Patient-level cost analysis of subfertility pathways in the Dutch healthcare system.

Background: Health economic evaluations require cost data as a key input, and reimbursement policies and systems should incentivize valuable care. Subfertility is a growing global phenomenon, and Dutch per-treatment DRGs alone do not support value-based decision-making because they don't reflect patient-level variation or the impact of technologies on costs across entire patient pathways.

Methods: We present a real-world micro-costing analysis of subfertility patient pathways (n = 4.

The impact of the multicomponent "Healthy and Vital" 3-month lifestyle intervention in health professionals: a single group pre-(multiple) post-study.

Background: Working in healthcare often involves stressful situations and a high workload, and many healthcare workers experience burnout complaints or suffer from mental or physical problems. This also affects the overall quality of health care. Many previous workplace interventions focused on knowledge exchange instead of other health cognitions, and were not particularly effective.

How do cultural elements shape speak-up behavior beyond the patient safety context? An interprofessional perspective in an obstetrics and gynecology department.

Introduction: Interprofessional working and learning thrives with speak-up behavior. Efforts to improve speak-up have mainly focused on isolated techniques and training programs within the patient safety scope, yet sustained improvement requires a cultural shift beyond this scope. This research investigates the influence of culture elements on speak-up behavior in interprofessional teams beyond the patient safety context.

Multidisciplinary Collaboration in Hospitals via Patient- and Process-Oriented Units: A Longitudinal Study.

Introduction: The complexity of healthcare is increasing, mainly due to the prevalence of multimorbidity in an ageing population. Complex care for patients with multimorbidity requires a multidisciplinary approach. Traditional physician-centered hospital structures do not facilitate the necessary multidisciplinary collaboration.

Clinical leaders crossing boundaries: A study on the role of clinical leadership in crossing boundaries between specialties.

Background: Due to the growing number of complex (multimorbid) patients, integrating and coordinating care across medical specialties around patient needs is an urgent theme in current health care. Clinical leadership plays an important role in stimulating coordination both within and between specialty groups, which results in better outcomes in terms of job satisfaction and quality of care.

Purpose: In this light, this study aims to understand the relation between physicians' clinical leadership and outcomes, focusing on the sequential mediation of relationships and coordination with physicians within their own medical specialty group and from other specialties.

Towards Process-Oriented Hospital Structures; Drivers behind the Development of Hospital Designs.

Hospitals have been encouraged to develop more process-oriented designs, structured around patient needs, to better deal with patients suffering from multi-morbidity. However, most hospitals still have traditional designs built around medical specialties. We aimed to understand how hospital designs are currently developing and what the important drivers are.

Effects and Working Mechanisms of a Multilevel Implementation Program for Applying Shared Decision-Making while Discussing Systemic Treatment in Breast Cancer.

Background: Enhancing the application of shared decision-making (SDM) is critical for integrating patient preferences in breast cancer treatment choices. We investigated the effect of an adapted multilevel SDM implementation program in breast cancer care. Methods: Breast cancer patients qualifying for (neo)adjuvant systemic treatment were included in a multicenter before−after study.

Collaboration Between Physicians from Different Medical Specialties in Hospital Settings: A Systematic Review.

Health care today is characterized by an increasing number of patients with comorbidities for whom interphysician collaboration seems very important. We reviewed the literature to understand what factors affect interphysician collaboration, determine how interphysician collaboration is measured, and determine its effects. We systematically searched six major databases.

Effectiveness of Individual Feedback and Coaching on Shared Decision-making Consultations in Oncology Care: Protocol for a Randomized Clinical Trial.

Background: Shared decision-making (SDM) is particularly important in oncology as many treatments involve serious side effects, and treatment decisions involve a trade-off between benefits and risks. However, the implementation of SDM in oncology care is challenging, and clinicians state that it is difficult to apply SDM in their actual workplace. Training clinicians is known to be an effective means of improving SDM but is considered time consuming.

Open organisational culture: what does it entail? Healthcare stakeholders reaching consensus by means of a Delphi technique.

Objectives: Open organisational culture in hospitals is important, yet it remains unclear what it entails other than its referral to 'open communication' in the context of patient safety. This study aims to identify the elements of an open hospital culture.

Methods: In this group consensus study with a Delphi technique, statements were constructed based on the existing patient safety literature and input of 11 healthcare professionals from different backgrounds.

Role of Dutch internal policy advisors in a hospital quality improvement programme and their influence on nurses' role development: a qualitative study.

Objective: Nurses are vital in providing and improving quality of care. To enhance the quality improvement (QI) competencies of nurses, hospitals in the Netherlands run developmental programmes generally led by internal policy advisors (IPAs). In this study, we identify the roles IPAs play during these programmes to enhance the development of nurses' QI competencies and studied how these roles influenced nurses and management.

Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice.

Background: Transitions in healthcare delivery, such as the rapidly growing numbers of older people and increasing social and healthcare needs, combined with nursing shortages has sparked renewed interest in differentiations in nursing staff and skill mix. Policy attempts to implement new competency frameworks and job profiles often fails for not serving existing nursing practices. This study is aimed to understand how licensed vocational nurses (VNs) and nurses with a Bachelor of Science degree (BNs) shape distinct nursing roles in daily practice.

Evaluation of a multilevel implementation program for timeout and shared decision making in breast cancer care: a mixed methods study among 11 hospital teams.

Objective: Evaluation of a multilevel implementation program on shared decision making (SDM) for breast cancer clinicians.

Methods: The program was based on the 'Measurement Instrument for Determinants of Innovations-model' (MIDI). Key factors for effective implementation were included.

Effect of a multilevel implementation programme on shared decision-making in breast cancer care.

Background: Women with newly diagnosed breast cancer face multiple treatment options. Involving them in a shared decision-making (SDM) process is essential. The aim of this study was to evaluate whether a multilevel implementation programme enhanced the level of SDM behaviour of clinicians observed in consultations.

What do we really assess with organisational culture tools in healthcare? An interpretive systematic umbrella review of tools in healthcare.

Introduction: A toxic organisational culture (OC) is a major contributing factor to serious failings in healthcare delivery. Poor OC with its consequences of unprofessional behaviour, unsafe attitudes of professionals and its impact on patient care still need to be addressed. Although various tools have been developed to determine OC and improve patient safety, it remains a challenge to decide on the suitability of tools for uncovering the underlying factors which truly impact OC, such as behavioural norms, or the unwritten rules.

From context to contexting: professional identity un/doing in a medical leadership development programme.

Physicians are known for safeguarding their professional identities against organisational influences. However, this study shows how a medical leadership programme enables the reconstruction of professional identities that work with rather than against organisational and institutional contexts to improve quality and efficiency of care. Based on an ethnographic study, the results illustrate how physicians initially construct conflicting leadership narratives - heroic (pioneer), clinical (patient's guardian) and collaborative (linking pin) leader - in reaction to changing organisational and clinical demands.

Ovarian tissue cryopreservation: Low usage rates and high live-birth rate after transplantation.

Introduction: The likelihood of survival after cancer treatment among young women with cancer has increased considerably, quality of life after treatment has drawn more attention. However, in young fertile women, fertility preservation is an important issue with regard to quality of life. One of the options of fertility preservation is ovarian tissue cryopreservation.

What makes an ideal hospital-based medical leader? Three views of healthcare professionals and managers: A case study.

Medical leadership is an increasingly important aspect of hospital management. By engaging physicians in leadership roles, hospitals aim to improve their clinical and financial performances. Research has revealed numerous factors that are regarded as necessary for 'medical leaders' to master, however we lack insights into their relative importance.

Ovarian survival after pelvic radiation: transposition until the age of 35 years.

Purpose: To evaluate the effectiveness of ovarian transposition (OT) prior to radiation therapy (RT) and to evaluate the effect of age on ovarian survival (OS) after OT.

Methods: We performed a retrospective control study, with women (aged < 45 years) who underwent OT prior to pelvic radiation, versus women diagnosed with cervical cancer and treated with hysterectomy/trachelectomy and radiation therapy. All women were treated between 1989 and 2010.

Do 'physicians in the lead' support a holistic healthcare delivery approach? A qualitative analysis of stakeholders' perspectives.

Objectives: Value-based healthcare implies that healthcare issues are addressed most effectively with the 'physicians in the lead' (PIL) strategy. This study explores whether PIL also supports a holistic care approach that patients are increasingly demanding.

Design: A qualitative research design was used.

Discursively framing physicians as leaders: Institutional work to reconfigure medical professionalism.

Physicians are well-known for safeguarding medical professionalism by performing institutional work in their daily practices. However, this study shows how opinion-making physicians in strategic arenas (i.e.

Accelerating implementation of shared decision-making in the Netherlands: An exploratory investigation.

Objective: To prioritize strategies to implement shared decision-making (SDM) in daily practice, resulting in an agenda for a nationwide approach.

Methods: This was a qualitative, exploratory investigation involving: Interviews (N = 43) to elicit perceived barriers to and facilitators of change, focus group discussions (N = 51) to develop an implementation strategy, and re-affirmation through written feedback (n = 19). Professionals, patients, researchers and policymakers from different healthcare sectors participated.

Learning Aspects in Implementing Vitrification Program Using Mouse Blastocysts.

Background: Oocyte vitrification is important for fertility preservation. There are debates, however, surrounding the components of the procedure itself.

Objective: before starting a vitrification program, we decided to (1) determine if blastocysts derived from previously frozen mouse embryos would be suitable to practice vitrification and (2) to analyze the factors that contributed to improving our "learning curve".