162b2 and ChAdOx1 with expected rates. Rates for people with COVID-19 were estimated to provide context. Methods: Primary care data from Catalonia, Spain, informed the analysis. Study participants were vaccinated with BNT162b2 or ChAdOx1 (27/12/2020-19/05/2021), diagnosed with COVID-19 (1/09/2020-1/03/2021) or present as of 1/01/2017. Outcomes included venous thromboembolism (VTE), arterial thromboembolism (ATE), thrombocytopenia, and thrombosis with thrombocytopenia syndrome (TTS). Incidence rates were estimated in the 21 and 90 days after vaccination and COVID-19 diagnosis, respectively, and up to 31/03/2019 for background rates. Age indirectly standardised incidence ratios (SIR) were estimated. Findings: We included 945,941 BNT162b2 (778,534 with 2 doses), 426,272 ChAdOx1, 222,710 COVID-19, and 4,570,149 background participants. SIRs for VTE were 1.29 [95% CI 1.13-1.48] and 0.90 [0.76-1.07] after first- and second-dose BNT162b2, and 1.15 [0.83-1.58] after first-dose ChAdOx1. The SIR for VTE in COVID-19 was 8.04 [7.37-8.78]. SIRs for thrombocytopenia were 1.35 (1.30-1.41) and 1.19 (1.14-1.25) after first- and second-dose BNT162b2, 1.03 (0.93-1.14) after first-dose ChAdOx1 and 3.52 (3.39 to 3.67) for COVID-19. Rates of ATE were similar to expected rates for BNT162b2 and ChAdOx1, as were rates of TTS for BNT162b2, while fewer than 5 such events were seen for ChAdOx1. Interpretation: Safety profiles of BNT162b2 and ChAdOx1 were similar. A safety signal was seen for VTE after first-dose of BNT162b2. Although confidence intervals were wider, a similar estimate was seen for first-dose of ChAdOx1. The 1.3 fold increase in the rate of VTE after first-dose of BNT162b2 compared with an 8 fold increase after diagnosis of COVID-19. No safety signals were seen for ATE or TTS. Further research is needed to investigate the causality in the observed associations. Funding Information: This study was funded by the European Medicines Agency in the form of a competitive tender (Lot ROC No EMA/2017/09/PE). Declaration of Interests: DPA’s research group has received research grants from the European Medicines Agency, from the Innovative Medicines Initiative, from Amgen, Chiesi, and from UCB Biopharma; and consultancy or speaker fees from Astellas, Amgen and UCB Biopharma. Peter Rijnbeek works for a research institute who receives/received unconditional research grants from Yamanouchi, Pfizer-Boehringer Ingelheim, GSK, Amgen, UCB, Novartis, Astra-Zeneca, Chiesi, Janssen Research and Development, none of which relate to the content of this work. Katia Verhamme works for a research institute who receives/received unconditional research grants from Yamanouchi, Pfizer-Boehringer Ingelheim, GSK, Amgen, UCB, Novartis, Astra-Zeneca, Chiesi, none of which relate to the content of this work .All other authors have no conflicts of interest to declare.Ethics Approval Statement: This study was approved by the Clinical Research Ethics Committee of the IDIAPJGol (project code: 21/054-PCV).

Strategies to Foster Competition for the Market in the Urban Bus Sector in Developing Countries

Different mechanisms have been adopted by developed and developing countries over the last decades to provide urban bus services. Although competitive tendering has been considered the standard method to procure urban bus services, it cannot be treated as a ready-made solution. Contracts are incomplete by nature and, after the tender, to avoid ex-post opportunism they must be properly monitored. Additionally, developing countries, in general, have weak regulatory bodies and limited capacity to oversee public contracts. This paper aims to review the literature to gather actions that can increase the competition in public tenders and improve service quality during the life of the contract in developing countries.

Benefits of implementing Six Sigma in competitive tendering process

PurposeThis research investigates the implementation of Six Sigma in competitive tendering processes to address persistent delays by identifying the potential benefits and challenges of implementing Six Sigma in construction competitive tendering processes. The results seek to encourage practitioners to implement Six Sigma in addressing competitive tendering process delays.Design/methodology/approachLiterature was reviewed to identify the benefits and challenges of Six Sigma implementation in construction processes and categorized under broad headings. Three case studies were used to authenticate the literature findings by applying Define-Measure-Analyse-Improve-Control to their construction competitive tendering processes. Furthermore, quality tools and techniques together with documentary analysis, content analysis and determination of frequencies of quantitised qualitative data were employed to identify potential benefits and challenges.FindingsThe most common Six Sigma benefits achievable in construction competitive tendering are Time Related benefits. Other benefits likely to emanate as ripple effects are Customer Focus Related, Quality Related, Process Improvement Related, Human Resource Related, Finance Related and Decision Related. However, implementation challenges should be expected.Practical implicationsSix Sigma implementation in construction competitive tendering promotes time efficiency. It is expected that this will encourage quantity surveyors, procurement practitioners and their institutions to implement Six Sigma in addressing persistent delays in their competitive tendering processes.Originality/valueThis paper demonstrates the use of merged approach under mixed method to identify the benefits and challenges of Six Sigma implementation in construction competitive tendering process within the Ghanaian context.

Designing a diagnostic Total Testing Process as a base for supporting diagnostic stewardship.

To more comprehensively support clinical management of patients in our hospital, we redesigned the diagnostic Total Testing Process (TTP) from request to report. To that end, clinical needs were identified and a vision on Total Laboratory Automation (TLA) of the TTP was developed. The Delft Systems Engineering Approach was used for mapping a desirable laboratory testing process. The desirable "To Be" diagnostic process was tendered and the translation of a functional design into a specific TLA-configuration- compliant with the vision andthe predefined functional design- was accomplished using a competitive dialogue tender variant (based on art. 29 of the EU guideline 2014/24). Realization of this high-end TLA-solution enabled a high-quality testing process with numerous improvements such as clear and supportive digital request forms, specimen consolidation, track and trace and non-conformity registration at the specimen level, better blood management (∼40% less blood sampled), lean and in line processing with increased productivity (42% rise in test productivity per capita), and guaranteed total turn-around-times of medical tests (95% of TLA-rooted in line tests are reported<120min). The approach taken for improving the brain-to-brain loop of medical testing, as fundament for better diagnostic stewardship, is explained.