Dutch Health Care Sector Research Articles

Five pathways into one profession: Fifty years of debate on differentiated nursing practice.

The persistence of multiple educational pathways into the nursing profession continues to occupy scholars internationally. In the Netherlands, various groups within the Dutch healthcare sector have tried to differentiate nursing practice on the basis of educational backgrounds for over 50 years. Proponents argue that such reforms are needed to retain bachelor-trained nurses, improve quality of care and strengthen nurses' position in the sector. Opponents have actively resisted reforms because they would mainly benefit bachelor-trained nurses and neglect practical experience and technical skills. This historical case study aims to provide insight in this apparent stalemate. Our analysis of this debate is informed by literature on institutional work and current debates within the historiography of nursing. This study contributes to a better understanding of this contemporary debate by examining a broader timeframe than is usually studied, and by highlighting nurses' roles in complex processes of change. We argue that, rather than being stuck in their professional development, different groups of nurses have forged their own path forward in their professional development, albeit via different strategies.

The Biodiversity Impact of Health Care: Quantifying the Extinction-Risk Footprint of Health Care in The Netherlands and Other European Countries

The health care sector exists to support and promote human wellbeing; however, its operations contribute to environmental degradation undermining nature’s capacity to support the same wellbeing. Biodiversity loss, in particular, creates threats to wellbeing through a reduction in ecosystem service provisioning and increases in disease. This study aims to estimate the extinction-risk footprint associated with the health care sector, focusing on Europe. We created an environmentally-extended multi-region input–output model using data on the extinction risk of species available from the International Union for Conservation of Nature’s (IUCN) Red List of Threatened Species. Using input–output analysis, we then quantified the extinction-risk footprint of the Dutch health care sector and, for comparison, that of the 30 European nations which use similar sector classifications in their National Accounts reporting. We found that the Netherlands has the highest health care extinction-risk footprint on a per-capita basis and that health care contributes 4.4% of the Dutch consumption extinction-risk footprint compared with an average of 2.6% across the comparator set. Food and beverage supply chains make a disproportionate contribution to health care’s extinction-risk footprint, while supply chains implicated in the sector’s carbon footprint make a limited contribution. These results suggest that reducing the environmental impact of the health care sector may require a differentiated approach when multiple environmental indicators are considered.

Assessing the relation between financial performance and long-term bank loan interest rates for healthcare providers in the Netherlands: a panel data analysis

The Dutch health system is financed predominantly by commercial bank loans, especially after the market-oriented reform in 2006, when government investment guarantees were abandoned. Commercial capital markets were envisaged to improve efficient capital allocation and management. We analyzed the effects of commercial bank loans on interest rates, investments and allocative efficiency in the Dutch healthcare sector. We aimed to explain variation in interest rates by financial performance of healthcare providers, hypothesizing that the reform reduced interest rates for financially well-performing providers. Using financial data from publicly available annual reports, we explored the effect of financial performance on long-term loan interest rates through pooled linear regressions. Our data showed that financial reserves have steadily increased, although profitability margins have declined since 2011–2013 (depending on the sector). While nominal interest rates have generally declined since 2006, the risk surplus on healthcare loans has steadily increased. Furthermore, we observed no significant relation between the financial performance of healthcare providers and interest rates on capital loans. Maintaining additional financial reserves provided no apparent benefit to capital costs. This suggests that healthcare providers may consider whether financial reserves should be maintained at current levels or can better be used for direct investments. Moreover, healthcare policymakers should evaluate whether the increase in risk surplus combined with an apparent lack of reward for financial scrutiny is a desired outcome of the reform.

Non-Conformism as a Mediator of the Leadership-Well-Being Relationship in the Dutch Healthcare Sector

In this study, a model is developed and tested to examine the influence of non-conformism on the relationship between the perceived leadership style and work engagement and the level of sickness absence amongst Dutch healthcare professionals. The results of this study showed that the perceived transformational leadership style is strongly positive related to work engagement, whereby work engagement is negatively related to sickness absence. The results of this study also showed non-conformism to be a significant influencer of the leadership style-work engagement relationship. Because of the strategic importance of human capital in healthcare, it is important that leaders practice effective leadership to improve well-being and organizational performance.

The Impact of Ex-Post Legislative Evaluations in Healthcare: A Mixed Methods Realist Evaluation Study Protocol for Conducting Case Studies.

Recent studies on the impact of ex-post legislative evaluations show that there are different types of impact and different factors that can influence it. These include the context of a legislative evaluation, research quality, and interactions between researchers and other actors within the evaluation process. However, thorough empirical research in this area is lacking. This warrants empirical research into the factors that influence the impact of ex-post legislative evaluations, so these insights can be used to increase the likelihood of ex-post legislative evaluations having an impact. In this protocol, we report on the realist evaluation methodology that will be used to evaluate the impact of three ex-post legislative evaluations in the Dutch healthcare sector. The mixed methods realist evaluation approach will facilitate this theory-driven, qualitative research. The study will consist of the following three steps: (1) Initial programme theory development, (2) theory validation, and (3) theory refinement. Knowledge from two scoping reviews conducted previously, and two subsequent expert meetings will form the basis for developing the initial programme theory. During this study, three case studies will be conducted, in which three individual ex-post legislative evaluations will be examined. Specificmethods for data collection will include: documentary review, observation, structured questionnaires and focus group discussions with purposefully identified key stakeholders. Using the framework approach, the data will be analysed thematically in a within-case analysis followed by a cross-case analysis. This protocol provides insight into how the study will be conducted. As this study uses multiple qualitative researchmethods to answer one question, this protocol supports refining data collection procedures. Careful consideration of the approach beforehand can minimise pitfalls, reduce publication bias and improve reproducibility. The protocol therefore specifies how the research question will be answered in detail, and this provides solid guidance for the research process.

The environmental impact of the Dutch health-care sector beyond climate change: an input–output analysis

Studies suggest that the Dutch health-care sector is responsible for 4-8% of the national carbon footprint, but the environmental footprint of this sector beyond climate change is not well understood. Therefore, we aimed to estimate the environmental footprint of the Dutch health-care sector for a range of environmental impact categories. In this input-output analysis, we used Exiobase (version 3), which contains data on global trade flows and their associated environmental impact, in combination with health-care expenditure data from Statistics Netherlands. We covered the impact categories: climate change, blue water consumption, abiotic material extraction, land use, and total waste generation. The calculated sectoral footprint was the sum of all impacts associated with the operational phase (direct impact) and impacts occurring in the value chain of purchased goods and services (indirect impact) given an expenditure vector. The expenditure vector was the sum of three elements of health-care expenditure: health-care services; pharmaceuticals and chemical products; and medical appliances. We calculated the impact share of health care on the total Dutch consumption footprint. We evaluated the contribution to the impact categories from the categories that composed the expenditure vector. We did a hotspot analysis in which the indirect impact was split according to where (sector, geography, or both) the impact physically occurred. These top-down results were complemented with bottom-up data on emissions from pressurised metered-dose inhalers, anaesthetic gases, and private travel. The health-care sector's share of the national footprint was highest for material extraction (13·0%), followed by blue water consumption (7·5%), climate change (7·3%), land use (7·2%), and waste generation (4·2%). Pharmaceuticals and other chemical products were the biggest contributors to all impacts. The sectors contributing to climate change were more evenly distributed than the sectors contributing to the other impact categories. The mining sector mostly contributed to material extraction and the agricultural sector contributed largely to blue water consumption and land use. The mining sector and the agricultural sector were the main contributors to waste generation. Climate change occurred mainly in the Netherlands, whereas the other impacts mainly occurred abroad. The Dutch health-care sector contributes to a broad set of environmental impact categories beyond climate change. Our results will help stakeholders involved in the health-care sector to pinpoint topics that need to be prioritised and to prevent trade-offs by addressing multiple environmental issues simultaneously. Dutch Ministry of Health, Welfare and Sport.

The Environmental Footprint of the Dutch Healthcare Sector: Beyond Climate Impact

The Environmental Footprint of the Dutch Healthcare Sector: Beyond Climate Impact

Sanitizer capacity up again

Chemical firms around the world are adding yet more production of hand sanitizer and sanitizer raw materials in an effort to meet unprecedented demand in the face of COVID-19. Huntsman has begun manufacturing multi-ton quantities of sanitizer in McIntosh, Alabama, using isopropyl alcohol (IPA) supplied by LyondellBasell Industries. Shell Chemical is increasing production of IPA at plants in Pernis, the Netherlands, and Sarnia, Ontario, and asking customers that use the alcohol for nonmedical purposes to delay orders. The firm says it will donate 2.5 million L of IPA to the Dutch health-care sector and a further 125,000 L to Canada. Dow plans to make hand sanitizer at five sites across the globe for more than 800,000 225-gram bottles. Clariant has started producing 2 million L of hand sanitizer per month in Gendorf, Germany, with ethanol supplied by CropEnergies. Lubrizol is increasing output of a polymeric thickening agent to enable production

Retirement concerns and planning of cooperative members: a study in the Dutch healthcare sector

Retirement planning is a key component in achieving goals and fulfilling expectations. Although several socioeconomic and psychological factors associated with retirement planning have been reported in the literature, little is known about the influence that specific retirement-related issues have on retirement planning. We examine the influence of five concerns—the individual’s financial situation, living situation, care provision, health condition, and loneliness—on retirement planning. In addition, we investigate the influence of these concerns on individuals’ perceptions of their ideal post-retirement situations in terms of financial standards. Our dataset is derived from a 2010 web-based survey of the care and well-being sector in the Netherlands.

Moving a mountain with a teaspoon: Toward a theory of digital entrepreneurship in the regulatory environment

Digital entrepreneurship is an emerging phenomenon in the digital era. While the literature has started to look into this phenomenon, the attention has been paid mainly to digital startups in free markets. In a regulatory environment, however, it is unclear how a new startup might digitally transform business through entrepreneurial actions to overcome the challenges and barriers from regulations. Drawing on the dynamic capabilities and digital innovation literature, I conduct an in-depth longitudinal study at a Dutch digital startup. I trace the underlying mechanisms through which it creates digital solutions to the regulations in the Dutch healthcare sector — demand-driven digital disruption, fast digital adaptation, and continuous digital transplantation. Novel implications for digital entrepreneurship in the regulatory environment are presented.

Opposing Views on the Urgency for Healthcare Changes in the Netherlands: A Temporal Narrative Struggle

This paper illuminates the way multiple narratives concerning urgency for change dynamically interact on different levels and influence change processes in healthcare organizations. It explores the processes of sensemaking and opposing urgency narratives during a period of implementation for new legislation within the Dutch healthcare sector. Building on recent debates on process theory, narratives, and temporality, a new perspective on change urgency is presented, which shows how urgency is not unilaterally created from one position but is produced and reproduced by different editors in a narrative struggle. A temporal framework for change urgency was developed to study these narrative dynamics. Three urgency narratives contested the dominant narrative in the public discourse. The article shows how directors of healthcare organizations, dominated by these narratives, also hold narrative power. Managing change processes implies managing discourse.

De winsten van zorginstellingen

In this feature authors discuss recent research findings that are of interest to readers of Beleid en Maatschappij.We calculate and describe profits obtained by health organizations in The Netherlands in the years 2014 and 2015. We distinguish between profit and not-for-profit organizations. We find that on average net profits amount to about 2 percent on turnover with a peak of more than 3 percent for mental-healthcare organizations. If we take the size of organizations into account, we find that for-profit organizations with a turnover of less than 1 million euro tend to have on average net profit rates of 4 percent to more than 5 percent with peaks amounting to more than 50 percent. We are not yet able to come up with explanations for these excessively high profit rates in parts of the Dutch health care sector. On the other hand, the highest losses can be found in small-sized organizations as well. We delved deeper into the financial accounts of a few for-profit organizations and found indications of misreporting of turnover or number of treatments. On the other hand, bad management and unhealthy cost structures might explain why some organizations incur excessive big losses. The sector does not appear to be well monitored by the government.

Service innovation quality in healthcare: service innovativeness and organisational renewal as driving forces

Drawing on an integration of service-dominant (S-D) logic and the dynamic capabilities approach, this study focuses on the relatively under-researched issue of service innovation quality in healthcare services. We propose a conceptual framework for the relationships between user-induced and organisation-based renewal, and service innovation quality in the healthcare sector. By putting service innovativeness and organisational renewal at the input side of the healthcare organisations’ value creation process, and treating service innovation quality as an output, this study hypothesises direct relationships between these two ends. We conducted an empirical study in the Dutch healthcare sector. Based on data from 168 service innovation projects in Dutch healthcare organisations, the empirical study verifies these hypothesised relationships. The results reveal that both service innovativeness and organisational renewal are significant antecedents of quality improvement of the healthcare service innovations in these projects. This study provides theoretical and managerial implications for improving the quality of healthcare service innovations. The key managerial insight is that healthcare organisations are implicated to pay more attention to continuous renewal of value propositions to their users/patients, as well as to continuous renewal of their organisations’ functioning.

Recognising the Skills and Competencies of Non-EU Foreign Nationals: A Case Study of the Healthcare Sector in the Netherlands

This article examines the institutional arrangements, practices and outcomes related to the recognition of skills, knowledge and competencies (SKC) of non-EU foreign nationals in the Netherlands (commonly referred to as Third Country Nationals (TCNs)) with specific reference to the Dutch healthcare sector. Although the national infrastructure for foreign recognition of educational and professional qualifications is well-developed by international standards, the system has a number of flaws as interviews with TCNs and experts in the field reveal. TCNs often discover that their qualifications are not considered equivalent to the relevant Dutch qualifications. Given the limitations of formally recognising the educational qualifications or work experience of TCNs, Dutch policies have supported other measures, including the accreditation and recognition of prior learning (RPL). However, expert interviews show that it remains a challenge to commit education providers and employers actually to validate these learning experiences. We consider various implications for policy-making and theory from this research.

Interactions between Financial Incentives and Health in the Early Retirement Decision

We present a theory of the relation between health and retirement that generates testable predictions regarding the interaction of health, wealth and financial incentives in retirement decisions. The theory predicts (i) that wealthier individuals (compared to poorer individuals) are more likely to retire for health reasons (affordability proposition), and (ii) that health problems make older workers more responsive to financial incentives encouraging retirement (reinforcement proposition). We test these predictions using administrative data on older employees in the Dutch healthcare sector for whom we link adverse health events, proxied by unanticipated hospitalizations, to information on retirement decisions and actual incentives from administrative records of the pension funds. Exploiting unexpected health shocks and quasi-exogenous variation in financial incentives for retirement due to reforms, we account for the endogeneity of health and financial incentives. Making use of the actual individual pension rights diminishes downward bias in estimates of the effect of pension incentives. We find support for our affordability and reinforcement propositions. Both propositions require the benefits function to be convex, as in our data. Our theory and empirical findings highlight the importance of assessing financial incentives for their potential reinforcement of health shocks and point to the possibility that differences in responses to financial incentives and health shocks across countries may relate to whether the benefit function is concave or convex.

Cooperative innovation through a talent management pool: A qualitative study on coopetition in healthcare

In recent years, the Dutch healthcare sector has been confronted with increased competition. Not only are financial resources scarce, Dutch hospitals also need to compete with other hospitals in the same geographic area to attract and retain talented employees due to considerable labour shortages. However, four hospitals operating in the same region are cooperating to cope with these shortages by developing a joint Talent Management Pool. ‘Coopetiton’ is a concept used for simultaneous cooperation and competition. In this paper, a case study is performed in order to enhance our understanding of coopetition. Among other things, the findings suggest that perceptions of organizational actors on competition differ and might hinder cooperative innovation with competitors, while perceived shared problems and resource constraints stimulate coopetition. We reflect on the current coopetition literature in light of the research findings, which have implications for future research on this topic.

Stigma in the Dutch Health Care Sector: HIV-Positive Substance Users’ Experiences and Health Care Providers’ Perspectives

We explored 15 HIV-positive substance users’ experiences with health care alongside theperspectives of 14 health professionals. Substance users with HIV reported positive and negative experiences.Positive experiences included equal treatment, receiving social support and extra care, and good continuityof care. Negative experiences included being met with fear and apprehension, excessive or differentialprecautions, unnecessary referrals, outright care refusal, confidentiality breaches, and poor care provision.Health professionals reported limited experience caring for substance users with HIV. Most spoke generallyabout substance users, claiming that they can be difficult clients who are demanding, impatient,unpredictable, and untrustworthy. Also, health professionals indicated that substance users can be shoppersin search of unnecessary prescriptions or avoiders of health care. Efforts to improve interactions shouldencourage positive contact, and should focus on combating attributions of personal responsibility, creatingan awareness of behaviors that are stigmatizing, and improving knowledge of occupational risks for HIV.

Examining pension beneficiaries’ willingness to pay for a socially responsible and impact investment portfolio: A case study in the Dutch healthcare sector

The debate on the sustainability of the Dutch pension system and the required reforms has initiated a discussion about introducing more individual choices to collective pension schemes. The objective of this research is to examine pension beneficiaries’ willingness to accept a lower pension for investing in a socially responsible portfolio with impact investment characteristics together with socially responsible investment criteria. Our sample stems from a Dutch pension administrative organization related to the healthcare sector. Using regression models, we examine the relationship between attitudes toward impact and socially responsible investments and willingness to pay for socially responsible choices. Furthermore, we examine the influence of involvement on willingness to pay for such a portfolio. We underline the issue of inconsistent choices in the decision-making process, and we integrate the notion of psychological distance into our model. The results suggest that attitudes towards positive SRI screenings have a significantly positive influence on willingness to pay. Additionally, people with higher product involvement are more willing to pay the extra cost. Our paper contributes to the literature on responsible investments and provides implications for the design of pension policies in the collective pension schemes.

Adding value by health care real estate: parameters, priorities, and interventions

PurposeBecause of the transition of the Dutch health care sector from a governmentally steered domain towards regulated market forces, health care organisations have become fully responsible for their real estate. This paper aims to explore if/how Dutch health care organisations adopt the concept of adding value by corporate and public real estate, which values are prioritised and how these values are implemented in daily practice.Design/methodology/approachLiterature study and a meta-analysis of six student theses (1 × BSc, 1 × MSc, 3 × post-MSc and 1 × PhD) on adding value by health care facilities were conducted, using document analysis and semi-structured interviews with CEOs, project leaders, real estate managers and facility managers. All respondents work in Dutch hospitals, assisted living facilities for the elderly, or mental health care facilities. The interviews were jointly prepared by the students, and the author of this paper being their supervisor.FindingsEnd-user satisfaction, enhancing productivity and stimulating innovation are highly prioritised. Which values are prioritised depends on the organisational objectives, target group, available budget, position in the life cycle of design, construction and use and external context, in particular governmental policy and competition with other health care suppliers. The operationalisation into concrete design choices and strategic management of buildings-in-use is still underdeveloped.Research limitations/implicationsThe interviews lasted 1-1.5 hours, which is rather limited to get a complete picture. Although much work has been done to operationalise the added value of corporate real estate and building-related facilities, there is still a lack of a widely agreed taxonomy of added values and how to measure and manage these values. Ongoing international collaboration between researchers and practitioners aims to contribute to a common framework and to develop standardised measurement methods.Practical implicationsThe insights can support decision-makers in value-adding real estate and facilities management value by public and corporate real estate. The listings of prioritised values and related interventions can be used as a frame of reference to improve the current design and management of health care real estate.Social implicationsA clear insight in value-adding management of corporate real estate may result in a better fit among real estate, organisational objectives and end-user needs.Originality/valueThe findings link the added value theory to corporate real estate management in Dutch health care practice.

Pension beneficiaries’ and fund managers’ perceptions of responsible investment: a focus group study

Purpose This study aims to explore the views of pension beneficiaries and fund managers regarding greater involvement and investment autonomy and the attitudes toward diverse responsible investment criteria. The conventional form of investing is usually vulnerable to high financial market volatility events and financial crises, and most importantly, it has proven insufficient in addressing important social issues. A newly introduced investment culture known as impact investing strives for social gains in the long term rather than the maximization of financial returns by aiming to tackle social problems. However, some in the field claim that implementing such investment policies compromises the fiduciary responsibility of pension funds’ trustees to manage trust funds in the best interest of beneficiaries. Design/methodology/approach This study uses qualitative methods to explore the perception of proposed pension policies, such as beneficiaries’ greater involvement in determining pension investment policies that can have a positive long-term impact on their lives and on the provision of investment autonomy. For this purpose, the study investigates beneficiaries’ positions regarding responsible investment criteria from a freedom-of-choice perspective. The study sample consists of members and managers of a Dutch pension administrative organization with a cooperative structure. Three semi-structured, homogeneous discussions with focus groups containing between seven and nine participants each are conducted. The data are coded both deductively and inductively, following the framework approach, which is a qualitative data analysis method. Findings Participants demonstrate positive attitudes toward greater involvement and freedom of choice. However, the findings also indicate that members and pension fund managers have different views regarding responsible investment criteria. Members have more favorable attitudes toward responsible investment than do managers. Research limitations/implications This research is limited to focus group discussions with managers and members in the Dutch healthcare sector. Practical implications How little the current pension system matches people’s investment preferences is a matter of concern, and the main implications of this research thus center upon designing a more democratic pension system for the future. Greater involvement by pension fund beneficiaries, whose roles are currently limited, would help legitimize responsible investing. This research implies that pension policies should be designed to align with the preferences of pension fund beneficiaries and be accompanied by diverse intervention strategies. Social implications Pension reforms that encourage pension beneficiaries to exert greater influence in determining pension policy will help shrink the democratic deficit in collective pensions. Originality/value This study contributes to the literature on pension fund governance and long-term responsible investing by examining the attitudes toward impact and sustainable investments and by making suggestions for future research. To the best of the authors' knowledge, this study is the first to investigate the attitudes of pension fund participants toward targeted impact investments.