Dutch Health Outlook 2013

Transcription

1 Dutch Health Outlook The First Edition- From Bench to Bed Monitoring Applied Research, Innovation and Valorization -Academic partners- -Developer- -Since Partners- 1 The Dutch Health Outlook is created under the supervision of Prof. dr. Fred van Eenennaam and Ir. Maarten Koomans. It is supported by the International Academic Advisory Council

2 Acknowledgement Thanks to all participating hospitals and its data collectors. 1 Albert Schweitzer ziekenhuis, Dordrecht 2 Amphia Ziekenhuis, Breda 3 Atrium Medisch Centrum, Heerlen 4 Canisius-Wilhelmina Ziekenhuis, Nijmegen 5 Catharina Ziekenhuis, Eindhoven 6 Deventer Ziekenhuis, Deventer 7 Gelre ziekenhuizen, Apeldoorn 8 HagaZiekenhuis, Den Haag 9 Isala klinieken, Zwolle 10 Jeroen Bosch Ziekenhuis, s Hertogenbosch 11 Kennemer Gasthuis, Haarlem 12 Maasstad Ziekenhuis, Rotterdam 13 Martini Ziekenhuis, Groningen 14 Máxima Medisch Centrum, Eindhoven 15 Meander Medisch Centrum, Amersfoort 16 Medisch Centrum Alkmaar 17 Medisch Centrum Haaglanden, Den Haag 18 Medisch Centrum Leeuwarden 19 Medisch Spectrum Twente, Enschede 20 Onze Lieve Vrouwe Gasthuis, Amsterdam 21 Reinier de Graaf Groep, Delft 22 Rijnstate, Arnhem 23 Sint Franciscus Gasthuis, Rotterdam 24 Sint Lucas Andreas Ziekenhuis, Amsterdam 25 Spaarne Ziekenhuis, Hoofddorp 26 St. Antonius Ziekenhuis, Nieuwegein 27 St. Elisabeth Ziekenhuis, Tilburg 28 VieCuri Medisch Centrum, Venlo Participating hospitals We would like to thank to all who made it possible. The help and insights of many (cluster) experts was essential in creating the Dutch Health Outlook For all experts involved please refer to page(s) 98 and 99.

3 Summary (1/3) The first Health Outlook aims to attract, and provide insights to applied research and its performance Aims Context Attract applied research Applied Research Hospitals* should attract applied research and need to be aware of the importance of applied research to supporting, connecting and improving the innovative Life Sciences & Health cluster, and their own contribution to applied research. Showcase the applied research performance Applied Research Hospitals should showcase to the Netherlands, to their industry and international clusters that the Dutch hospitals are performing well on applied research. Providing affordable and high quality care. Health Provide insights into the applied research Applied Research Hospitals should provide insights in applied research since this proves a valuable tool for all healthcare stakeholders, as individual hospitals can use the results to compare and optimize their outcomes. Wealth * From now on, applied research hospitals will be called hospitals. University Medical Centers (UMCs) are not included in this report. This study was conducted on 16 out of 28 STZ hospitals. In this report the words applied research hospitals and (total) STZ hospitals are used interchangeably. 3

4 Summary (2/3) Dutch Life Sciences & Health Outlook 2013: by collecting and comparing data of 16 applied research hospitals, in order to build a database for the future which will show progress, be comparable with international clusters Data Key Conclusions OUTPUT No. of publications: 3057 publications cited Lead time of clinical trials: 65 days No. of new products: 21* new protocols: 144** new guidelines: 159** new treatments : 101** Size of clinical trials: Inflow of patients from outside catchment area: SIZE INPUT 7745 patients* 12 % admissions 10.4 % outpatient visits Applied research hospitals seem to vary heavily in their ability to be relevant in applied research that connects with industry and patients. Size, level of expertise, support and connection with industry and openness seem to matter. Hospitals that outperform collaborate above average with the industry. Outperformance on output: publications, innovation and efficiency. Publishing and performing applied research are clearly part of the core business of applied research hospitals. In particular clinical trials in phase 3 and medical devices. Industry investments: 630 research projects** Hospital R&D investments: 10,8 m ** *Extrapolation based on number of publication cited. ** Extrapolation based on number of employees. For detailed For more data information please see see chapter chapter 3 4 4

5 Summary (3/3) and stimulate and improve applied research by sharing (next) best practices in 4 overall themes. A) Attract and invest in expertise and create internal structures BP 4: Stimulate an active policy and support the research committee and LTC (Local Ethics Committee) that enforces guidelines and business plans to optimize research. BP 8: Obligate the recording (protocoleren) of research. BP 9: Register new protocols, treatments and guidelines adopted in a common, central database. BP 11: Stimulate and build research support structures. BP 13: Attract and invest in the expertise of the core staff members. BP 16: Coordinate research at a decentralized level too, to stimulate multicenter studies. B) Invest in industry BP 1: Harmonize, discuss and share knowledge on events, to create leverage and enhance innovation. BP 3: Invest in a relationship with the industry. BP 5: Cooperate with industry and other partners, as universities and connect with their experts and professors. BP 12: Create visibility to industry partners, cluster location seems to matter. Key (next) Best Practices C) Create visibility, a research culture and commitment BP 6: An education-driven organization will stimulate the preparation of protocols. BP 7: Involve specialists in quality management, and create commitment and (double) learning loops. BP 15: Invest in a research culture. BP 17: Create insight into costs and investments, to be able to allocate the right resources to the right activities. D) Cooperate with other hospitals BP 2: Initiate, cooperate and participate in multidisciplinary studies to have access to knowledge. BP 10: Share best practices internally to increase knowledge: exchange of ideas may help the development of new products. The Key (next) Best Practices are based on: 1) best performing hospitals, 2) literature research, 3) advice from experts, 4) International Academic Advisory Council, 5) cluster experiences by researches, 6) other industries. More detailed information about the Key (next) Best Practices can be found in chapter 4. 5

6 Contents of the Dutch Health Outlook Key outcomes Dutch Health Outlook 2013 Executive summary 8 Background (Shaping Defining Measuring) 9 Data and conclusions 20 Next best practices 27 Guide to interpret data A roadmap 32 Monitoring Key performance indicators (Definition Measuring Improving) Output 38 Size 52 Input 59 Appendices A. History, development and structure of the Health Outlook 67 B. About the involved partners 86 C. Bibliography 90 D. Consulted experts and organizations 97 Not included in this version but available for download at E. Key steering indicators 102 F. Monitoring Methodology extended version 114 The Outlook 2013 has been compiled with the utmost care based upon available data in Readers are advised to contact the authors of the report to avoid potential misinterpretations of the reported results. Authors welcome suggestions for improvement for the Outlook 2014 (please contact info@thedecisiongroup.nl). 6

7 Should you like to make a decision based on: Applied research Improving Health Cluster Outperformance Source SS df MS Number of obs = F( 18, 10870) = Model Prob > F = Residual R-squared = Adj R-squared = Total Root MSE = See page no 15, 16, 22 lw Coef. Std. Err. t P> t [95% Conf. Interval] expe expe hh dip dip dip dip dip enf enf en dso dso dso dso dso dso wcj 5.77e e e e-06 _cons See page no 41, 44, 47, 50, 55, 58, 62, 65 See page no 11, 13, 14, 15 See page no 25, 28-30, Measuring KPIs & KSIs Core business See page no 40, 43, 46, 49, 54, 57, 61, 64 See page no See page no 22, 26, 40, 54 7

8 1 Key outcomes Dutch Health Outlook 2013 Executive summary Background (Shaping Defining Measuring) Data & Key Conclusions Key best practices Rebke Klokke, Utrecht 8

9 Need for a shift in productivity SHAPING BACKGROUND DEFINING In order to make the Dutch healthcare system sustainable, a shift is needed in its productivity frontier: optimizing value per Euro spent Health Expenditure is outgrowing, resulting in a pressure to cut costs and in the same time to delivery better value to patients. Current situation Sources: Blendon et al. (2004), Christensen et al. (2009), and a The Decision Group analysis (2010) Based upon: Porter (1996). What is Strategy? Harvard Business Review, November-December 1996:

10 Enhancing applied research, innovation and development SHAPING BACKGROUND DEFINING by improving cooperation between the Life Science cluster and the Health cluster and enhancing at the same time applied research, innovation and valorization. Applied Research, Innovation and Valorization is the base of the five recognized leverages of Christensen, to increase productivity. Sources: Blendon et al. (2004), Christensen et al. (2009), and a The Decision Group analysis (2010) 10

11 BACKGROUND A focus on the cross-over: Life Sciences & Health SHAPING DEFINING On the cross-over of Life Science & Health (product supply market) the four main players each have their own point of view on the current situation of cooperation. Views on the cross-over Patients I would like to receive the best care there is. New products and treatments should be available on the market as soon as possible. However, safety and the added value should be known. Insurers Of course, we would like to stimulate cooperation, to create new ideas and innovation. Our main concern is to get people healthy as soon as possible. Care & Cure In our hospital patient care is number 1, however a focus on research and creating new treatments and products is also necessary to increase patient value. Industry We need the hospitals to run clinical trials on our new products; speed, patient size and expertise of researchers are critical success factors in our business. Since we have a commercial point of view, trust is sometimes difficult and hampers co-creation and product development. 11

12 BACKGROUND Monitoring the cross-over SHAPING DEFINING The Health Outlook measures and monitors applied research, innovation, valorization and cooperation annually to contribute to a successful and innovative Life Science & Health cluster. Attract applied research Applied Research Hospitals* should attract applied research and need to be aware of the importance of applied research to supporting, connecting and improving the innovative Life Sciences & Health cluster, and their own contribution to applied research. Showcase the applied research progress Showcasing to the Netherlands, to its industry and international clusters that the Dutch hospitals are performing well on applied research. Provide insights into the applied research Getting insights in applied research proves a valuable tool for all healthcare stakeholders, as individual hospitals can use the results to compare and optimize their outcomes. 12

13 Definition of the Dutch Health Outlook 2013 SHAPING BACKGROUND DEFINING The focus of the Dutch Life Sciences & Health Outlook 2013 is the performance of the innovative core of the cluster of both the industry and part of the teaching and specialized care and cure providers. Suppliers Value Chain Service Providers Bioelectronics, Bioinformatics Analysis Software Medical Equipment Laboratory Equipment Ophthalmic Goods Diagnostic Substances Containers and Packaging Chemical products Care and Cure providers Manufacturing R&D companies Drugs and Medical Device companies (Pharma, Biotech, Medical Engineering) Distribution Marketing & Sales Specialized Research service providers Contract Manufacturing Organizations, Contract Research Organizations Clinical studies Synthesis services Specialized Research suppliers Cluster Organizations Niaba, Nefarma, Biofarmind, LSH Regulation CCMO, METCs, FDA, EMA Reimbursement Healthcare Insurance Companies, VWS Specialized Business Services Banking, Accounting, Legal Specialized Risk Capital VC Firms, Angel Networks Health Insurance Laboratory, Clinical Testing The cluster map shows both the value chain and the supporting industries in the Dutch LSH cluster. The cluster map is in the process of international recognition Core Value Chain, referred to top-sector plan as innovative core. Monitored with Life Sciences Outlook. 16 out of 28 Top-clinical hospitals are included in the Health Outlook. Translational Research TiPharma, BMM, CTMM Fundamental Research NGI, Hubrechts Institute Educational Institutions Universities The Dutch Life Sciences Outlook 2013 was launched on 8 th Feb 2013 The Dutch Health Outlook is launched on 14 th June

14 Quality of care The Care & Cure providers - Top-clinical hospitals SHAPING BACKGROUND DEFINING The Care & Cure providers include among others all Top-clinical hospitals of the Netherlands that perform applied research. Academic hospital In 2014, the definition may broaden to: 1. More STZ hospitals 2. Specialty hospitals and UMCs may be included. Top-clinical hospitals (STZ) 1 Albert Schweitzer ziekenhuis, Dordrecht 2 Amphia Ziekenhuis, Breda 3 Atrium Medisch Centrum, Heerlen 4 Canisius-Wilhelmina Ziekenhuis, Nijmegen 5 Catharina Ziekenhuis, Eindhoven 6 Deventer Ziekenhuis, Deventer 7 Gelre ziekenhuizen, Apeldoorn 8 HagaZiekenhuis, Den Haag 9 Isala klinieken, Zwolle 10 Jeroen Bosch Ziekenhuis, s Hertogenbosch 11 Kennemer Gasthuis, Haarlem 12 Maasstad Ziekenhuis, Rotterdam 13 Martini Ziekenhuis, Groningen 14 Máxima Medisch Centrum, Eindhoven 15 Meander Medisch Centrum, Amersfoort 16 Medisch Centrum Alkmaar 17 Medisch Centrum Haaglanden, Den Haag 18 Medisch Centrum Leeuwarden 19 Medisch Spectrum Twente, Enschede 20 Onze Lieve Vrouwe Gasthuis, Amsterdam 21 Reinier de Graaf Groep, Delft 22 Rijnstate, Arnhem 23 Sint Franciscus Gasthuis, Rotterdam 24 Sint Lucas Andreas Ziekenhuis, Amsterdam 25 Spaarne Ziekenhuis, Hoofddorp 26 St. Antonius Ziekenhuis, Nieuwegein 27 St. Elisabeth Ziekenhuis, Tilburg 28 VieCuri Medisch Centrum, Venlo * 16 out of 28 STZ hospitals are included 1 Please note that a number of top-clinical hospitals provides patient care up to the highest level complexity of care. 2 Please note that a schematic representation is given of hospital activities, i.e., general hospitals are not included in the group of top-clinical hospitals Specialization The Dutch Healthcare system consists of 91 hospitals (without specialized centers); including 8 University Medical Centers and 28 tertiary medical teaching hospitals engaged in applied research. 14

15 Applied Research Hospitals - Activities SHAPING BACKGROUND DEFINING The Health Outlook 2013 focuses on the value chain of the health cluster and its related activities to applied research for the top medical teaching hospitals. Applied research: Scientific publications, presentations Reporting on scientific activities (e.g. within annual reports) Complies to guidelines of Dutch Clinical Trial Foundation (DCTF) for applied scientific research measured by the Health Outlook 15

16 Methodology to measure applied research SHAPING BACKGROUND DEFINING Together with experts, we developed a methodology to establish the first Health Outlook, monitoring applied research. Literature Study - Monitoring Health International Advice on Clusters Pilot Study to Test Indicators Support of Research Experts Roll out Study & Building the Database Review & Validation We would like to thank all who made it possible. The help and insights of many (cluster) experts was essential in creating the Dutch Health Outlook For all experts involved please refer to page(s) 98 and

17 Monitoring, Improving & Sharing Best Practices SHAPING BACKGROUND DEFINING 9 Key Performance Indicators and 7 Key Steering Indicators have been developed to monitor and improve applied research and to share (next) Best Practices. Key Performance Indicators monitor the success of a cluster or set of organizations. Typically, performance indicators cannot be influenced directly by policy. OUTPUT Key performance indicators Monitoring Key steering indicators Improving Key Steering Indicators can be influenced directly by policy makers. Typically, steering indicators are selected so as to have high impact on the success of a cluster or set of organizations. Number of publications cited Lead time of clinical trials Number of best practices shared among hospitals Number of new products Costs of research projects Number of new protocols, guidelines and treatments Adoption rate of new products* SIZE Size of clinical trials (number of patients in trial) Inflow of patients from outside catchment area INPUT Best Practices Level of expertise Staff responsiveness Participation of staff in the development, undertaking and use of research Presence of research support offices and transfer facilities in each hospital Cooperation relationships of hospital research Industry investments Hospital R&D investments * At this moment adoption rate of new products is not measured. Next year we aim to find and determine the right definition and to collect data on this specific performance indicator 17

18 neurolog Rijnstate ja nee c a a a a a Rijnstate nee c a a a a a kinderarts Rijnstate ja b c a a a a a Rijnstate nee b a a a b a internist-intensivist Rijnstate ja nee d a a a c a kinderarts/medisch manager zorg Rijnstate nee c a a a a a she arts Rijnstate nee b a a a a a medish specialist Rijnstate nee b b a a a a klinisch geriater MC Alkmaar ja ja b b a a a a gynaecoloog MC Alkmaar ja nee b b a a a a radioloog Rijnstate nee c a a b a a anesthesioloog Rijnstate nee c a a b a a SHE Rijnstate ja nee c a a b b a chirurg Rijnstate ja ja b c a a b b a radioloog Rijnstate ja ja b c a a b c a internist Rijnstate ja nee c a a b a a gynaecoloog Rijnstate ja nee c a a b a a gynaecollog Zevenaar nee b a a b a a longarts MC Alkmaar ja nee d a a b a a arts onderzoeker MC Alkmaar ja ja c a a b a Ziekenhuisapotheker MC Alkmaar ja nee c a a b a a internist Rijnstate ja nee d b a b b a patholoog Rijnstate nee c b a b a a geriater Rijnstate ja nee b b a b a a internist Rijnstate ja nee d b a b b a anesthesioloog Rijnstate nee c b a b a a internist-nefroloog MC Alkmaar ja c b a b c a psycholoog MC Alkmaar ja nee b b a b a a Hoofd Diëtetiek MC Alkmaar ja nee c b a b b a MDL-arts Rijnstate ja nee d a b b a a MDL-arts Rijnstate ja nee e b a c c a orthopedish chirurg Rijnstate nee c b a a a tandarts Rijnstate nee a a kinderarts MC Alkmaar ja nee c a a a a b arts-onderzoeker MC Alkmaar ja ja b b a a a a b kinderarts Haga ja nee c c c a a b radioloog MC Alkmaar ja nee c a a b b MDL-arts Rijnstate ja nee d b b b b b researchvpk Spaarne ja nee b a a c b chirurg Rijnstate ja nee d a a a a c anesthesioloog Rijnstate ja nee a d b b a b c longarts Rijnstate ja ja c d d c a b c dermatoloog Rijnstate ja nee d b a b c orthopedish chirurg Rijnstate ja ja b b b a b b c internist Rijnstate ja nee c b a b b c chirurg Rijnstate ja ja a d b a b a c internist-oncloog MC Alkmaar ja nee e b a b b c researchverpleekundige MC Alkmaar ja nee b b a a a e hoofd expertisecentrum Laboratorium MC Alkmaar ja nee c b a a b e MKA-chirurg Rijnstate nee d b a b d e longarts Haga ja ja b c b b a b neurolog Rijnstate ja nee b b a c b locatiemanager MC Alkmaar ja ja c c b a b c c project leader clinical research Spaarne ja nee b a b a anesthesioloog Rijnstate nee d b b a a a neurolog Rijnstate nee a a orthopedish chirurg Rijnstate ja nee c b a b c c reumatolog Rijnstate ja ja b c b a a a orthopedish chirurg Rijnstate ja c b a a b Building and expanding the Health database SHAPING BACKGROUND DEFINING A new database was built to analyze data of the hospitals and based on a survey of which the answers were carefully centralized. Additional internal and external validity checks performed: Hospital data from 16 individual hospitals More than 500 respondents to survey employed within the 16 STZ hospitals taking part in this year s Health Outlook Per hospital data HagaZiekenhuis St. Antonius Ziekenhuis Rijnstate Catharina Ziekenhuis M.C. Haaglanden Hospital by hospital checked database Monitoring methodology to assess performance: The methodology approach is based on the World Economic Forum approach. The nine key performance indicators are validated by 20+ hospital CEOs and management and medical staff. The methodology is used to create international standards within EU clusters. The methodology has been checked by the International Academic Advisory Council. Data on Key Performance and Key Steering Indicators Function Question / hospital Centralization of survey answers a 2.1.b 2.1.c 2.1.d 2.1.e 2.2.a 18

19 BACKGROUND Experiences during data collection SHAPING DEFINING Data collection itself results in building new infrastructures and gaining insight in the processes and procedures. New ideas develop which improve the performance and the efficiency of applied research. Experiences Bibi Blijham, Msc. Data collector at 3 hospitals Kwaliteitsmedewerker Wetenschap Data registration, in general, is insufficient in hospitals, not only at research offices but also at other supporting departments such as Human Resources, Financial management and Health administration. Obtaining comparable data is difficult because the way of registration of research projects differs between hospitals; how data is registered differs between hospitals and which research projects are registered differs as well between hospitals Hospitals have different local procedures, such as the local feasibility procedure of the Board of Directors, with a different focus which leads to different ways of registering data and thus, collecting data. The functionality of research offices is developing in a different way between hospitals. Sharing best practices (such as a uniform way of data collection of research projects) is desirable but there is also a need for standardization. 19

20 Data on the Life Sciences & Health Cluster 2013 DATA & KEY CONCLUSIONS Health cluster¹ Life Sciences cluster² OUTPUT No. of publications: 3057 publications cited Lead time of clinical trials: 65 days No. of new products: 21 * new protocols: 144 ** new guidelines: 159 ** new treatments : 101 ** OUTPUT Revenue: 17.8 b (+0.6%) Number of products: 122 (+10%) SIZE Size of clinical trials: 7745 patients * Inflow of patients from outside catchment area: 12% admissions 10.4% outpatient visits SIZE Number of companies: 343 (+4.3%) Employment: jobs (-6.7%) INPUT Industry investments: 630 research projects ** Hospital R&D investments: 10,8 m ** INPUT Public investments: 291 m (-2%) Private investments raised: 1887 m (+574%) *Extrapolation based on number of publication cited ** Extrapolation based on number of employees ¹ For more info please see ² For more info please see 20

21 DATA & KEY CONCLUSIONS Key conclusions 1 Hospitals seem to vary heavily in their ability to be relevant in applied research which connects with industry and patients. Ability depends on size, level of expertise, support and connection with industry and openness. 2 Hospitals that outperform, collaborate more than average with industry. Outperformance on output: publications, innovation and efficiency. 3 Publishing and performing applied research is clearly part of the core business of hospitals. In particular clinical trials in phase 3 and medical devices. 21

22 No of research projects Mean normalized citation score DATA & KEY CONCLUSIONS Hospital seems to vary heavily in their ability to be relevant in applied research 1 Variation in size, input and output is observed among the hospitals, showing differences in performance and cooperation with industry. 40 No. of Industry Invested Projects Examples of Key Performance Indicators, with high variation No. of publications cited 25 Position of individual hospitals Hospitals See chapter 3 for detailed information about KPI Industry Investments & Number of publications. Source: STZ & NFU (Red bars are Academic Medical Centers) STZ individual hospitals 22

23 Individual hospitals Individual hospitals DATA & KEY CONCLUSIONS Multiple affecting factors 1 Factors such as size, level of expertise (number of professors, PhDs, GCP-certified), research support capacity, connection with industry and openness to share best practices, seem to matter. Example of 2 factors that influence variation Total employment Variation is a logic result of various factors. Some of these factors, such as size, are not easy to influence. However, openness to industry and other hospitals are more receptive and can be steered. Researcher Employees No. of Professors Professors As for the number of professors I dare to say that this is partly the result of an active policy that we follow in cooperation with academic institutions. Unlike many other hospitals, we focus not only on cooperation with UMC's but also with other academic institutions and disciplines. Employee hospital See chapter 3 for detailed information about KPI Size of clinical trials & Level of expertise. 23

24 Individual Hospitals Performance of hospitals DATA & KEY CONCLUSIONS 2 The best performing hospitals measured by output: the number of publications, products, protocols, guidelines and treatments (innovation) and lead time of clinical trials (efficiency) Lead time of clinical trials No of days See chapter 3 for detailed information about KPI Lead time of clinical trials 24

25 Relationship performance & cooperation with industry DATA & KEY CONCLUSIONS 2 collaborate more than average with industry based on industry invested research projects and staff responsiveness to external partners (e.g. MKB* & Pharma). The graph shows an increasing trend: hospitals with many industry invested research projects have a higher number of publications. The graph shows a decreasing trend: hospitals with many industry invested research projects have shorter lead times for approval of clinical trials. *MKB stands for Midden en Klein bedrijven (Small and Medium-sized companies) 25

26 Applied research is core business DATA & KEY CONCLUSIONS 3 Publishing and performing applied research is clearly part of the core business of hospitals. A total of 7445 patients are enrolled in clinical trials, with a total of 3057 citations Patients enrolled in clinical trials 10% 46% 44% PH2 PH3 M.D Hospitals reported that for the year 2011, 90% of patients participating in clinical trials have been enrolled in Phase 3 (44%) and in Medical Devices trials (46%). See chapter 3 for detailed information about KPI Number of Publications and Size of Clinical Trials. 26

27 (Next ) Best Practices - Expertise & Internal structures BEST PRACTICES 1 Via various internal structures, such as research support offices and research committees the support can be organized. A good database and information infrastructure facilitates decision making. Research Support Offices (roles and tasks) Training and educating personnel Negotiations with partners (industry METC & subsidy applications Data collection / project management Statistics Business development Support researches How to deal with rules and regulations How to set up a research line in their own department. 27

28 (Next ) Best Practices - Relationships with Industry BEST PRACTICES 2 Create a flywheel for applied research by investing in the relationships with industry. Participate in multidisciplinary studies and industry related events to share and have access to knowledge. Industry as a flywheel for research Invest in attracting industry which in turn will fund large projects. It is like a circle, money earned can be reinvested in applied research which is attracting more industry investments which in turn will fund large projects, etc. A large number of specialists and their departments have developed a beautiful structure, in which they have become and remained a loyal partner of the industry, resulting in many clinical trials and investments. Because of these trials, a large part of their own initiated studies can be funded. 28

29 (Next ) Best Practices - Culture & Commitment BEST PRACTICES 3 An ambitious culture and commitment is one of the internal keys of success. Research and innovation ideas should be supported, shared and encouraged to create an optimal research environment. Rebke Klokke, Utrecht Everything starts with an ambition and a specialist s guts and a norm that will be created. Some departments have developed a mentality with an imbued realization that if you want to ensure specialized care (topreferente zorg) this cannot be realized without the input of scientific research. Next to patient care, the hospitals have committed themselves to perform applied scientific research and stimulate health care innovation. 29

30 (Next ) Best Practices - Cooperate (Networks & Clusters) BEST PRACTICES 4 Hospitals are more successful when they operate in a cluster with a strong local dynamic. Share best practices, treatments, guidelines with partner hospitals to create leverage and enhancement of innovation. The outperforming departments also have a specialist who is connected as a professor at a university. As a result, research lines are created with a continuous flow of PhD students and publications. We cooperate in many networks with universities, IKZ (integral cancer south), and industry research which also made research possible Hospital structure and strategy Red: STZ Hospitals Blue: University Hospitals: Green: Other universities Yellow: Others Source: STZ, Bibliometric analysis of STZ-hospitals 30

31 Health Outlook 2014: Learn, Share and Inspire The Health Outlook aims to further improving. Learn from it, share it, get inspired and join the Life Sciences Outlook 2014 and Health Outlook To be determined 11 th Feb 2014 Innovation for Health Event include more hospitals include University Medical Centers address the international clusters improve KPIs and KSIs 31

32 2 Guide to read the data A roadmap Rebke Klokke, Utrecht 32

33 Monitoring & Improving The Radar The performance of the health cluster can be steered and improved by focusing on three themes: business knowledge, cluster building and investment climate, each with their key steering indicators. Monitoring Dutch health cluster; Cluster success Measuring performance and progress Dutch health cluster; Key patient value concepts Strategic assessment of progress based on Key Performance Indicators Improving Dutch health cluster; Key recommendations Improving success of the health cluster and present its international potential. based on Key Steering Indicators 33

34 Extrapolation The Health Outlook 2013 aims to report the applied research of all hospitals. So far the data has been built using the reports of 16 out of 28 hospitals. In some cases data is extrapolated across all hospitals. This is based on extrapolation having as proxy, either the number of employees or number of publications cited. Example: there are 13 hospitals reporting the number of research projects with industry. The sum of all reported projects is 301 and the number of employment for those reporting hospitals is Total employment with STZ hospitals is By applying the Three Rule: hospitals. equals 628 research projects for the STZ The number of employees and or the number of publications cited was/were taken as a proxy because the researchers found a correlation* between the implied key performance indicators which had been extrapolated and the number of Health Outlook employees. Extrapolation based on number of publications cited - No. new products - Size of clinical trials Extrapolation based on number of employees - No. new protocols - No. new guidelines - No. new treatments - Industry investments - Hospital R&D investments * 61,3% and 43,41%. For detailed information about calculations and statistical tests please check ch. 4 on Monitoring Methodology Not extrapolated -No. of publication -Lead time of clinical trials -Inflow of patients from outside catchment area 34

35 Short management summaries Every key performance indicator will have a short management summary: explanation on the rationale (definitions), the results (measuring) and best practices (improving). DEFINITION IMPROVING 35

36 Interpreting the graphs For each indicator several scores are presented. Hospitals can compare their own results in their individual hospital-specific Outlook. The average, median, minimum and maximum value reported by hospitals is depicted, as well as the number of hospitals reporting (n). A separate graph indicates the total numbers for the Health Outlook hospitals and a total (extrapolated number) for all STZ hospitals. 630 N = 15 *The Health Outlook is checked for validity by the International Academic Advisory Council. For more info please refer to page 72. Totals are obtained by extrapolation. In this edition; totals are based on all applied research hospitals minus the University Medical Centers. KPI Information On every slide the specific KPI or KSI is explained. 36

37 3 Monitoring Key performance indicators (Definition Measuring Improving) TWU Rebke Klokke, Utrecht 37

38 DEFINITION IMPROVING Key performance indicators - output Number of Publications Lead time of clinical trials No. of new protocols, treatments and guidelines Number of products EXTRA: short story on adoption rate of new treatments OUTPUT Rebke Klokke, Utrecht 38

39 KPI - Number of publications cited DEFINITION IMPROVING A higher number of publications cited indicates that a hospital or member of a hospital is more visible on the international research stage. The Bibliometric analysis of STZ is used in the Health Outlook KPI Number of publications cited Number of publications cited from the hospital in one year. Number of publications cited Definition This indicator counts how many times a member hospital has been cited world wide, excluding local citations. Proxy Bibliometric analysis of STZ publications Rationale An higher number of citation indicates that an applied research hospital / or member of an applied research hospital is more visible on the international research stage. 39

40 No of quotations No of citations KPI - Number of publications cited DEFINITION IMPROVING On average the number of citations of a hospital is 127 times a year. Compared to 2010, the total number of citations increased by 9.14% (from 2801 to 3057) in No of publications cited Total no of publications cited Total STZ hospitals (n=28) Health Outlook hospitals (n=16) N=16 0 Minimum Average Median Maximum Source : The Decision Group and STZ database. KPI Number of publications Number of publications cited from the hospital in one year. The Bibliometric analysis of STZ has been used. See for a detailed explanation Ch 4 Appendices - F. Monitoring Methodology Extended version. 40

41 KPI - Number of publications cited DEFINITION IMPROVING The high scoring hospitals perform more research projects with industry, indicating the importance of cooperation. Steering The number of specialist that are first/main applicant at LTC* (KSI5) and the number of participation to researchevents initiated by MKB (KSI 4) may be associated** with the number of publications cited. (Next) Best Practices 1. Harmonize, discuss and share knowledge on events, to create leverage and enhance innovation. Some departments have developed a mentality with an imbued realization that if you want to ensure specialized care (topreferente zorg) this cannot be realized without the input of scientific research. These departments also have a specialist who is connected as a professor at a university. As a result, research lines are created with a continuous flow of PhD students and publications. 2. Initiate, cooperate and participate in multidisciplinary studies to have access to knowledge. 3. Invest in a relationship with the industry: The best scoring hospitals have more industry invested research projects, showing a positive effect of industry on output (i.e. publications). *LTC stands for Lokale Toetsingcommissie which reads in English Local Ethics Committee ** The correlation coefficient with KSI 5 is 79,23% and with KSI 4 MKB is 39,48%. See for a detailed explanation on correlations Ch. 4 Appendices page 82 and

42 KPI - Lead time of clinical trials DEFINITION IMPROVING To get an insight in efficiency, waiting time is measured: number of days from proposal received to local feasibility. KPI Lead time of clinical trials (Phase II and III for drugs and for medical devices) Number of days from Proposal Received (regardless of completeness of proposal) to local feasibility (signature board of directors) Proposal received to Local feasibility Definition The date on which the request for approval of each clinical trial has been registered. Definition The starting date of a clinical trial, which is considered to be the date that the board signs the proposal. Proxy A sample of 10 studies within each hospital has been used to determine the lead time of clinical trials. Rationale To get an insight into the waiting time for approving of a clinical trial request by the board and until the first patient is enrolled 42

43 No of days KPI - Lead time of clinical trials DEFINITION IMPROVING A large variance in number of days from submission to approval is reported. The best performing hospital had a lead time of 16 days. Lead time N= Minimum Average Median Maximum - Source: The Decision Group database - The figures are based on an average among reporting hospitals. See for a detailed explanation Ch 4 Appendices - F. Monitoring Methodology Extended version. KPI Lead time of clinical trials (Phase II and III for drugs and for medical devices) Number of days from Proposal Received (regardless of completeness of proposal) to local feasibility (signature board of directors) 43

44 KPI - Lead time of clinical trials DEFINITION IMPROVING In addition, performing more industry invested research projects has a positive relation on performance, in case of efficiency: lead time of clinical trials. Steering The level of expertise (no of professors) (KSI 3) is linked* with the lead time of clinical trials. (Next) Best Practices 4. Stimulate an active policy and support the research committee and LTC (Local Ethics Committee) that enforces guidelines and business plans to optimize research. 5. Cooperate with industry and other partners, as universities and connect with their experts and professors. Optimization of processes as lead time of clinical trials, and in this case approval of proposals should be a logical result of cooperation with partners, especially in case these partners are profit-driven organizations like big pharma. Prof. dr. Fred van Eenennaam cluster expert. * The correlation coefficient with KSI3 Professors is 12,91%. See for a detailed explanation on correlations Ch. 4 Appendices on page 82 and 83. As for the number of professors I dare to say that this is partly the result of an active policy that we follow in cooperation with academic institutions. Unlike many other hospitals, we focus not only on cooperation with UMC's but also with other academic institutions and disciplines. Employee hospital 44

45 KPI - No. of new protocols, treatments and guidelines DEFINITION IMPROVING New protocols, treatments and guidelines are the result of applied research and innovation. KPI Number of new protocols / treatments and guidelines Number of new protocols and treatments New protocols and treatments Definition The plan for a course of medical treatment or for a scientific experiment. Proxy Answers to survey* questions 3.1 to 3.4 are taken as a proxy for the number of new protocols, treatments and guidelines. Rationale New protocols and treatments are the result of applied research that lead to better patient outcomes. * For an overview of the question please see Ch4. Appendices on Monitoring Methodology Extended version 45

46 # of protocols / guidelines / treatments KPI - No. of new protocols, treatments and guidelines DEFINITION IMPROVING The respondents to the survey indicated they implemented a number of 96 protocols, 106 guidelines and 67 treatments. Protocols / Guidelines / Treatments * Protocols Guidelines Treatments Total STZ hospitals (n=28) Health Outlook Hospitals (n=13) - Source: The Decision Group database - *Underestimated due to self reporting. Next year improvements will be made to measure this indicator. **There is a positive linear correlation between no of new protocols, treatments and guidelines and no of citations. See for a detailed explanation on correlations Ch4. Appendices on page 82 and 83. KPI Number of new protocols / treatments and guidelines Number of new protocols and treatments (adopted at a national level, e.g., in guidelines) for which the hospital is the main applicant. 46

47 KPI - No. of new protocols, treatments and guidelines DEFINITION IMPROVING Infrastructure to support research as well as participation in multicenter research studies increases the number of new protocols and treatments. Steering The cost of research (KSI 2), the number of specialist with application at LTC (KSI 5) and participation to multicenter studies (KSI 7) shows a relationship* with the number of new protocols, treatments and guidelines. (Next) Best Practices 6. An education-driven organization will stimulate the preparation of protocols. 7. Involve specialists in quality management, and create commitment and (double) learning loops. Learning, training and research are a crucial part of our hospital. All our specialists are a member of the quality committee. This committee has a strong focus on education. The enthusiasm of this committee will lead to a culture whereby creating protocols of new ways of working is stimulated. 8. Obligate the recording (protocoleren) of research. Done by one of the best performing hospitals. 9. Register new protocols, treatments and guidelines adopted in a common, centrally database. At this moment hospitals do not have a clear view. * The correlation coefficient with KSI 2 Cost of research is 38,56%. See for a detailed explanation on correlations Ch4. Appendices on page 82 and 83.: 47

48 KPI - Number of products DEFINITION IMPROVING Patents awarded are the confirmation that the research process was found through novel features and support the process of innovation and valorization. KPI Number of new products # registered patents for which the hospital is main applicant. Registered patents Definition A patent is the registered, exclusive right of an inventor to make, use, or sell an invention. Proxy Answers to survey* question 3.1 of the survey are taken as a proxy for the number of products Rationale Patents awarded are the confirmation that the research process was found through novel features and support the process of innovation and valorization. * For an overview of the question please see Ch 4 Appendices - F. Monitoring Methodology Extended version. 48

49 No of patents No of patents KPI - Number of products DEFINITION IMPROVING In 2011, Health Outlook hospitals reported to have registered 11 new patents. 7 of them were reported by the same hospital. Two other hospitals registered two patents. Total number of registered patents Total STZ hospitals (n=28) 8 Health Outlook hospitals (n= 14) Source: The Decision Group database Registered patents in N=14 Individual hospitals *The total no of registered patents is based on question 3.1 of the survey. For detailed info please see Ch 4 Appendices - F. Monitoring Methodology Extended version. KPI Number of new products # registered patents for which the hospital is main applicant. 49

50 KPI - Number of products DEFINITION IMPROVING The number of new products might increase by enlarging high skilled labor force and incentivize staff to be more open and cooperative with other hospitals. Steering (Next) Best Practices The number of PhDs (KSI 3), participation to industry initiated events (KSI 4) and multicenter investigator initiated researches (KSI 7) are linked* with the number of products. 10.Share best practices internally to increase knowledge: exchange of ideas may help the development of new products. The STZ hospital which outperformed KPIs Number of Products explained: Our culture is probably the key for success. Collaboration and innovation are stimulated and encouraged. At this moment we are rolling out an internal policy which is based upon sharing best practices. Hopefully, this policy will strengthen our position. * The correlation coefficient with KSI 3 (PhD) is 11,14%, KSI 4 (industry initiated) 15,48% and with KSI 7 (multicenter investigator initiated studies) is 19,36%.. See for a detailed explanation on correlations Ch. 4 Appendices on page 82 and

51 EXTRA: KPI - Adoption Rate of New Products DEFINITION IMPROVING At this moment adoption rate of new products is not measured. Next year the aim is to find and determine the right definition and to collect data on this specific performance indicator. Marc Rinkes, Manager Wetenschap & Kennis Adoption rate of product innovation At this moment, the said indicator does not provide a significant outcome in this first Health Outlook. The indicator aims at finding the introduction rate and penetration grade primarily of new medicines. The present data search did not turn out enough hits to support broader analysis. We expect that it will be a mere question of time before the indicator will be supported by more adequate data registry. It is probably more significant that present innovation in hospitals focuses mainly on therapy and treatment rather than on product and technology innovation. Pieter Kievit, Head of medical education and research support In an era dominated by an aging population and rising costs of healthcare, one would expect the scope on healthcare innovation to be on medical, technical, process and social innovation. Membership of STZ presupposes a certain size of the institution and number of patients they treat. Under these conditions it seems attractive to realize and sustain local innovations resulting in lower costs of treatment and higher (social) return on investments in terms of clinical outcome, patient satisfaction and quality of life. Admittedly, this will have to be picked up by a whole new set of partners like MKB and HBO organizations in a new variety of business case. The hospitals that started in this way are confronted by both new and time-honored challenges, the difficult acceptation of foreign (not invented here) concepts being one of them. However, opening up for innovative concepts that will increase the quality of care in feasible business cases will automatically invite other innovators and their innovative concepts to present themselves. Healthcare innovation appears to be in its infancy. Possibly, the current KPI 6 score s most important signal is: Demanding attention. Marc Rinkes & Pieter Kievit 51

52 DEFINITION IMPROVING Key performance indicators - Size Size of clinical trials (no of patients in trial) Inflow of patients outside catchment area Size Rebke Klokke, Utrecht 52

53 KPI - Size of clinical trials (no of patients in trial) DEFINITION IMPROVING The number of patients are representative for the size of the clinical trials assessed. KPI Size of Clinical Trials ( number of patients in trial ) Total Number of target patients to be included in clinical trials, Phase II of III for Drugs or trials for medical devices started during a year. Ph2, Ph3 and Medical Devices clinical trials Definition Clinical trials performed by applied research hospitals in the Dutch Health cluster can be divided in two categories : 1. Drugs : a drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters normal bodily functions 2. Medical Devices : Medical devices: Medical device means any instrument, apparatus, implement, machine, appliance, implant, in vitro reagent or calibrator, software, material or other similar or related article, intended by the manufacturer to be used, alone or in combination, for human beings for one or more of the specific purposes of (WHO). Proxy Total number of patients aimed to be enrolled in clinical trials over the entire period of these studies. Rationale The number of patients are representative for the size of the clinical trials assessed. 53

54 No of patients KPI - Size of clinical trials (no of patients in trial) DEFINITION IMPROVING Hospitals have a focus on phase 3 (2067 patients) and medical devices trials (2300 patients), compared to phase 2 (589 patients). Per total 7445 patients were enrolled in clinical trials. Total - Size of clinical trials Ph 2 Ph 3 Medical Devices Total STZ hospitals N=14 N=14 N=13 - Source: The Decision Group database - Total STZ hospitals (n=28) Health Outlook hospitals 148 patients were enrolled in average in phase 3 clinical trials. 177 patients were enrolled in average in medical device trials. See for a detailed overview Ch 4 Appendices - F. Monitoring Methodology Extended version. KPI Size of Clinical Trials ( number of patients in trial ) Total Number of target patients to be included in clinical trials, Phase II of III for Drugs or trials for medical devices started during a year. 54

55 KPI - Size of clinical trials (no of patients in trial) DEFINITION IMPROVING A larger presence of research support activities will help hospitals to manage the patients in clinical trials. Steering Size of clinical trials and the presence of research support offices (KSI 6) are associated*. (Next) Best Practices 11.Stimulate and build research support structures: Outperforming hospitals on size of clinical trials, have more FTEs available to support research than other hospitals. These hospitals have built more structures to manage the large number of patients in trials. 12.Create visibility to industry partners, cluster location seems to matter. A hospital suggested that large phase 3 and medical devices studies are assigned more often to hospitals located in one of the Dutch Life Sciences sub clusters. LS sub cluster * The correlation coefficient with KSI 6 is 49.46%. See for a detailed explanation on correlations Ch4. Appendices page 82 and

56 KPI - Inflow of patients outside catchment area DEFINITION IMPROVING If there is a high ratio of patients outside catchment area (inpatient and as well outpatient) then the hospital is attractive. KPI Inflow of patients from outside catchment area Number of unique patients outside hospital catchment area that got care delivered when inpatient (admissions) and outpatient visits (vert.: opnames en 1ste polikliniek bezoeken). Outside catchment area Definition The outer part of a specific geographic area for which a particular institution is responsible. Proxy The patients reported at the hospital living outside the geographic areas than the institution. Rationale If there is a high ratio of patients outside catchment area then more attractive for the patients is that specific institution. Inpatient and outpatient Definition Inpatient : a patient who is admitted to a hospital or clinic for treatment that requires at least one overnight stay. Outpatient: a patient who is admitted to a hospital or clinic for treatment that does not require an overnight stay. Proxy An overnight stay. Rationale To get a good insight in the complexity of pocedure that a patient may undergo. 56

57 % of patients outside catchment area % of visits outside catchment area KPI - Inflow of patients outside catchment area DEFINITION IMPROVING In 2011, the Health Outlook hospitals reported that on average 14.5 % of total admissions and 10,3% of outpatient visits were from patients located outside the catchment area. First admissions First outpatient visits 35% 30% 29,8% 30% 25% 26,2% 25% 20% 15% 10% 12,0% 11,4% 20% 15% 10% 10,4% 9,7% 5% 4,5% 5% 3,9% 0% Minimum Average Median Maximum N=11 Source: The Decision Group database - N=11 0% Minimum Average Median Maximum The first position with the maximum number of first admissions and first outpatients visits outside catchment area is hold by the same hospital. See for a detailed explanation Ch 4 Appendices - F. Monitoring Methodology Extended version. KPI Inflow of patients from outside catchment area Number of unique patients outside hospital catchment area that got care delivered inpatient (admissions) and outpatient visits (vert.: opnames en 1ste polikliniek bezoeken) 57

58 KPI - Inflow of patients outside catchment area DEFINITION IMPROVING Expertise of employees might attract patients from outside catchment area to the hospital. Steering The level of expertise (KSI 3) is linked* with the inflow of patients outside catchment area that are admitted for the first time. (Next) Best Practices 13.Attract and invest in the expertise of the core staff members: The expertise of the attractive hospitals, (inflow of patients from outside catchment area) is higher compared to average attractive hospitals. Next to expertise, data shows a trend on size of clinical trials and inflow of patients outside catchment area. Further research has to validate the hypothesis that inflow of patients with clinical trials may affect the inflow of patients for admissions and outpatient visits. * The correlation coefficient with KSI 3 PhD is 8,83%.and KSI Prof is 44,08% See for a detailed explanation on correlations Ch. 4 Appendices on page 82 and

59 DEFINITION IMPROVING Key performance indicators Input Industry Investments Hospital investments INPUT Rebke Klokke, Utrecht 59

60 KPI - Industry Investments DEFINITION IMPROVING Industry investments give an approximation of the ability of hospitals to collaborate with industry in common projects. KPI Industry Investments (in the core value chain) Number of research projects with industry partners, (including self-initiated healthcare research with industry investment) started in a given year. Core value chain of the Dutch health cluster Definition of the core value chain The Dutch Health cluster contains all top clinical and research hospital from the Netherlands, including all STZ hospitals that perform applied research. Proxy The number of research projects commissioned by industry is taken as a proxy for industry investments. Rationale Industry investments give an approximation of the ability of hospitals to collaborate with industry in common projects. 60

61 No of projects No of projects KPI - Industry Investments DEFINITION IMPROVING In 2011, the industry invested in, on average, 21 research projects per hospital with a maximum of 49 research projects. In total 630 research projects within the hospitals were started. Industry investments Total - Industry investments N = Minimum Average Median Maximum Health Outlook hospitals (n=15) Total STZ hospitals (n= 28) - Source: The Decision Group database - There is a large variation among the reported industry investments. See for a detailed explanation Appendices on Monitoring Methodology extended version. KPI Industry Investments Number of research projects with industry partners, (including self-initiated healthcare research with industry investment) started in a given year. 61

62 KPI - Industry Investments DEFINITION IMPROVING Hospitals that are participating actively in multi center studies attract more industry investments. Furthermore, ambitious specialists have a large impact on performance. Steering The participation in multicenter studies (KSI 7) seems to influence* the industry investments. (Next) Best Practices 15.Invest in a research culture. This generates an exciting and vibrant learning community, reinforces the links with industry, and contributes to highquality applied research. The hospital which outperformed KPI Industry Investments explained: Our specialists are very research minded. They have a lot of ambition, and this influences other specialists. A science-driven culture is growing. The money they receive from the industry is often reinvested in investigator research, which attracts industry, a motor of innovation is created. 16.Coordinate research at a decentralized level too, to stimulate multicenter studies. Another hospital clarified: Our main departments have own research coordinators who facilitate in bringing in multicenter studies. *The correlation coefficient with KSI 7 is 83.66%. See for a detailed explanation on correlations Ch. 4 Appendices on page 82 and

63 KPI - Hospital investments applied research & innovation DEFINITION IMPROVING Hospitals that invest in applied research & innovation create a breeding ground for innovation. KPI Hospital applied research & innovation Money invested in applied research & innovation by the hospital in a given year. Money invested in applied research & innovation Definition Applied research is a form of systematic inquiry involving the practical application of science. Proxy Hospital budget and a sample of the 3 largest partnerships (maatschappen) for investment in applied research & innovation apart from industry sponsored is taken as a proxy. Rationale Hospitals that invest in applied research & innovation are create a breeding ground for innovation. 63

64 Investments in Investments in KPI - Hospital investments applied research & innovation DEFINITION IMPROVING The hospital investments applied research & innovation vary between the hospitals in There is a huge gap between the minimum (invested 10k) and the maximum (invested 905k). N= Source: The Decision Group database - Hospital investments Minimum Average Median Maximum KPI Hospital applied research & innovation Money invested in applied research & innovation by the hospital in a given year. Ranking - Hospital investments Different reporting sources were considered. See for a detailed explanation Appendices on Monitoring Methodology extended version: Individual hospitals 64

65 KPI - Hospital investments applied research & innovation DEFINITION IMPROVING An explanation for the differences is based on the availability of internal data on investments. Steering (Next) Best Practices The steering indicators level of expertise (KSI 3) and participation to industry and health related events (KSI 4) are associated* with Hospital investments. 17.Create insight into costs and investments, to allocate the right resources to the right activities. * The correlation coefficient with KSI 3 (CGP) is 56.81% and with KSI 4 (participation to health related events is 60.50% See for a detailed explanation on correlations Appendices on page 82 and

66 4 Appendices A. History, development and structure of the Dutch Health Outlook B. About the involved partners C. Bibliography D. Consulted experts and organizations Rebke Klokke, Utrecht 66

67 Appendix A History, development and structure of the Dutch Health Outlook Rebke Klokke, Utrecht 67

68 Partners to create the Health Outlook 2013 STZ and The Decision Group proudly present the first edition of the yearly Outlook on the Dutch Health cluster. The Outlook is commissioned by the STZziekenhuizen. STZ stands for the Dutch association of tertiary medical teaching hospitals. STZ members can be seen as high care hospital providers and top referral centers. STZ plays an important role in applied medical research having the aim to provide effective and efficient care with focus on patient value. Contacts: Maarten Rook The Outlook is created in cooperation with the Grenoble School of Management, School of Public Health, part of The George Washington University, Stockholm School of Economics Contact: Prof. dr Fred van Eenennaam The Outlook is created in cooperation with consulting firm The Decision Group. The Decision Group helps clients take better strategic decisions, using methods such as strategic dialogue and strategic alignment. The creation of the Outlook is supervised by Prof. dr. Fred van Eenennaam, and ir. Maarten Koomans managing partners of The Decision Group. Contacts: Prof. dr. Fred van Eenennaam Ir. Maarten Koomans, Kim Bruheim, MSc. Bogdan Toma, BA, BSc +31(0)

69 Background of the Health Outlook 2013 (1/2) The Life Sciences Outlooks and the recent STZ publications have created the bases for the Health Outlook 2013 Nyenrode LSH Biotech Outlook 2010 Monitoring and improving the red biotech cluster Draft for High Profile Group review only October 2009 The Nyenrode LSH Biotech Outlook is created under supervision of prof. dr Fred van Eenennaam and Ir Maarten Koomans. 69

70 Background of the Health Outlook 2013 (2/2) which aims to register, monitor and report the outcomes (valorization) of research and cooperation with the industry and applied research hospitals uniformly. 70

71 Approach of the Health Outlook 2013 (1/2) The Outlook builds on existing and available reports to leverage and improve on the current data position of the health cluster. Extensive and valuable cluster information is available through reports that 1) focus on specific cluster elements 2) are often one-time only publications. Selection of key policy studies and reports on the Dutch biotech cluster Innovation in Healthcare Delivery Systems: A Conceptual FrameworkThe Innovation Journal: The Public Sector Innovation Journal, Volume 15(1), 2010, Article ICT in Dutch Healthcare: An International Perspective (2006) Den Haag, Nederland Denken, doen en delen: UMC s als regionale expertisecentra voor onderwijs & opleiding (2007) The Role of Integration into External Informational Environments, John R. Kimberly, Journal of Health and Social Behavior Vol. 19, No. 4 (Dec., 1978), Health consumer powerhouse: EuroHealth Consumer Index (2012) STZ expertisecentra in beeld. (2011) Determinants of technological innovation and its effect on hospital performance, African Journal of Business Management Vol.5 (11), pp , 4 June, 2011 WHO Draft Guidelines for adverse event reporting and Learning Systems (2005) STZ-ziekenhuizen in het Nederlandse ziekenhuislandschap. (2011) 71

72 Learning loop Approach of the Health Outlook 2013 (2/2) The needs of research and innovation that address the patient value in the Dutch Health cluster will be aligned by a systematic yearly cluster dialogue, based on: Creating Reporting Using To make sure the actual needs are addressed The Outlook is created with the hospitals, using: A few sources with each hospital Dialogue sessions Round table discussions To monitor progress systematically on the overall cluster, key business impact areas and key policies The Outlook reports to hospitals & entrepreneurs: Showing progress & performance of hospitals Communicating needs of hospitals to policy makers To have a dialogue on improvements The Health Outlook is used for monitoring and improving: The key policies have direct impact on the success of the health cluster. Learning loop The Outlook uses insights from the strategic dialog, where the key cluster challenges were identified according to the needs of its members. The Outlook is the starting point for cluster-wide strategic dialogues among entrepreneurs and policy makers. Improving business knowledge can have large impact on the cluster success. Learning loop Learning loop Learning loop 72

73 International Academic Advisory Council The International Academic Advisory Council 1, with the members providing advice on the development of the Outlook, cluster policies and methodology development, is listed below. Christian H.M. Ketels Principal Associate Harvard Business School Dr. Christian Ketels is a member of the Harvard Business School faculty at Professor Michael E. Porter s Institute for Strategy and Competitiveness and Director of The Competitiveness Institute (TCI), a global network of professionals interested in competitiveness and cluster development. Victoire demargerie Professor at Grenoble School of Management Dr. de Margerie is specialized in strategy, technology management and corporate governance and holds various management and executive positions in Germany, France and the USA in multinational industrial groups. She holds numerous positions in boards of listed companies. Göran Lindqvist Principal Associate at the Center for Strategy and Competitiveness (CSC) at the Stockholm School of Economics and Cluster Observatory project manager. His research focuses on agglomerations, clusters, cluster initiatives, and cluster policy. Robert E. Burke Professor at the George Washington University Professor Burke is a medical sociologist and a nationally known expert in long-term care, with extensive experience in developing, evaluating and implementing health care policy and managing multidisciplinary professional staff. Leonard H. Friedman Professor at the George Washington University Dr. Leonard Friedman is an expert on the mechanisms of organizational change and strategic decision-making in health service organizations. Fred van Eenennaam Professor of Strategy and Dynamics of Strategy Professor Fred van Eenennaam is an expert on corporate governance & strategy. He is also well known for his expertise in the life sciences and healthcare industry. 1 The council meets twice a year with Prof. dr. Fred van Eenennaam as chair and Kim Bruheim, MSc. as secretary of the council. 73

74 Background on Monitoring methodology CHOICES DEFINITIONS The Monitoring methodology of the Outlook consists of: 1) choices, 2) definitions, and 3) measurement of the key performance and steering indicators The Decision Group MONITORING METHODOLOGY 1) CHOICES Choice of the key performance and steering indicators The key performance and steering indicators are selected to best reflect the success of the Dutch health cluster: 2) DEFINITIONS Definitions of the key performance and steering indicators The key performance and steering indicators are defined to best reflect the success of the Dutch health cluster: 3) Data collection for the key performance and steering indicators The data collection methodology is set up to provide accurate measurements: 74

75 What were the design considerations? CHOICES DEFINITIONS The main goal of the design was to find a set of indicators that would help to improve the cluster success. All choices made to select the key performance and steering indicators are based on the added value for the cluster. Scope The scope of the Dutch Health Outlook is the Dutch Health cluster. Aim The performance indicators monitor the success of a cluster or set of organizations. Typically, performance indicators cannot be influenced directly by policy. Steering indicators can be influenced directly by policy makers. Steering indicators are selected so as to have high impact on the success of a cluster or set of organizations. Focus The combined set of performance and steering indicators gives insight in the success of the hospitals in the Dutch Health cluster. Use To ensure that the performance indicators are practical for policy makers, a small controllable set of performance indicators is selected which can be influenced and steered upon. Health Cluster - High social interests in new healthcare products (performance indicator Number of products ). - Increased need for personalized medicine and cost reduction. Validation The approach has been validated through a pilot program and the International Academic Advisory Council that meets on a regular basis. 75

76 Methodology development CHOICES DEFINITIONS An extensive three-step proces is followed, starting with the analysis of all hospital performance and steering indicators extracted from key sources. Key Sources All indicators Selection Step 1: Step 2 Step 3 Action Select Key sources Key sources: Best practice hospitals, healthcare policy institutes ((e.g., Cleveland Clinic, Centers for Medicare and Medicaid Services etc), healthcare management journals and universities Selection of reports, academic papers, interviews on monitoring and improving hospital performance Extract all hospital performance and steering indicators Analysis of sources to extract a full list of hospital performance indicators Select key performance indicators Select key steering indicators Selection of indicators that monitor and improve the valorization and cooperation of hospitals with the innovative industry Output 47 key sources with 85 key documents 523 hospital performance indicators 8 key performance indicators 7 key steering indicators 76

77 Step 1 - Zooming on the key sources CHOICES DEFINITIONS 47 key sources are used that report in 85 key documents on monitoring and improving hospital performance. Best practice hospitals Karolinska Hospital Sarasota Memorial Hospital Mayo Clinic Cleveland Clinic Johns Hopkins Central Manchester University Hospital Duke University Medical Center Childrens Hospital of Philadelphia National Taiwan University Hospital Universities Stanford University University of York Harvard Business School The George Washington University Bocconi University General hospital performance The Advisory Board Company Health Evidence Network ScienceDaily Clinical Connection Life Sciences Health (LSH) Dutch Clinical Trial Foundation Dutch hospitals Vereniging Samenwerkende Topklinische opleidingsziekenhuizen (STZ) Universitair Medische Centra (UMC's) Nederlandse Federatie Universitair Medische Centra (NFU) Key Sources Nederlandse Vereniging van Ziekenhuizen Healthcare management journals Public Sector Innovation Journal The Academy of Management Journal Journal of Health and Social Behavoir Journal of Managerial Issues BeyeNetwork Healthcare management review African Journal of Business Management Gesundheitswesen Healthcare management review Healthcare policy institutes World Health Organization Australian Government Centers for medicare and Medicaid Services (CMS, USA) U.S. Department of Health and Human Services; Food and Drug Administration (FDA) Agency for Healthcare Research and Quality (AHRQ; USA) National Board of Health and Welfare (Sweden) National Health Service (NHS; UK) National Quality Forum (USA) Nederlandse Zorgauthoriteit (NZA) Het Rijskinstituut voor Volksgezondheid en Milieu (RIVM) Dutch Ministry of Health Welfare and Sports (VWS) Inspectie voor de Gezondheidszorg (IGZ) Raad voor de Volksgezondheid en Zorg (RVZ) Centrale Commissie Mensgebonden Onderzoek CCMO 77

78 Step 2 - Zooming on all available indicators CHOICES DEFINITIONS 523 performance and steering indicators are available. id id Monitoring/Improving Category Category Name of indicator Best practice hospitals Healthcare management journals Healthcare policy institutes Healthcare policy Universities institutes Universities General hospital performance General hospital Dutch hospitals performance.. 26 Monitoring Size Amount of IC beds 6 27 Monitoring Size Amount of papers published 15 Monitoring/Improving Name of indicator 1 Monitoring 28 Input Monitoring Budget Size by law A-segment Amount of part-time specialists Monitoring 29 Input Monitoring Budget Size by law B-segment Amount of publications in top 1% segment 9,11, 13, Monitoring 30 Input Monitoring Budget Size of Medical Amount faculty of (ministry topreferent of education, patients culture and science) Monitoring 31 Input Monitoring External Sizegrants/funding Amount (for of translational research) research 7 13, Monitoring 32 Input Monitoring Free Size market competition A-segment health volume care development budget (insurers) Monitoring 33 Input Monitoring Health Size care budget A-segment (insurers) volume development per type of care provider Monitoring 34 Input Monitoring Healthcare Size budget Availability (Ministry of of multidisciplinary Health, Welfare infrastructure and Sport and health insurers) Including government 27 2 grant for tertiary care and innovation 35 Monitoring Size Availability of data 4 8 Monitoring Input Hospital R&D investments Monitoring Monitoring size Availability of necessary departments Input Industry investments Monitoring Monitoring Size Availability of necessary supporting specialties Input Research grants 7, Monitoring Monitoring Size Availability of quality, expertise and key opinion leaders in clinical trial research Input Revenues: Ministry of Education, Culture and Science Monitoring Monitoring Size Average population per hospital Input Rx subsidy % (The percentage of total prescription drug sales paid by subsidy) Monitoring Monitoring Size Average risk residents w ith pressure ulcers Input Third-party revenues: medical research council, charities, contract research Monitoring Monitoring Size Avoidance of unnecessary care Size Absentee rate Monitoring Size Brute force indicator (product of the total number of publications in a period, multiplied by the fieldnormalized impact score (CPP/ FCSm) 15 Monitoring Size Access times for outpatient clinics 3 16 Monitoring 43 Size Monitoring Accidental Size puncture Care or is laceration offered by (sub)specialized experts in that area (approved by the association narrow Monitoring Size Activeness of medical (sub)specialties) staff in their field or administrative and/or in the health care Monitoring Monitoring Size Care is proceeding according to tested protocols Size Amount of adverse events during the length of the research Monitoring Monitoring Size Central line bundle compliance Size Amount of approved METC projects Monitoring Monitoring Size Citation score Size Amount of beds 9,11,13,14, Monitoring Monitoring Size Clinical hospitalizations Size Amount of biomedical research Monitoring Monitoring size Clinical trial phases covered Size Amount of citations per article Monitoring Size Collaboration of CRO (Contract Research Organization) and pharmaceutical industry w ith hospitals and 29 Monitoring Size Amount of citations per publication (excl. Self citations) 15 hospital boards (to overcome collaboration bottlenecks) 24 Monitoring 50 Size Monitoring Amount Sizeof citations Contribution per publication to the 20/10/5/2/1 (inc. Self citations) % most frequently cited research papers w orldw ide Monitoring Size Amount of Clinical research 13,29 Best practice hospitals Healthcare management journals Dutch hospitals.. 78

79 Step 3 - The selection of indicators CHOICES DEFINITIONS The key performance and steering indicators have been selected so that they can lie within the focus of the Life Sciences and Health Outlook. Focus: 1. Including clinical phase II,III and Medical Devices 2. Self-initiated healthcare research 3. Adoption of new products and treatments Focus of the Health Outlook 2013 The Decision Group 79 79

80 Remarks CHOICES DEFINITIONS A few remarks about definitions and measuring should be made : 1. The researchers have opted not to include in the following pages a detailed overview on definitions and measuring of KSIs. For those who might like to read the detailed definitions and measuring are welcome to check the extended version of this Health Outlook available at 2. The researchers thought it relevant to offer the definitions of KPIs in Chapter 3, before introducing the results scored for each indicator. The measuring methodology used for each KPI is to be found in the extended version of the Health Outlook. 3. The results of each KSI is provided in a different section called Health Outlook extended. 80

81 Geachte heer, mevrouw, Ons ziekenhuis doet namens de STZ topklinische ziekenhuizen mee aan het ontwikkelen van een Life Sciences & Health Outlook, in samenwerking met The Decision Group Met behulp van de Outlook willen we meten en monitoren hoe we als STZ ziekenhuis presteren op het gebied van onderzoek en innovatie. Graag maken we van uw expertise en knowhow gebruik om een aantal van de indicatoren die we met de STZ leden hebben opgesteld invulling te geven. Momenteel voeren we een pilot uit. Hieruit kan ook blijken dat vragen minder goed aansluiten bij de informatie die we zoeken. Als u suggesties heeft horen we dat graag. Het invullen van de vragen kost naar schatting ongeveer 10 minuten van uw tijd en levert zeer waardevolle input voor de Outlook. We stellen het op prijs als u de ingevulde vragenlijst voor 1 februari zou kunnen toesturen aan Niels van Gorp: n.vangorp@thedecisiongroup.nl Bij voorbaat hartelijk dank voor uw bijdrage. We houden u graag op de hoogte van de ontwikkelingen rond de Life Sciences & Health Outlook. Wilt u hier uw naam invullen? Wat is uw functie? Voor welk ziekenhuis werkt u? Dit onderdeel gaat over de mate waarin u met onderzoekers van andere STZ ziekenhuizen best practices deelt en adopteert in uw onderzoekspraktijk. (bijvoorbeeld Standard Operating Procedures) De indicator sluit aan bij het speerpunt "coordination of research" van de STZ ziekenhuizen. 1.0 Heeft u in 2011 medisch wetenschappelijk onderzoek (trials, productontwikkeling of anderszins) uitgevoerd? A) Ja B)Nee (ga door naar vraag 2) 1.1 Komt het voor dat u onderzoeksprocedures aanpast (bijv beschreven in protocol)? A) Ja B)Nee (ga door naar vraag 2) 1.2 Hoe vaak deelde u in 2011 naar schatting zulke aanpassingen met collega's in andere ziekenhuizen? A) niet (0 keer) B) 1-2keer C) 3-5 keer D) 6-10 keer E) >10 keer Partnering met derden gaat over de mate waarin u met het bedrijfsleven (ondernemers in MKB, farmaceutische industrie, anderen) contacten opbouwt en onderhoudt en samenwerkingen aangaat 2.1 Bijeenkomsten en symposia a Hoe vaak nam u ongeveer deel aan congressen, symposia, science meets business en gelijksoortige bijeenkomsten in 2011, waarbij de industrie of het bedrijfsleven vertegenwoordigd was? A) niet (0 keer); Ga verder naar vraag 2.2 B) 1-2keer C) 3-5 keer D) 6-10 keer E) meer dan 10 keer b Hoeveel van die bijeenkomsten waren door de farmaceutische of medical devices industrie geinitieerd? A) geen enkele B) 1-2 C) 3-5 D) 6-10 E) meer dan 10 c Hoeveel van deze bijeenkomsten waren er geinitieerd door het bedrijfsleven/mkb (anders dan farmaceutische of medical devices industrie)? A) geen B) 1-2 C) 3-5 D) 6-10 E) meer dan 10 d Hoeveel bijeenkomsten waren door uw eigen ziekenhuis georganiseerd? A) geen B) 1-2 C) 3-5 D) 6-10 E) meer dan 10 e Hoeveel van dit soort bijeenkomsten heeft u in 2011 zelf (mede) georganiseerd? A) geen B) 1 C) 2 D) 3 E) meer dan Contact met industrie en MKB a Hoe vaak heeft u in 2011 in het kader van uw onderzoek contacten gelegd met de industrie of de industrie benaderd? (hoeveel verschillende partijen) A) geen enkele keer B) 1 keer C) 2 keer D) 3 keer E) meer dan 3 keer b Hoe vaak met het MKB? A) geen enkele keer B) 1 keer C) 2 keer D) 3 keer E) meer dan 3 keer 2.4 Doelen van contact met bedrijfsleven a Wat waren de doelen van uw contacten met industrie? b Wat waren de doelen van uw contacten met MKB/overig bedrijfsleven? Dit onderdeel gaat over uw bijdrage aan innovaties; het ontwikkelen van nieuwe producten, behandelingen, richtlijnen of protocollen. 3.1 Patenten a Heeft u in 2011 in het kader van uw onderzoek patent aangevraagd? A) Ja en tevens toegewezen gekregen B) Ja, maar nog niet toegewezen ga naar vraag 3.2 C)Nee, ga door naar vraag 3.2 b Hoeveel patenten heeft u geregistreerd? 3.2 Heeft u nieuwe protocollen opgesteld die in 2011 op (inter)nationaal niveau zijn geimplementeerd? A) Ja (graag ook aantal vermelden) B)Nee 3.3 Heeft u nieuwe richtlijnen opgesteld die in 2011 op (inter)nationaal niveau zijn gepubliceerd? A) Ja (graag ook aantal vermelden) B)Nee 3.3 Heeft u nieuwe behandelingen ontwikkeld die in 2011 op (inter)nationaal niveau zijn geimplementeerd? A) Ja (graag ook aantal vermelden) B)Nee Antwoord: Antwoord: Hartelijk dank voor uw deelname aan deze vragenlijst. Mocht u geinteresseerd zijn in de uitkomsten van het onderzoek, vult u dan graag even uw adres in, dan houden we u op de hoogte. adres: Information about the survey CHOICES DEFINITIONS To measure the key performance indicators 8 & 9 and key steering indicators 1 & 4 a survey was sent. 593 people from 14 hospitals have replied. STZ & The Decision Group Life Sciences & Health Outlook 2013 Survey onderzoekers en medisch specialisten 1. Delen van best practices in onderzoek * 2. Partnering met derden 3. Ontwikkeling van nieuwe producten, protocollen, richtlijnen, behandelingen * Haga Ziekenhuis sent an own internal survey to measure the Key Performance Indicators: No of products and No of protocols, treatments and guidelines. The numbers of respondents was

82 Information about correlations (1/2) CHOICES DEFINITIONS To compute the correlation between KPIs and KSIs the statistical software package STATA version 11 was used. The first column ksi3_emp indicates employment and on each row the performance indicator can be found. The intersection between the employment line and a specific key performance indicator gives the correlation coefficient. For a series of a few KPIs i.e. KPI5, KPI8 and KPI9 the relationship between the above mentioned indicators and KPI7 Number of publications has been considered more appropriate to be used when extrapolating. ksi3_~mp kpi1_1~j kpi3_1~2 kpi3_1~3 kpi3_1~d kpi4_1~p kpi4_1~1 ~3_part1 ~d_part1 kpi7 kpi9pr~s kp kpi7 ~d_part1 kpi8 kpi9pr~s ksi3_11_emp kpi1_11_proj kpi kpi3_11_ph kpi5_11_md~ kpi3_11_ph kpi3_11_md kpi kpi4_11_outp kpi9protoc~s kpi4_11_ou~ kpi9guidel~s kpi5~3_part kpi9treatm~s kpi5_11_md~ kpi kpi9protoc~s kpi9treatm~s Source: The Decision Group database STATA print out. 82

83 Information about correlations (2/2) CHOICES DEFINITIONS For a series of KPIs and KSIs presented in chapter 4 the correlation coefficients are given. The table underneath shows an overview of the given coefficients, based on STATA calculations. Indicators KPI 7 KPI 5 KPI 9 KPI 4 KPI 1 KPI 2 KPI 3 KSI 4 Mkb 0,3948 KSI 4 Health 0,358 0,605 KSI 5 Spec 0,7923 0,3856 KSI 3 Prof 0,1291 0,4408 KSI 1 0,1932 KSI 2 0,365 KSI 3 PhD 0,0883 KSI 7 0,836 KSI 6 0,4946 KSI 3 GCP 0,5681 Source: The Decision Group database. 83

84 Data validation (1/2) CHOICES DEFINITIONS Several steps have been taken to check the consistency of data Pilot study Before the set up of the Health Outlook 2013 a pilot study was launched. In this way the results could be calibrated and definitions and indicators were adjusted. Communication Along the elaboration of the Health Outlook, there was a permanent and constructive communication between the researchers of The Decision Group and hospital members / employees that participated in this study. The individuals in charge of data-collection have discussed and harmonized data-collection procedures and agreeing on sources for data. Public sources A web search has been performed to check the consistency of data reported for indicator employment. The figures that were available publically corresponded with the ones reported. Cooperation among data collectors In some cases the data collators were the same individuals for multiple hospitals, e.g. the same individuals gathered data from Medisch Centrum Alkmaar, Rijnstate, St. Elisabeth Ziekenhuis and Medisch Centrum Leeuwarden. Hence, a consistency in data collection has been assured. Outlier Check In a few cases, where researchers considered that the reported data may be an outlier, discussions were carried out with the reporting hospital to assure that no reporting mistake had occurred. 84

85 Data validation (2/2) CHOICES DEFINITIONS.. and its reliability through using STZ database and a survey. STZ Database The figures for number of publications cited are pulled together centrally by STZ and are publicly available through its reports. Survey For a series of 2 performance indicators and 2 steering indicators a survey was sent. 85

86 Appendix B About the involved partners Rebke Klokke, Utrecht 86

87 The Life Sciences & Health - Focusing on patient value The main objective of STZ is to capitalize on knowledge by stimulating the applied research with focus on patient value. The Outlook is is commissioned by by the the Life Sciences STZ- ziekenhuizen. & Health innovation program. Driven by the cluster and empowered by the STZMinistry stands of foreconomic the Dutch Affairs, association the LSH of program tertiary medical has the teaching objective hospitals. to improve STZ the life members sciences caninnovation be seenand as investment high care climate hospital in providers the Netherlands. top referral The centers. Outlook is STZ part plays of the anfour-year important work roleplan. in applied medical research having the aim to provide effective and efficient care with focus on patient value. Contact: Willem de Laat, MD, PhD Contacts: Annemiek Verkamman Maarten Rook +31(0) info@lifescienceshealth.com info@stz-ziekenhuizen.nl 87

88 Value Based Healthcare Center Europe Value Based Healthcare Center Europe works closely with Prof. Michael Porter from Harvard Business School on the concepts of value-based healthcare with the goal of making better decision for patient value. The Outlook is supported by Value Based Health Care Center Europe It is the vision and aim of the Value Based Health Care Center Europe to share key practices, our experiences and knowledge on Value Based Health Care to put Patient Value at the core. Contacts: ir. Maarten Koomans Value Based Health Care Center Europe +31(0)

89 About The Decision Group The Decision Group is a niche strategy consulting firm founded in 1996 with a focus on the healthcare & life sciences industry. The Outlook is created in cooperation with consulting firm The Decision Group. The Decision Group helps clients take better strategic decisions, using methods such as strategic dialogue and strategic alignment. The creation of the Outlook is supervised by prof. dr. Fred van Eenennaam & ir Maarten Koomans, managing partner of The Decision Group. Contacts: Prof. dr. Fred van Eenennaam, Ir. Maarten Koomans Kim Bruheim, MSc. Bogdan Toma, BA, BSc. +31(0) info@thedecisiongroup.nl 89

90 Appendix C Bibliography Rebke Klokke, Utrecht 90

91 Key documents (1/6) Best practice hospitals 1. Chen, M. F. (2011). Interview Pharma Focus Reports. 2. Clinical Trials Management System (CTMS). (n.d.). Retrieved 10 06, 2011, from Mayoresearch: 3. ctr clinical research. (n.d.). Retrieved 10 06, 2011, from Sarasota memorial health care system: 4. Hopkins, J. (n.d.). Johns Hopkins Medicine Clinical Trials. Retrieved 10 06, 2011, from 5. Nederlandse Federatie van Universitair Medische Centra, Acute Zorg: Een beschrijving van het niet te plannen deel van de ziekenhuiszorg (2010), Utrecht, NL. 6. Nederlandse Federatie van Universitair Medische Centra, At a glance: Facts and figures for the Netherlands University Medical Centers (2009), Utrecht, NL. 7. Nederlandse Federatie van Universitair medische Centra, Bibliometric study on Dutch Academic Medical Centers (2009), Utrecht, NL, p Nederlandse Federatie van Universitair Medische Centra, In één oogopslag: Feiten en cijfers over de Universitair Medische Centra 2009 (2009), Utrecht, NL. 9. Nederlandse Federatie van Universitair Medische Centra, Kwaliteitsborging van mensgebonden onderzoek (2010), Utrecht, NL, p Nederlandse Federatie van Universitair Medische Centra, Naar een goede waarde: Valorisatie in de Universitair Medische Centra van Nederland- Uitgangspunten voor vorm en regelgeving (2009), Utrecht, NL, p13, p Nederlandse Federatie van Universitair Medische Centra, Onderzoek onderzocht: een bibliometrische analyse van het onderzoek van de universitair medische centra (2004), Utrecht, NL 12. Nederlandse Federatie van Universitair Medische Centra, OOR-zaak en gevolg:opleidingen in de zorg NFU-visiedocument (2005), Utrecht, NL, p Nederlandse Federatie van Universitair Medische Centra, Patiëntveiligheid,de handen ineen (2006), Utrecht, NL. 14. Nederlandse Federatie van Universitair Medische Centra, Publieke functies van de UMC s in een marktomgeving (2006), Den Haag, NL, p Nederlandse Federatie van Universitair Medische Centra, Report on the research management of the University medical centers in the Netherlands (2005), p.13,15,16,17,23, Nederlandse Federatie van Universitair Medische Centra, Tevredenheid gepeild (2005), Utrecht, NL 17. Nederlandse Federatie van Universitair Medische Centra, Trends in tevredenheid (2007/08) De tevredenheid van patiënten van de acht Universitair Medische Centra (2008),Utrecht, NL. 18. Nederlandse Federatie van Universitair Medische Centra, Trends in tevredenheid (2003/2009):Samenvatting van het vierde onderzoek naar tevredenheid van patiënten in Universitair Medische Centra (2010), Utrecht, NL. 91

92 Key documents (2/6) Best practice hospitals 19. Nederlandse Federatie van Universitair Medische Centra, UMC s gespiegeld 2008: Resultaten van de basisset prestatie-indicatoren (2009),Utrecht, NL. 20. Nederlandse Federatie van Universitair Medische Centra, UMC s gespiegeld 2009 (2010),Utrecht, NL. 21. Nederlandse Federatie van Universitair Medische Centra, UMC s gespiegeld:presentatie van de scores op de IGZ prestatie-indicatoren (2008),Utrecht, NL. 22. Nederlandse Federatie van Universitair Medische Centra, University Medical Centers in the Netherlands (2008), Utrecht, NL, p12, p Nederlandse Federatie van Universitair Medische Centra, Van vele markten thuis: de universitair medische centra in nederland Wat zijn ze, wat doen ze, wat willen ze, Utrecht, NL, p Nederlandse Federatie van Universitair Medische Centra, Wetenschap gewaardeerd (2008), Utrecht, NL, p Nederlandse Federatie van Universitair Medische Centra, Wetenschap gewaardeerd (2009), Utrecht, NL, p Nederlandse Federatie van Universitair Medische Centra, Zaaien en oogsten: Een profi leringsnota over onderwijs en onderzoek in de umc s(2010), Houten, NL, p.25, p29, p30, p33, p Nederlandse Federatie van Universitair Medische Centra, Zeldzaam Gewoon: Grensverleggende geneeskunde voor topreferente patiënten (2005), Utrecht. 28. Nederlandse Federatie van Universitair Medische CentraDenken, doen en delen: UMC s als regionale expertisecentra voor onderwijs & opleiding (2007,), Utrecht, NL, p Research & Clinical Trials - Cleveland Clinic, Clinical Connection. (n.d.). Retrieved 10 06, 2011, from Cleveland Clinic: Shaw C (2003) How can hospital performance be measured and monitored? Copenhagen, WHO Regional Office for Europe (Health Evidence Network report; accessed 29 August 2003) 31. Sibley, C. (2011). Our performance. Retrieved 10 06, 2011, from Central manchester university hospitals: Tidd, J., Bessant, J., & Pavitt, K. (2005). Case_studies. Retrieved 11 14, 2011, from Managing innovation: Universities 33. Daniele Fabbri, Silvana Robone, The geography of hospital admission in a National Health Service with patient choice: evidence from Italy, University of York, HEDG (Dec 2008) 34. Nicholas Bloom, Carol Propper, et al., The Impact of Competition on Management Quality: Evidence from Public Hospitals (Stanford University, Aug 2011) 92

93 Key documents (3/6) General hospital performance studies 35. Research & Clinical Trials - Cleveland Clinic, Clinical Connection. (n.d.). Retrieved 10 06, 2011, from Cleveland Clinic: Rijswijk-Trompert, L. (2011). Stakeholder opinions on the position of the Netherlands in conducting clinical drug trials. Nederland: Life sciences health, umcg, dutch clinical trial. 37. ScienceDaily, Hospitals That Participate In Clinical Trials May Provide Better Patient Care ( Mar. 25, 2008) 38. The Advisory Board Company, Clinical investments, How has hospital investment strategy evolved over time? (Aug 2011) Dutch hospitals 39. De Vereniging Samenwerkende Topklinische Ziekenhuizen: 15 jaar STZ: Wat STZ-ziekenhuizen verbindt. (2011) Nederland, Utrecht. 40. De Vereniging Samenwerkende Topklinische Ziekenhuizen: Kengetallen Nederlandse Ziekenhuizen. (2009) Nederland, Utrecht. 41. De Vereniging Samenwerkende Topklinische Ziekenhuizen: STZ expertisecentra in beeld. (2011) Nederland, Utrecht. 42. De Vereniging Samenwerkende Topklinische Ziekenhuizen: STZ opnieuw in beeld. (2011) Nederland, Utrecht. 43. De Vereniging Samenwerkende Topklinische Ziekenhuizen: STZ Toelatings- en hervisitatiecriteria. (2011) Nederland, Utrecht. 44. De Vereniging Samenwerkende Topklinische Ziekenhuizen: STZ-ziekenhuizen in het Nederlandse ziekenhuislandschap. (2011) Nederland, Utrecht. 45. Leeuwen, van T. Noyons, E. Medina, C.C. Bibliometric analysis of STZ-hospitals. Leiden, Leiden University Nederlandse vereniging van ziekenhuizen. (2010). Retrieved 10 20, 2011, from ziekenhuis transparant: 93

94 Key documents (4/6) Healthcare management journals 47. Blendon, R., Schoe, C., DesRoches, C. M., Osborn, R., Zapert, K., & Raleigh, E. (2004). Confronting competing demands to improve quality: a five-country hospital survey. Health Affairs, 23(5); Christensen, C. M., Grossman, J. H., & Hwang, J. (2009). The innovator s prescription, a disruptive solution for health care. McGraw-Hill; New York. 49. Greg Nelson, Implementing Metrics Management for Improving Clinical Trials Performance, BeyeNetwork/ThotWave Technologies 50. Hospital Adoption of Innovation: The Role of Integration into External Informational Environments, John R. Kimberly, Journal of Health and Social Behavior, Vol. 19, No. 4 (Dec., 1978), pp Interorganizational Links and Innovation: The Case of Hospital Services, James B. Goes and Seung Ho Park,The Academy of Management Journal, Vol. 40, No. 3 (Jun., 1997), pp Organizational Innovation: The Influence of Individual, Organizational, and Contextual Factors on Hospital Adoption of Technological and Administrative Innovations, John R. Kimberly and Michael J. Evanisko, The Academy of Management Journal, Vol. 24, No. 4 (Dec., 1981), pp Porter, M. (1996). What is Strategy? Harvard Business Review, November-December 1996: Rhay-Hung Weng, Jin-An Huang, et al, Determinants of technological innovation and its effect on hospital performance, African Journal of Business Management Vol.5 (11), pp , 4 June, Technological Adoption in Dynamic Environments: The Case of Not-for-Profit and For-Profit Hospitals, Journal article by James J. Hoffman, John G. Irwin, Lester A. Digman; Journal of Managerial Issues, Vol. 8, Vera A, Salge TO, The impact of research and development on hospital performance - an empirical analysis in the English hospital sector, Gesundheitswesen (Mar 2011) 57. Vera A, Salge TO,Hospital innovativeness and organizational performance: evidence from English public acute care. Health Care Manage Rev Jan- Mar;34(1): Vincent K. Omachonu, Norman G. Einspruch, Innovation in Healthcare Delivery Systems: A Conceptual Framework The Innovation Journal: The Public Sector Innovation Journal, Volume 15(1), 2010, Article 2. 94

95 Key documents (5/6) Healthcare policy institutes 59. Agency for Healthcare Research and Quality. Framework for Considering Study Designs for Future (2011), Rockville, United States, p.10, Agency for Healthcare Research and Quality. Project Title: Comparative Effectiveness of Screening for Methicillin-Resistant Staphylococcus Aureus (MRSA) (2011), Rockville, United States, Published online: Agency for Healthcare Research and Quality. Project Title: Public Reporting as a Quality Improvement Strategy: A systematic review of the multiple pathways public reporting may influence quality of health care (2011), Rockville, United States, Published online: Australian government, Clinically competitive: boosting the business of clinical trials in Australia (2011) 63. Chief Scientist Office: Scottish Executive Health Department, Scottish exexutive health department research governance framework for health and community care. p. 8/9 64. Ministry of Health Welfare and Sports: Here you work safely or you don t work here at all (2004) Den Haag, Nederland. 65. National Quality Forum: Measurement Framework: Evaluating Efficiency Across Patient-Focused Episodes of Care (2009) Washington, DC, p National Quality Forum: National voluntary consensus standards for patient safety measures, first report: a consensus report (2010) Washington, DC 67. National Quality Forum: The ABCs of Measurement, Washington, DC 68. Seow H, Snyder CF, Mularski RA, et al. A framework for assessing quality indicators for cancer care at the end of life. J Pain Symptom Manage 2009 Dec;38(6): p Socialstyrelsen: Open Comparison and Assessment 2009 Cardiac Care, Ordförrådet AB. 70. Socialstyrelsen: Quality and Efficiency in Swedish Health Care Regional Comparisons (2010), Ordförrådet AB, p Socialstyrelsen: Quality and Efficiency in Swedish Health Care Regional Comparisons (2008), Ordförrådet AB. 72. Socialstyrelsen: Quality and Efficiency in Swedish Health Care Regional Comparisons (2009), Ordförrådet AB. 73. World Health Organization, Measuring hospital performance to improve the quality of care in Europe: a need for clarifying the concepts and defining the main dimensions, Report on a WHO Workshop Barcelona, Spain, January World Health Organization, The World Health Report 2000, Health Systems: improving performance (2000) Geneva, Switserland 95

96 Key documents (6/6) Healthcare policy institutes 75. Benthem, B. v. (2010, 09 14). Trend_in_prevalentie_van_ziekenhuisinfecties_in_Nederland_2007_2009. Retrieved 10 20, 2011, from Het Rijksinstituut voor Volksgezondheid en Mileu (RIVM): mber_2010/inhoud_september_2010/trend_in_prevalentie_van_ziekenhuisinfecties_in_nederland_2007_ De Centrale Commissie Mensgebonden Onderzoek: Onderzoek met proefpersonen , jaarverslag 2010, Den Haag, Nederland 77. Halbertsma, R. (2008). Kwaliteit van zorg & marktwerking: Een overzicht van de economische literatuur. Utrecht: Nederlandse zorgauthoriteit. 78. Inspectie voor de gezondheidszorg: Kwaliteitsindicatoren 2012 (2011) Utrecht, Nederland 79. Inspectie voor de gezondheidszorg: Veiligheidsindicatoren ziekenhuizen (2010) Utrecht, Nederland 80. Mansley, Mark. Health and safety indicators for institutional investors. United Kingdom: Health and safety executive, Ministry of Health Welfare and Sports: Health consumer powerhouse: 2005 EuroHealth Consumer Index (2005) 82. Ministry of Health Welfare and Sports: ICT in Dutch Healthcare: An International Perspective (2006) Den Haag, Nederland. 83. Nederlandse Zorgautoriteit (NZA) : Marktscan Medisch specialistische zorg (2011) Utrecht, Nederland 84. Preventie, Ziekte & Zorg: medische technologie. (sd). Opgeroepen op 10 20, 2011, van Het rijksinstituut voor volksgezondheid en milieu: Raad voor de volksgezondheid en zorg: Ruimte voor arbeids-besparende innovaties in de zorg door slimmer werken meer kwaliteit met minder mensen (2010) Den Haag, Nederland. 86. Translating Clinical Trials into Practice, Robert M. Califf, MD, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina (July. 27, 2005) 87. WIP richtlijn handhygiene. (sd). Opgeroepen op 10 20, 2011, van Het Rijksinstituut voor Volksgezondheid en Mileu: ne_zkh 88. WIP-richtlijn Bloedcontact. (sd). Opgeroepen op 10 20, 2011, van het rijksinstituut voor volksgezondheid en milieu : ct_zkh 89. World Health Organization, WHO Draft Guidelines for adverse event reporting and Learning Systems (2005) Geneva, Switserland 96

97 Appendix D Consulted experts and organizations Rebke Klokke, Utrecht 97