Dutch System Research Articles

A forgotten message? von Bertalanffy's puzzle

PurposeThis paper aims to celebrate Felix Geyer's many contributions to the systems movement. He participated from the beginning, with the energy that has become his hallmark. The area of systems studies was introduced in The Netherlands in about 1970, mainly through the activities of the Systeemgroep Nederland or Dutch Systems Group, initiated by Ab Hanken. The paper aims to unearth the original message that made the field of systems attractive.Design/methodology/approachThe aim is achieved on the basis of a re‐analysis of von Bertalanffy's systems papers, which he published under the title of “General System Theory”.Findingsvon Bertalanffy's message was not what is usually thought – that many political leaders treat their problems incompetently and hence make them less solvable or even create messes. He answered a general question about knowledge acquisition, in an area where an answer was sorely needed.Practical implicationsvon Bertalanffy's answer inspired hope that one day one would be able to acquire the knowledge needed to solve the politicians' problems. He even identified a number of methods to do so.Originality/valueThe claim of the paper is that von Bertalanffy intended systems thinking to extend methods of knowing. This intention has been obscured by the limited methods he introduced. This claim is argued in an original way.

Re: Cost‐effectiveness of different treatment strategies with intrapartum antibiotic prophylaxis to prevent early‐onset group B streptococcal disease

COBJECTIVE: To estimate the costs and effects of different treatment strategies with intrapartum antibiotic prophylaxis to prevent early-onset group B streptococcal (GBS) disease in the Netherlands. The treatment strategies include a risk-based strategy, a screening-based strategy, a combined screening/risk-based strategy and the current Dutch guideline. DESIGN: Cost-effectiveness analysis based on decision model. SETTING: Obstetric care system in the Netherlands. POPULATION/SAMPLE: Hypothetical cohort of 200,000 neonates. METHODS: A decision analysis model was used to compare the costs and effects of different treatment strategies with no treatment. Baseline estimates were derived from literature and a survey among parents of children affected by GBS disease. The analysis was performed from a societal perspective, and costs and effects were discounted at a percentage of 3%. Main outcome measures Cost per quality adjusted of life-year (QALY). RESULT: The risk-based strategy will prevent 352 cases of early-onset GBS for 5.0 million Euros, indicating a cost-effectiveness ratio of 7600 Euros per QALY gained. The combined screening risk-based strategy has comparable results. The current Dutch guideline resulted in lower effects for higher costs. The screening-based strategy shows the highest reduction in cases of early-onset GBS, however, at a cost-effectiveness ratio of 59,300 Euros per QALY gained. Introducing the polymerase chain reaction (PCR) test may lead to a more favourable cost-effectiveness ratio. CONCLUSION: In the Dutch system, the combined screening/risk-based strategy and the risk-based strategy have reasonable cost-effectiveness ratios. If it becomes feasible to add the PCR test, the cost-effectiveness of the combined screening/risk-based strategy may even be more favourable. hemicals / CAS: chlorhexidine, 3697-42-5, 55-56-1

Transfer effects in learning a second language grammatical gender system

In this article second language (L2) knowledge of Dutch grammatical gender is investigated. Adult speakers of German, English and a Romance language (French, Italian or Spanish) were investigated to explore the role of transfer in learning the Dutch grammatical gender system. In the first language (L1) systems, German is the most similar to Dutch coming from a historically similar system. The Romance languages have grammatical gender; however, the system is not congruent to the Dutch system. English does not have grammatical gender (although semantic gender is marked in the pronoun system). Experiment 1, a simple gender assignment task, showed that all L2 participants tested could assign the correct gender to Dutch nouns (all L2 groups performing on average above 80%), although having gender in the L1 did correlate with higher accuracy, particularly when the gender systems were very similar. Effects of noun familiarity and a default gender strategy were found for all participants. In Experiment 2 agreement between the noun and the relative pronoun was investigated. In this task a distinct performance hierarchy was found with the German group performing the best (though significantly worse than native speakers), the Romance group performing well above chance (though not as well as the German group), and the English group performing at chance. These results show that L2 acquisition of grammatical gender is affected more by the morphological similarity of gender marking in the L1 and L2 than by the presence of abstract syntactic gender features in the L1.

Assessing Physician Compliance With the Rules for Euthanasia and Assisted Suicide

When any state or country considers permitting physician assisted suicide or euthanasia, one of the most important questions to be faced is how to make sure that physicians comply with the rules and stay within the allowed limits. Data suggest that the Dutch system for assuring physician compliance has thus far worked poorly, as that system relies largely on physician self-report. The Oregon system also relies largely on physician self-report. Oregon has created no mode of data collection to assess what proportion of cases are actually being reported. Oregon’s annual assessment of practice under its statute permitting physician-assisted suicide fails to capture cases that physicians do not report. Thus, we have no way at present to evaluate Oregon’s statistics and reported practice of physician-assisted suicide. In the Netherlands, after a patient dies from euthanasia or assisted suicide, the physician must complete a report and notify the municipal pathologist of a death from nonnatural causes. The pathologist then performs an autopsy and prepares a report, which goes to the public prosecutor. Thus, physician reporting is the trigger for review. To the credit of the Dutch, their researchers have repeatedly assessed whether this system works - whether physicians in the Netherlands comply with requirements to report performing assisted suicide and euthanasia. In 1990 and 1995 less than half of physicians reported. By 2001, the percentage of physicians reporting was still only 54%. In this issue of the Archives of Internal Medicine, Jansen-van der Weide and colleagues report on a survey of Dutch general practitioners conducted 2000-02. The written questionnaire asked these physicians about the number of requests for assisted suicide and euthanasia received in the last year, how the physician handled them, and characteristics of the last explicit request received in the past 18 months. Remarkably, this study finds high levels of physician compliance with the rules. Sadly, there are substantial reasons to doubt this reassurance. All physicians being surveyed were either recently trained in the rules as consultants or the target of a project to encourage them to use these consultants and follow the rules. There was no control group, and retrospective self-report was the only data collection method. This is not an adequate basis for assessing whether physician practice actually complies with the rules. Persuasive assessment cannot rest on physician retrospective self-reports after training in the rules as consultants or encouragement to use such consultants and follow the rules. The ultimate question remains - if you permit physicians to take life deliberately by assisting suicide or performing euthanasia, can you control the practice? Can you keep it within agreed boundaries? Can you avoid sliding down the slippery slope? These are questions of great importance that demand sophisticated study. We do not yet know the answers.

Driving collaborative improvement processes

Continuous improvement is a consolidated concept in theory and practice, mainly in the context of stand-alone companies. However, the battlefield of competition is increasingly moving from the level of individual firms to that of organizational settings based on loose company boundaries and collaborative relations among different units, such as the extended manufacturing enterprises (EMEs). The concept of continuous improvement has hardly been applied in inter-organizational settings. The purpose of this paper is to propose preliminary theory on collaborative improvement (CoI), i.e. continuous improvement at the EME level. Based on a literature study on supply networks and continuous improvement, evidence from an in-depth case study of a large Dutch system integrator in the automotive industry and three of its suppliers, a model of CoI is proposed, explaining how collaborative improvement takes place within the EME context.

Competing explanations for adopting energy innovations for new office buildings

An integrative model to explain potential adopters’ decisions to adopt energy innovations was adapted and applied in the field of new office building construction. We tested the relative effects of competing theoretical explanations (derived from economics, innovation science and policy science) on the decision to adopt. The research covered 35 projects representing 9% of the total volume of new office construction in the Netherlands between 2000 and mid-2002. Two levels of explanations for adopting innovations were derived: (a) the potential adopter's weighed assessments of the innovations and his or her nature of decision making and (b) explanation of those first-level variables. Using multiple regression techniques, we determined the relative influence on innovation-adoption of variables covering economy and technology, government intervention, company characteristics, and influences from market and society. The decision to adopt ‘mature’ innovations, in contrast to ‘young’ innovations, is based more on routine procedures than project-specific considerations. Policies need to take this difference into consideration. We also show evidence that in promoting adoption of E-innovations for new office buildings the Dutch system of applying Energy Performance Standards and subsidies proofs to be effective.

Cost‐effectiveness of different treatment strategies with intrapartum antibiotic prophylaxis to prevent early‐onset group B streptococcal disease

To estimate the costs and effects of different treatment strategies with intrapartum antibiotic prophylaxis to prevent early-onset group B streptococcal (GBS) disease in the Netherlands. The treatment strategies include a risk-based strategy, a screening-based strategy, a combined screening/risk-based strategy and the current Dutch guideline. Cost-effectiveness analysis based on decision model. Obstetric care system in the Netherlands. Hypothetical cohort of 200,000 neonates. A decision analysis model was used to compare the costs and effects of different treatment strategies with no treatment. Baseline estimates were derived from literature and a survey among parents of children affected by GBS disease. The analysis was performed from a societal perspective, and costs and effects were discounted at a percentage of 3%. Main outcome measures Cost per quality adjusted of life-year (QALY). The risk-based strategy will prevent 352 cases of early-onset GBS for 5.0 million Euros, indicating a cost-effectiveness ratio of 7600 Euros per QALY gained. The combined screening risk-based strategy has comparable results. The current Dutch guideline resulted in lower effects for higher costs. The screening-based strategy shows the highest reduction in cases of early-onset GBS, however, at a cost-effectiveness ratio of 59,300 Euros per QALY gained. Introducing the polymerase chain reaction (PCR) test may lead to a more favourable cost-effectiveness ratio. In the Dutch system, the combined screening/risk-based strategy and the risk-based strategy have reasonable cost-effectiveness ratios. If it becomes feasible to add the PCR test, the cost-effectiveness of the combined screening/risk-based strategy may even be more favourable.

Euthanasia Is Out of Control in The Netherlands

Euthanasia Is Out of Control in The Netherlands Stephen Drake (bio) The March 10 issue of the New England Journal of Medicine featured an article by two Dutch doctors defining a "problem" and a "solution." Drs. Verhagen and Sauer announced that a survey had found that, contrary to Dutch law, some infants with severe disabilities have been euthanized. In an effort to end "uncontrolled" euthanasia, they proposed adoption of a set of protocols, known as the "Groningen protocol," for legally euthanizing infants with disabilities and serious medical conditions. It's hard to believe anyone could be surprised by the news of this latest effort to expand the practice of euthanasia in the Netherlands. For the sake of brevity, one might compare Dutch euthanasia practices to a highway system. In this system, drivers are responsible for monitoring their own speed. As long as they tell officials how fast they're driving, the authorities generally won't issue tickets for speeding. Here's the hitch: the problem of speeding has become so problematic that every few years a driver is actually issued a ticket. In every reported case, the offender was given a slap on the wrist, and the speed limit was raised. Predictably, this just results in a general rise in the speed of traffic and further requests to raise the speed limits. This is, in effect, what happened in 1994 when Dr. Boudewijn Chabot was convicted of aiding the suicide of a woman in despair over the death of her two sons. It happened again in 2001 when Dr. Wilfred van Oijen was tried and convicted for "euthanizing" an elderly woman without her permission. The main difference between the Dutch system and the American system, I'd suggest, is one of degree. We've set the speed limits at a lower level and mostly resisted requests to raise them. However, there is significant evidence that at least some medical professionals in the United States would embrace legalization of infanticide based on disability. It wasn't that long ago that passive euthanasia of infants with Downs Syndrome and spina bifida was an accepted practice here, and it's still unclear to what extent the practice persists. The sentiment for facilitating the deaths of infants with disabilities is evident in numerous research studies. For example, in 2001, Streiner and colleagues published a study in Pediatrics comparing the attitudes of parents and health care professionals in "quality of life" assessments of premature infants. The study found that neonatologists and neonatal nurses were both more pessimistic about pediatric outcomes, and also more likely to judge death to be the best outcome, than were the parents or siblings of the same children. This study, conducted in Canada, is consistent with earlier U.S. studies that have demonstrated a bias on the part of medical professionals in devaluing the lives of infants with severe disabilities. No one should mistake this bias for anything other than what it is—an over-valuation of physical and mental norms, which is bigotry. That prejudice is often mistaken for objectivity in bioethics discussions. It's one reason most public discussion of euthanasia is tainted by misinformation. For example, the Associated Press story on the Groningen protocol misinformed readers that the protocol applied to "euthanizing terminally ill newborns." This is a gross distortion: Verhagen and Sauer made no attempt to hide that they were talking about newborns with "serious medical conditions." It's both puzzling and disturbing that this misinformation was met with total silence from the bioethics community. You would think that bioethicists, eager to claim expertise and promising to bring clarity to public debates, would have jumped all over the Associated Press report. This silence reinforces the cynical view that the righteous anger bioethicists express at outspoken disability advocates has less to do with providing clarity than with protecting turf. Bioethicists who appear in popular media often decry the simplistic way in which complex issues are addressed. On behalf of Not Dead Yet and other disability rights organizations, I have a not-so-respectful request: admit your failure to promote a complex and accurate public discussion of bioethical issues and make room for those of us who seem more...

The Role of the Non-Modal Auxiliary 'Hebben' in the Acquisition of Dutch as a Second Language

The paper addresses the issue of a possible relationship between the acquisition of non-modal auxiliaries and the acquisition of syntactic phenomena in an L2. It has been claimed in the literature that the acquisition of non-modal auxiliaries enables learners to acquire syntactic phenomena such as post-verbal negation (cf. Parodi, 2000; Dimroth, 2004) and syntactic finiteness (Dimroth et al., 2003; Jordens, 2004). The present paper aims to make a contribution to this line of research by investigating the role of hebben in the acquisition of certain V2 phenomena in L2 Dutch. More specifically, it seeks to answer the question of whether the production of hebben by Turkish and Moroccan learners of Dutch is related to these learners' acquisition of topicalisation and post-verbal negation. An exploratory study is described in which longitudinal production data are examined both quantitatively and qualitatively. The data are taken from the ESF-corpus (cf. Feldweg, 1992) and concern interview data and film retellings from two Turkish and three Moroccan learners who learned Dutch in a naturalistic setting. The data show that all five learners fail to produce topicalised structures and post-verbal negations as long as they do not produce hebben. Moreover, learners start to produce such V2 structures shortly after they have produced their first instances of hebben. These findings seem to indicate that the production of hebben is related to the acquisition of topicalisation and post-verbal negation, i.e., the non-modal auxiliary seems to serve as a bootstrap into the V2 system of Dutch. To explain the observed relationship between hebben and V2 phenomena, an explanation by Jordens (2004) is considered. It is concluded that the present data are in line with his account. It is also stressed, however, that some caution is needed in interpreting the findings, due to the exploratory character of the study.

Comparison of Dutch and Czech Systems of Pharmacy Studies

This article describes the comparison of two systems of pharmacy studies, one in the Netherlands (NL) and one in the Czech Republic (CZ). The schemes of the study of pharmacy, the Dutch curriculum and Czech curriculum for students of pharmacy, credit systems and practices were compared. Special attention was devoted to the comparison of all the subjects involved in the Dutch and Czech curricula. In the Netherlands, it is possible to study pharmacy in two programmes: Bachelor’s Degree or Master’s Degree. In the Czech Republic it is only possible to study pharmacy as a Master’s Degree. The length of study for Dutch students in the Master’s Degree programme takes six years, while Czech students need only five years for the same programme. Dutch students are educated through a block system and Czech students through a 14 day schedule with a regular exchange of subjects. The credit system (European credits) is the main tool for the evaluation of students in Europe. The credit system used in the Netherlands is as follows: one European credit 5 28 h of work. The credit system is not yet established in the Czech Republic, where students are still evaluated by a system of grades. Pharmacy practice as a topic runs in both curricula, but in different ways. However, six months of pharmacy practice in the last year of study (according to the requirements of the European Union directives) will start in the academic year 2004 / 2005 in the Czech Republic.

Parliamentary Democracy in the Netherlands

Dutch parliamentary democracy was shaken by ‘the long year of 2002’, a period of political instability related to the meteoric rise of the populist politician Pim Fortuyn, and his assassination. This has opened a window of opportunity for existing and newly developed proposals for constitutional change. The proposals have in common that they seek to strengthen relations between the electorate and parliament, and to emphasise the separation of powers between parliament and the government. The most important of these proposals that are currently debated are replacing the current electoral system of nation-wide Proportional Representation with a Mixed Member Proportional system, and the introduction of popularly elected executives at the local level (mayors), and possibly also at the national level (the prime minister). It remains to be seen whether such proposals, if implemented, will change the balance between consensus-seeking and competition in the Dutch system

A comparison of in situ and in vitro methods to estimate in vivo fermentable organic matter of forages in ruminants

Several known in situ and in vitro methods were compared for their reliability for determining — directly or indirectly — in vivo fermentable organic matter ( in vivo FOM) of forages in ruminants. Twelve forage types were used: fresh and conserved forms of lucerne, red clover, orchard grass and perennial ryegrass. Organic matter truly digested in the rumen — which in our study was regarded as equivalent to in vivo FOM — was determined in six cannulated sheep, using the flow markers 51Cr-EDTA and 103Ru-Phenan-throlin. In vivo FOM was estimated directly from results of the in situ nylon bag technique using three cows, and from the results of three in vitro methods, and indirectly by calculating in vivo FOM using equations from the Dutch and French protein evaluation systems. The in vitro methods were an enzymatic technique using pepsin and cellulase, the method of Tilley & Terry and the gas production technique. In vivo FOM was best correlated (R 2 = 0.74; n = 12) with gas production after 20 hours of incubation. The correlation improved when fresh and conserved forages were considered separately (R 2 = 0.90; n = 12). Indirectly, in vivo FOM was well estimated from the results of the in situ, the gas production and the Tilley & Terry methods (R 2 = 0.76–0.80; n = 12). The accuracy of the direct and indirect in vivo FOM estimates was similar. However, the direct in vivo FOM estimate was a regression and the indirect estimate was a validation. In conclusion, in vivo FOM was best estimated indirectly using the equation from the Dutch protein evaluation system, whereas the estimate was more accurate with the in situ and the gas production techniques than when the other in vitro methods were used.

Reforms in German Higher Education: Implementing and Adapting Anglo-American Organizational and Management Structures at German Universities

Currently, the German higher education system is undergoing drastic reform. Competitive structures and funding mechanisms are being introduced that are already successfully used in other countries. However, critics state that cultural differences prevent the effective application, in German universities, of funding mechanisms and incentives developed elsewhere. The authors analyzed how funding arrangements and incentives vary between different higher education systems; how they affect the work of academics and whether acceptance by academics depends on specific national university cultures. Altogether 171 in-depth interviews were conducted within the US–American, British, Dutch, Swiss, and German higher education systems as part of a research project funded by the German Research Foundation (DFG). The study shows that the use and acceptance of funding models differs internationally; however, acceptance of competitive elements increases when the knowledge about these mechanisms and their effects is enhanced.

"Knowledge Utilisation" in Dutch social policy: the case of the Disability Insurance Act (WAO)

This article studies research on the Dutch Disability Insurance Act (WAO) of 1967 and its impact on subsequent policy reform. Because of certain unique technical features, the WAO scheme has long operated as a hidden unemployment scheme, which is widely regarded as one of the major socio-economic problems of the Netherlands. From the 1980s onwards (a period of high unemployment for the country), debate about possible reforms was a regular feature on the political agenda and several restrictive changes were in fact implemented. At the same time, extensive research was commissioned. The article surveys the research and selects three particular cases for in-depth analysis. It concludes, in line with standard Knowledge Utilisation literature, that direct policy use of research is very limited, and that the conceptual influence of research on background policy framework, while not negligible, is narrowly circumscribed by political context. However, the assessment also points to the need for a complementary perspective on research as a “lubricant” of the politico-administrative system, which is a significant, albeit perhaps unusual, feature of a Dutch system characterised by a combination, which is atypical in international terms, of extreme consensualism, strong formalism, and extreme pragmatism. Further research is required on the relation between national “policy styles” and research-policy linkages.

Inside self‐regulation: peer review (visitatie) by Dutch medical specialists

To deepen our insight into the Dutch system of visitatie, a doctors‐led and ‐owned external peer review mechanism through site visits, a process evaluation was performed. The study focussed on the practice‐specific recommendations for improvement as the measurable outcome of the peer review process, the attitude of medical specialists towards visitatie, and towards the recommendations. Medical specialists’ positive attitudes towards visitatie hold promise for the implementation of the recommendations for improvement, an essential final step in the process. In order to achieve improvements tailor made implementation strategies need to be offered. Specialty societies and hospital managers could play a role in facilitating improvement.

The Effects of Practicing Registration of Organ Donation Preference on Self-Efficacy and Registration Intention: An Enactive Mastery Experience

To evaluate an intervention to increase self-efficacy intentions to register organ donation preference, a Randomized Controlled Trial was conducted among 242 Dutch high-school students aged 15 to 18 years. On the basis of Social Cognitive Theory, practicing with a standard registration form (according to the Dutch system) was expected to increase the intention to register an organ donation preference through increasing self-efficacy.

Comparison of the National Research Council-2001 Model with the Dutch System (DVE/OEB) in the Prediction of Nutrient Supply to Dairy Cows from Forages

The objective of this study was to compare the DVE/OEB system (DVE = truly absorbed protein in the small intestine; OEB = degraded protein balance) and the NRC-2001 model in the prediction of supply of protein to dairy cows from selected forages: alfalfa (Medicago sativa L. cv. Pioneer and Beaver) and timothy (Phleum pratense L. cv. Climax and Joliette). Comparisons were made in terms of 1) ruminally synthesized microbial CP, 2) truly absorbed protein in the small intestine, and 3) degraded protein balance. In addition, the effects of variety and cutting stage of the selected forages on the potential nutrient supply to dairy cows were also studied. The results showed that the predicted values from the DVE/OEB system and the NRC-2001 model had significant correlations with high R (>0.96) values. However, using the DVE/OEB system, the overall average microbial protein supply based on available energy was 12% higher, and the truly absorbed protein in the small intestine was 15% lower than that predicted by the NRC-2001 model. The difference was also found in the prediction of the degraded protein balances, which was 11% higher based on data from the NRC-2001 model. These differences are due to considerably different factors used in calculations in the two models, although both are based on similar principles. This indicates that a further refinement is needed for a modern protein evaluation and prediction system. In addition, this study showed that the two alfalfa varieties studied (Pioneer vs. Beaver) had no effect, but cutting stage had a profound influence on ruminally synthesized microbial CP (93, 96, 86 g/kg DM at stage of early bud, late bud, and early bloom, respectively) and truly absorbed intestinal protein predicted by the DVE/OEB system (80, 79, 67 g/kg DM at stage of early bud, late bud, and early bloom, respectively). With timothy, both variety (Climax vs. Joliette) and cutting stage had significant impacts on the potential protein supply predicted by both models. The potential protein supply (DVE or MP) to the dairy cow from Climax timothy was higher than that from Joliette timothy (DVE: 46 vs. 32 g/kg DM; MP: 61 vs. 38 g/kg DM). With increasing stage of cutting, the potential protein supply (DVE or MP) was reduced (DVE: 53, 39, 25 g/kg DM; MP: 62, 51, 36 g/kg DM at stage of joint, prebloom head, and full head, respectively).

Nieuwe manieren, sterke frontieren. Het bouwconcept van Menno van Coehoorn en zijn aandeel in de verbetering van het verdedigingsstelsel

J. P. C. M. van Hoof, New methods, strong borders. Menno van Coehoorn's building plans and contribution to improving the defence systemDuring the years 1680 to 1685, Menno van Coehoorn (1641-1704) designed a remarkable fortification system. It provided a sound alternative to both the traditional Dutch system of fortification, which reached its peak during the Eighty Years' War (1568-1648), and the French method, which had been used in our country since 1680. In his capacity as chief engineer, Coehoorn played a leading role in modernising the fortifications located along the borders during the years 1698-1702. With his design for the protection of Dutch territory by using lines of defence, he also created a new defence structure. His role as consultant to the policy-makers of the time meant that his views had a decisive influence. At the same time, he took a keen, personal interest in implementing and executing his own building plans. This article is part of the special issue 'Legerorganisatie en oorlogvoering in de Lage Landen tijdens de zestiende en zeventiende eeuw'.

Medicalization and obstetric care: an analysis of developments in Dutch midwifery.

The Dutch system of obstetric care is often recommended for midwife-attended births, the high number of home deliveries, and the low rate of intervention during pregnancy and labour. In this contribution, the question is addressed whether processes of medicalization can be demonstrated in the Dutch midwife practice. Medicalization of pregnancy and childbirth is often criticized because it creates dependency on the medical system and infringement of the autonomy of pregnant women. It is concluded that medicalization is present in the practice of Dutch independent midwives, however it is less clear and outspoken than in hospital policies.

The Dutch system of external quality assessment: description and experiences.

Generally speaking, quality assurance in Dutch higher education consists of four parts: a self-evaluation, written by the faculty, a review committee, consisting of experts, the site visit, and a public report of the assessment outcomes. TASK OF THE REVIEW COMMITTEE: The organization, in which all universities are united, appoints a review committee for each educational program. Most educational programs are taught at different universities. Consequently, the review committee visits several universities. The task of the review committee is: to assess the overall quality of these educational programs in The Netherlands; and to assess the quality of each school separately. The members of the review committee start their activities by formulating the evaluation criteria (standards) for the content of an educational program and for the educational process. This ends with a paper that will be used as a reference for the assessment. Then the review committee studies the self-evaluation reports. The faculties write these reports along established guidelines. In cases where the self-evaluation is not completely clear, or not sufficient, the committee formulates questions and asks for additional information. Then the committee visits the faculties. These visits take usually two days each. During these visits, the committee gets information from the dean of the faculty, the program committee, teachers, students, and from other employees of the faculty. In addition, the members of the committee inspect the facilities of the faculty, e.g. the library. Directly after the visit, the chair of the committee gives, orally, a first impression of the findings. After visiting all faculties, the committee starts their deliberations, which result in a report of the assessment of the overall quality of the educational programs. The committee also assesses the quality of each faculty separately, often ending with recommendations. The Dutch system of quality assurance in higher education is much copied by other countries. The essence is the self-evaluation on one hand, and the site visit on the other. Committees try to act as consultants, and not as executioners. Therefore, the way the members of the committee play their role is very important.