Dutch Health Care Organizations Research Articles

The relations between work centrality, psychological contracts, and job attitudes: The influence of age

The current study sought to explain a largely overlooked theme in psychological contract literature, that is, how individual factors are related to formation of psychological contract. It investigated the relationship between work centrality, psychological contracts, and job attitudes. It was expected that people with higher work centrality would be less likely to have a transactional contract and more likely to have a relational contract. Furthermore, it was expected that psychological contract mediates the relations between work centrality and job attitudes. Finally, we expected age to moderate the relations between work centrality and the psychological contract, with stronger relations for older workers than for younger workers. Based on life span psychology, it was argued that work centrality becomes an important factor for older workers in deciding whether or not to invest in the relationship with the organization. The study was conducted among 465 employees in a Dutch health care organization. Structural equation models supported the mediating effect of psychological contract types in the relations between work centrality and three job attitudes (work engagement, job satisfaction, and turnover intention). Moreover, it was found that the relations between work centrality and psychological contract were indeed stronger for older workers than for younger workers.

When Employees Stop Talking and Start Fighting: The Detrimental Effects of Pseudo Voice in Organizations

Many organizations offer their employees the opportunity to voice their opinions about work-related issues because of the positive consequences associated with offering such an opportunity. However, little attention has been given to the possibility that offering voice may have negative effects as well. We propose that negative consequences are particularly likely to occur when employees perceive the opportunity to voice opinions to be “pseudo voice”—voice opportunity given by managers who do not have the intention to actually consider employee input (i.e., managerial disregard). The effects of this kind of deception were examined by means of a survey among employees (N = 137) and managers (N = 14) of a Dutch healthcare organization. We hypothesized and found that perceived pseudo voice led to reduced voice behavior and, as a result, increased intragroup conflict. These results imply that while offering voice opportunity is mostly seen as an effective management strategy, negative effects are likely to occur when a manager is perceived to try to deceive employees by pretending to be interested in their points of view.

A new combined strategy to implement a community occupational therapy intervention: designing a cluster randomized controlled trial

BackgroundEven effective interventions for people with dementia and their caregivers require specific implementation efforts. A pilot study showed that the highly effective community occupational therapy in dementia (COTiD) program was not implemented optimally due to various barriers. To decrease these barriers and make implementation of the program more effective a combined implementation (CI) strategy was developed. In our study we will compare the effectiveness of this CI strategy with the usual educational (ED) strategy.MethodsIn this cluster randomized, single-blinded, controlled trial, each cluster consists of at least two occupational therapists, a manager, and a physician working at Dutch healthcare organizations that deliver community occupational therapy. Forty-five clusters, stratified by healthcare setting (nursing home, hospital, mental health service), have been allocated randomly to either the intervention group (CI strategy) or the control group (ED strategy). The study population consists of the professionals included in each cluster and community-dwelling people with dementia and their caregivers. The primary outcome measures are the use of community OT, the adherence of OTs to the COTiD program, and the cost effectiveness of implementing the COTiD program in outpatient care. Secondary outcome measures are patient and caregiver outcomes and knowledge of managers, physicians and OTs about the COTiD program.DiscussionImplementation research is fairly new in the field of occupational therapy, making this a unique study. This study does not only evaluate the effects of the CI-strategy on professionals, but also the effects of professionals' degree of implementation on client and caregiver outcomes.Clinical trials registrationNCT01117285

Malnutrition in Dutch health care: Prevalence, prevention, treatment, and quality indicators

Objective In most health care organizations there is still insufficient awareness for recognizing and treating malnourished patients. To gain more insight into nutritional care policies in Dutch health care organizations, this study investigated screening, treatment, and other quality indicators of nutritional care. Methods In 2007 a cross-sectional multicenter study was performed that included 20 255 patients (hospitals, n = 6021; nursing homes, n = 11 902; home care, n = 2332). A standardized questionnaire was used to study nutritional screening and treatment at the patient level and quality indicators at institutional and ward levels (e.g., malnutrition guidelines/protocols, nutritional education, and weighing policy). Results Nutritional screening was performed more often in nursing homes (60.2%) than in hospitals (40.3%) and home care (13.9%, P < 0.001). In general, one in every five patients was malnourished, and nutritional treatment was applied in fewer than 50% of all malnourished patients in nursing homes, hospitals, and home care. At ward level nursing homes focused more on the quality of nutritional care than did hospitals and home care, especially with respect to controlling the use of nutritional guidelines (54.6%, P < 0.03), weighing at admission (82.9%, P < 0.01), and mealtime ambiance (91.8%, P < 0.01). Conclusion This large-scale study shows that malnutrition is still a considerable problem in one of every five patients in all participating health care settings. It furthermore demonstrates that recognizing and treating malnutrition continues to be problematic. To target the problem of malnutrition adequately, more awareness is needed of the importance of nutritional screening, appropriate treatment, and other nutritional quality indicators.

Insulin therapy in type 2 diabetes is no longer a secondary care activity in the Netherlands

Because Dutch health care organisations did want to establish well-defined diabetes shared care groups, we investigated the organisation of insulin therapy in general practice in the Netherlands and assessed factors that were associated with providing insulin therapy in type 2 diabetes (DM2) patients. Questionnaire to half of the Dutch general practitioners (GPs) (n=3848). We compared GPs who both start insulin treatment and monitor the dosages with those who always refer patients requiring insulin therapy or only monitor insulin dosages. Total response was 42% (n=1621). 67% of the GPs start insulin therapy in patients with DM2, especially male GPs and those above the age of 40, as well as GPs working in a health centre and those working together with a practice nurse. GPs working in urban regions less often start insulin. The most often mentioned barriers for starting and/or monitoring insulin therapy are lack of knowledge of insulin therapy, lack of time and insufficient financial incentives. This nation-wide overview shows that insulin therapy is no longer a secondary care based activity. However, there is still need to enlarge the practice staff and to overcome the perceived skills deficit.

Experiences of foreign European nurses in The Netherlands

As a result of the shortage of nurses, Dutch health care organizations want to recruit nurses from outside Europe (e.g. Indonesia, South Africa). The Dutch government, however, is not encouraging this policy and prefers to recruit within the European Union. In order to better support such nurses, it is important to know the problems European nurses encounter in The Netherlands. This study is about the experience of nurses from other European countries in The Netherlands. This paper addresses itself to three principal questions. First, how many nurses qualified in other EU or EU candidate states are starting to work in The Netherlands. Second, why do they come to The Netherlands. And finally what problems do they encounter when working in The Netherlands. A questionnaire has been send to all registered nurses trained in another EU or EU candidate state. The response has been 987 or 67%. Thus, far approximately 1500 nurses from other EU/candidate states have come to The Netherlands. Personal reasons, including marriage, are the most important reasons for their coming here. Half of the nurses took one or more courses before starting work in nursing in The Netherlands. These were often Dutch language courses. The nurses had to make a number of adjustments. Major difficulties were unfamiliarity with Dutch laws and the fiscal and social security systems, recognition of their qualifications and application for permits. Some basic issues, such as how to write a letter of application, caused problems. The language and unfamiliarity with the Dutch health care system made it difficult to find a job. When they had gained employment in nursing these problems remained the most serious. The conclusion is that international employment mobility in nursing is rather low in the case of The Netherlands. If the Dutch government decides to encourage the employment of nurses from abroad, several measures can be taken to make working in The Netherlands more attractive.

Progress in the implementation of Quality Management in Dutch health care: 1995-2000

Policymakers and researchers in all countries like to know whether the implementation of Quality Management (QM) in health care is proceeding satisfactorily. Longitudinal surveys can reveal whether sufficient progress is being made. The main objective of the study was to investigate the progress in QM in Dutch health care organizations during the period 1995-2000. A second objective was to explore whether the progress in QM was related to subsectors of care and/or to cultural characteristics of health care organizations. The study has a descriptive longitudinal design, based on repeat measurements in 1995 and 2000. Empirical data about QM activities in health care organizations were gathered using a questionnaire. The analyses are based on data from the 474 health care organizations that participated in the study in 1995 and 2000. Participants in the study were organizations from all subsectors of health care, including providers of home care, nursing homes, hospitals, and other care sectors. Outcome measures are 46 distinct QM activities, which were listed in the questionnaire. Two-thirds of the organizations had made progress in the implementation of QM activities. A mean of 25 QM activities per organization was found in 2000 compared with 20 in 1995. More care providers had set up a client council and had carried out patient satisfaction surveys. Home care organizations had made twice as much progress as many other health care organizations. However, nearly one-third of the health care organizations showed a decline in QM activities. Patient organizations were less often involved in the development of quality criteria and protocols. Progress in QM was weakly related to the dedicated and flexible attitude of employees and a non-hierarchical decision-making structure. The study demonstrates that the implementation of QM activities can be monitored at the national level and that differences between subsectors of care can be assessed. The decline in QM activities in one-third of the organizations needs to be researched further.

Quality function deployment in healthcare

In the current decade, client requirements appear to play an increasingly important role in designing not‐for‐profit organisations, in particular in the domains of services and healthcare. Quality function deployment (QFD) is a well‐known design method. This method has a vested reputation in industrial production as a means of systematically incorporating customer requirements in product design. However, in the domain of the services, and especially the professional services, there is little experience in applying QFD. Application in this domain probably causes problems, for instance with respect to the customer concept, which is more ambiguous in this domain, and with respect to the interrelated nature of the product (service) and the process. In this paper we present some limitations of conventional QFD outside physical industrial production and we present a refinement and an extension of QFD for healthcare applications, based on research methods in the social sciences. Illustrations are given from two cases in Dutch healthcare organisations.

The impact of legislative versus non-legislative quality policy in health care: a comparison between two countries

An important aim of the government's quality policy is to stimulate quality management (QM) in health care organizations. The relationship between the government's quality policy and QM in health care organizations is unknown. This article explores that relationship by comparing two countries with different quality policies, The Netherlands and Finland. In The Netherlands QM is required by law and health care is organized at national level. In Finland, QM is not required by law and the responsibilities for organizing health care are delegated to the municipalities. The question is whether or not these differences in national policy are reflected in the extent and effectiveness of QM in health care organizations in the two countries. A cross sectional survey was conducted in late 1999. Data about QM in both countries were gathered by questionnaire. The subsectors involved were hospitals, care for the disabled and care for the elderly. A total of 1172 health care organizations participated in the study (response rate 64%). The results show that-in keeping with our hypothesis-slightly more QM-activities and more patient participation were found in Dutch health care organizations compared with the Finnish ones. However, contrary to our expectations, the Finnish organizations reported more perceived effects of their QM-activities. Further analyses showed that some QM-activities are more closely related to the effectiveness of QM than others. In particular, cyclic quality improvement procedures, human resource management and the flexible attitude of employees showed the strongest relationship with the perceived effects of QM. The difference between the national approach in The Netherlands and the decentralized approach in Finland did not, as we had assumed, result in more regional variation in QM in Finland. Conclusions: a government's quality policy may have some influence on the extent of QM in health care organizations. However, more QM-activities do not necessarily imply more effects. Recommendations: since QM-activities differ in the degree to which they bring about changes and improvements in care, it is recommended that policy makers promote those QM-activities, which are the most potent, in order to improve the quality of care.

Improvement and renewal of healthcare processes: results of an empirical research project

Professionals in healthcare organizations, who generally produce high-quality work, commonly operate in isolation or locally. However, due to developments in society and legislation, healthcare organizations are forced to integrate healthcare activities, and achieve integral quality management, instead of suboptimal, local quality management. Eindhoven University of Technology set up a study in 11 Dutch healthcare organizations in the area of interface management. The study was performed in general and mental hospitals, and clinics for care and treatment of drug addicts. The research projects aimed to develop methods to achieve an improvement or a renewal of healthcare processes. Special attention was paid to the interfaces between departments and individual parts of the healthcare process. In this paper an outline is given of both the improvement and the renewal approach, results of three of the 11 case studies are presented (as an example) and the improvement and the renewal approach are compared with respect to healthcare processes.

EFQM approach and the Dutch Quality Award

Different approaches to improve quality are used in organizations delivering health care. Donabedian introduced structure, process and outcome, from which other approaches like self-assessment, accreditation, visitation, International Standards Organisation (ISO) and European Foundation for Quality Management (EFQM) can be aligned. The EFQM model is one such approach that has been adopted and adapted by the Dutch Institute for Quality Management. This article describes the background and progress relating to the use of the EFQM business excellence model within Dutch health care organizations. In addition the process for applying for the European Quality Award and the Dutch Quality Award are described in detail. Finally, the reader is enlightened regarding the work of the European ExPeRT research group who are promoting the use of quality models within health care.

Interaction between target and mailing characteristics in direct marketing, with an application to health care fund raising

The major decision variables for the development of a direct mail campaign are the characteristics of the mailing and the characteristics of the targets receiving the mailing. Traditional direct mail research treats both aspects separately although they are likely to interact. We present a new target selection strategy that simultaneously takes both characteristics into account by using different mailings offereng the same product to different targets. Using data from an experiment conducted by a Dutch health care organization, we show that our selection strategy increases the net returns of a fund raising campaign.