Dutch Health Outlook 2013

1see also www.healthoutlook.nl

Dutch Health Outlook 2013

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

-Academic partners--Developer-

“From Bench to Bed”

Monitoring Applied Research,

Innovation and Valorization

-Since 2013-

-Partners-

-The First Edition-

http://www.grenoble-em.com/accueil.aspx?lg=en



Acknowledgement

Thanks to all participating hospitals and its data collectors.

Participating hospitals 2013

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 2013. For all experts involved please refer to page(s) 98 and 99.

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



Summary (1/3)

The first Health Outlook aims to attract, and provide insights to applied research and its performance…

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.

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.

* 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.

Context

Providing

affordable

and high

quality care.

Health

Wealth

Aims



Dutch Life Sciences & Health Outlook 2013:

Key Conclusions

Summary (2/3)

…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…

• 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.

For detailed data please see chapter 3

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

Size of clinical trials: 7745 patients*

Inflow of patients from

outside catchment area: 12 % admissions

10.4 % outpatient visits

INPUT

Industry investments: 630 research projects**

Hospital R&D investments: 10,8 m€**

Data

*Extrapolation based on number of publication cited. ** Extrapolation based on number of employees. For more information see chapter 4



Summary (3/3)

… and stimulate and improve applied research by sharing (next) best practices in 4 overall themes.

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.

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.

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.

Key (next) Best Practices

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.



Contents of the Dutch Health Outlook 2013

Key outcomes Dutch Health Outlook 2013

Executive summary 8

Background (Shaping – Defining – Measuring) 9

Data and conclusions 20

Next best practices 27

The Outlook 2013 has been compiled with the utmost care based upon available data in 2011. 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 [email protected]) .

1

Guide to interpret data

A roadmap 32

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 www.healthoutlook.nl

E. Key steering indicators 102

F. Monitoring Methodology – extended version 114

2

4

Monitoring

Key performance indicators (Definition – Measuring – Improving)

Output 38

Size 52

Input 59

3



Should you like to make a decision based on:

_cons -.2098312 .3924445 -0.53 0.593 -.979094 .5594315 wcj 5.77e-07 3.49e-07 1.66 0.098 -1.06e-07 1.26e-06 dso6 .0098075 .3915849 0.03 0.980 -.7577703 .7773853 dso5 -.028818 .4020896 -0.07 0.943 -.8169869 .7593509 dso4 .0843082 .0983582 0.86 0.391 -.1084917 .2771082 dso3 .043337 .390496 0.11 0.912 -.7221063 .8087804 dso2 .0709971 .3904501 0.18 0.856 -.6943563 .8363505 dso1 .0771048 .3902956 0.20 0.843 -.6879458 .8421553 en18 -.027078 .0071182 -3.80 0.000 -.0410309 -.0131251 enf6 -.0081408 .014602 -0.56 0.577 -.0367635 .0204818 enf3 .0264903 .01663 1.59 0.111 -.0061076 .0590882 dip6 .0779941 .0245033 3.18 0.001 .0299632 .126025 dip5 .0796747 .0175065 4.55 0.000 .0453587 .1139906 dip4 .1522206 .0231657 6.57 0.000 .1068115 .1976296 dip3 .1814161 .0263996 6.87 0.000 .1296682 .2331641 dip1 .1824788 .0320881 5.69 0.000 .1195804 .2453773 hh .2240197 .0003729 600.79 0.000 .2232888 .2247506 expe2 -.000369 .0001039 -3.55 0.000 -.0005726 -.0001654 expe .0188156 .0041323 4.55 0.000 .0107154 .0269157 lw Coef. Std. Err. t P>|t| [95% Conf. Interval]

Total 213648.347 10888 19.6223684 Root MSE = .67525 Adj R-squared = 0.9768 Residual 4956.30251 10870 .455961593 R-squared = 0.9768 Model 208692.045 18 11594.0025 Prob > F = 0.0000 F( 18, 10870) =25427.59 Source SS df MS Number of obs = 10889

Applied research Improving Health Cluster

Measuring KPIs & KSIs Core business

Outperformance

See page no 15, 16, 22See page no 41, 44, 47, 50, 55, 58, 62, 65 See page no 11, 13, 14, 15

See page no 40, 43, 46, 49, 54, 57, 61, 64 See page no 39-65 See page no 22, 26, 40, 54

See page no 25, 28-30,



Key outcomes Dutch Health Outlook 2013

© Rebke Klokke, Utrecht

Executive summary

• Background (Shaping – Defining – Measuring)

• Data & Key Conclusions

• Key best practices

1



Need for a shift in productivity

In order to make the Dutch healthcare system sustainable, a shift is needed in its productivity frontier: optimizing

value per Euro spent…

DEFINING MEASURINGSHAPING

Sources: Blendon et al. (2004), Christensen et al. (2009), and a The Decision Group analysis (2010)

Current situation

Based upon: Porter (1996). What is Strategy? Harvard Business Review, November-December 1996: 59-78

Health Expenditure is outgrowing, resulting in a

pressure to cut costs and in the same time to

delivery better value to patients.

BACKGROUND



Enhancing applied research, innovation and development

…by improving cooperation between the Life Science cluster and the Health cluster and enhancing at the same

time applied research, innovation and valorization.

Sources: Blendon et al. (2004), Christensen et al. (2009), and a The Decision Group analysis (2010)

Applied Research, Innovation and Valorization is the base of the five

recognized leverages of Christensen, to increase productivity.


BACKGROUND



A focus on the cross-over: Life Sciences & Health

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.

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”.

Views on the cross-over

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.”

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”.


BACKGROUND



Monitoring the cross-over

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.


BACKGROUND



Definition of the Dutch Health Outlook 2013

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.

Fundamental ResearchNGI, Hubrechts Institute

R&D

companies

Drugs and Medical

Device companies

(Pharma, Biotech,

Medical

Engineering)

Specialized Risk Capital

VC Firms, Angel Networks

Specialized Research

service providers

Contract

Manufacturing

Organizations,

Contract Research

Organizations

Clinical studies

Synthesis services

Specialized Business

Services

Banking, Accounting, Legal

Health Insurance

Laboratory, Clinical Testing

Laboratory

Equipment

Analysis Software

Diagnostic

Substances

Containers and

Packaging

Medical Equipment

Ophthalmic Goods

Educational InstitutionsUniversities

Cluster Organizations

Niaba, Nefarma,

Biofarmind, LSH

Chemical products

Bioelectronics,

Bioinformatics

Regulation

CCMO, METCs, FDA, EMA

Translational ResearchTiPharma, BMM, CTMM

Marketing & Sales

Reimbursement

Healthcare Insurance

Companies, VWS

Manufacturing

Distribution

Specialized

Research suppliers

Suppliers Value Chain Service Providers

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

Care and Cure

providers

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.

The Dutch Life Sciences Outlook 2013 was launched on 8th Feb 2013

The Dutch Health Outlook is launched on 14th June 2013


BACKGROUND



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

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.

The Care & Cure providers - Top-clinical hospitals

The Care & Cure providers include among others all Top-clinical hospitals of the Netherlands that

perform applied research.

In 2014, the definition

may broaden to:

1. More STZ hospitals

2. Specialty hospitals

and UMCs may be

included.

1Please note that a number of top-clinical hospitals provides patient care up to the highest level complexity of care.

2Please note that a schematic representation is given of hospital activities, i.e., general hospitals are not included in the group of top-clinical hospitals

Top-clinical hospitals (STZ)Academic hospital

Specialization

Qualit

y o

f care

* 16 out of 28 STZ hospitals are included


BACKGROUND


http://www.stz.nl/interactieve-kaart.html


Applied Research Hospitals - Activities

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


BACKGROUND



Methodology to measure 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 2013. For all experts involved please refer to page(s) 98 and 99.

Together with experts, we developed a methodology to establish the first Health Outlook, monitoring applied

research.


BACKGROUND



Monitoring, Improving & Sharing Best Practices

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

Key

steering

indicators

ImprovingMonitoring

Best Practices

OUTPUT

• Number of publications cited

• Lead time of clinical trials

• Number of new products

• 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

• Industry investments

• Hospital R&D investments

• Number of best practices shared

among hospitals

• Costs of research projects

• 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

* 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

Key Performance Indicators monitor the success of a cluster or set of organizations. Typically, performance indicators cannot be influenced directly by policy.

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.


BACKGROUND



Building and expanding the Health database

A new database was built to analyze data of the hospitals and based on a survey of which the answers were

carefully centralized.

Per hospital data

Data on Key Performance

and Key Steering Indicators

HagaZiekenhuis

St. Antonius Ziekenhuis

Rijnstate

Catharina Ziekenhuis

M.C. Haaglanden

Hospital by hospital checked database

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

Function

Question / hospital

1.0 1.1 1.2 2.1.a 2.1.b 2.1.c 2.1.d 2.1.e 2.2.aneurolog 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 voor KCHIMC 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

Centralization of survey answers

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.


BACKGROUND



Experiences during data collection

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.

• 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.

Experiences

Bibi Blijham, Msc.

Data collector at 3 hospitals

Kwaliteitsmedewerker

Wetenschap


BACKGROUND



Data on the Life Sciences & Health Cluster 2013

OUTPUT

Revenue: 17.8 b€ (+0.6%)

Number of products: 122 (+10%)

SIZE

Number of companies: 343 (+4.3%)

Employment: 22.732 jobs (-6.7%)

INPUT

Public investments: 291 m€ (-2%)

Private investments raised: 1887 m€ (+574%)

Life Sciences cluster²Health cluster¹

*Extrapolation based on number of publication cited

** Extrapolation based on number of employees

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

Size of clinical trials: 7745 patients *

Inflow of patients from

outside catchment area: 12% admissions

10.4% outpatient visits

INPUT

Industry investments: 630 research projects **

Hospital R&D investments: 10,8 m€ **

DATA & KEY CONCLUSIONS

¹ For more info please see www.healthoutlook.nl

² For more info please see www.lifesciencesoutlook.com



2

Key conclusions

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.

Hospitals that outperform, collaborate more than average with industry.

Outperformance on output: publications, innovation and efficiency.

Publishing and performing applied research is clearly part of the core business

of hospitals.In particular clinical trials in phase 3 and medical devices.

3

1




0

5

10

15

20

25

30

35

40

No

of

rese

arch

pro

ject

s

Hospitals

No. of Industry Invested Projects

Position of

individual

hospitals

Hospital seems to vary heavily in their ability to be relevant in applied research

Variation in size, input and output is observed among the hospitals, showing differences in performance and

cooperation with industry.

Source: STZ & NFU (Red bars are Academic Medical Centers)

No. of publications cited

Examples of Key Performance Indicators, with high variation.

See chapter 3 for detailed information about KPI Industry Investments & Number of publications.

1

STZ individual hospitals

Mean n

orm

aliz

ed c

itatio

n s

core




Multiple affecting factors1

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.

0 1000 2000 3000 4000 5000 6000

Employees

Ind

ivid

ual

ho

spit

als

Total employment

0 2 4 6 8

Professors

Ind

ivid

ual

ho

spit

als

No. of 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

“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

See chapter 3 for detailed information about KPI Size of clinical trials & Level of expertise.

Example of 2 factors that influence variation




Performance of hospitals

The best performing hospitals measured by output: the number of publications, products, protocols, guidelines

and treatments (innovation) and lead time of clinical trials (efficiency)…

0 20 40 60 80 100 120 140No of days

Indiv

idu

al

Hospitals

Lead time of clinical trials

See chapter 3 for detailed information about KPI Lead time of clinical trials

2




Relationship performance & cooperation with industry

…collaborate more than average with industry based on industry invested research projects and staff

responsiveness to external partners (e.g. MKB* & Pharma).

*MKB stands for Midden en Klein bedrijven (Small and Medium-sized companies)

The graph shows a decreasing trend: hospitals with many

industry invested research projects have shorter lead times for

approval of clinical trials.

The graph shows an increasing trend: hospitals with many

industry invested research projects have a higher number of

publications.

2




Applied research is core business

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.

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%).

10%

44%

46%

Patients enrolled in clinical trials

PH2PH3M.D

3057

See chapter 3 for detailed information about KPI Number of Publications and Size of Clinical Trials.

3

7445




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.

(Next ) Best Practices - Expertise & Internal structures

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.

1

BEST PRACTICES



(Next ) Best Practices - Relationships with Industry

Create a flywheel for applied research by investing in the relationships with industry. Participate in multi-

disciplinary studies and industry related events to share and have access to knowledge.

“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.”

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.

2

BEST PRACTICES



(Next ) Best Practices - Culture & Commitment

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.

“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.

3


BEST PRACTICES



(Next ) Best Practices - Cooperate (Networks & Clusters)

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”

Source: STZ, Bibliometric analysis of STZ-hospitals

Red: STZ Hospitals Blue: University Hospitals: Green: Other universities Yellow: Others

Hospital structure

and strategy

4

BEST PRACTICES



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 2014.

• include more hospitals

• include University Medical Centers

• address the international clusters

• improve KPIs and KSIs

11th Feb 2014 – Innovation for Health EventTo be determined



Guide to read the data

A roadmap

2




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.

Dutch health cluster;

Key recommendations

Improving success of the health cluster and present

its international potential.

based on Key Steering Indicators

Improving


Cluster success

Measuring performance and progress


Key patient value concepts

Strategic assessment of progress

based on Key Performance Indicators

Monitoring



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.

* 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

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 47116. Total

employment with STZ hospitals is 93307. By applying

the Three Rule: equals 628 research projects for the STZ

hospitals.

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



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 MEASURING IMPROVING



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 graphindicates the total numbers for the Health Outlook hospitals and a total (extrapolated number) for all STZ hospitals.

KPI Information

On every slide the specific KPI or KSI isexplained.

*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.

N = 15

630



Monitoring

© TWU

Key performance indicators (Definition – Measuring – Improving)

3




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

MEASURING IMPROVINGDEFINITION

OUTPUT© Rebke Klokke, Utrecht



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.

KPI - Number of publications cited

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 2013.


KPI – Number of publications cited

Number of publications cited from thehospital in one year.



1320 13891631

18332035659 665

929968

1022

0

500

1000

1500

2000

2500

3000

3500

2007 2008 2009 2010 2011

No

of

cita

tio

ns

Total no of publications cited

Total STZ hospitals (n=28)

Health Outlook hospitals(n=16)


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 2011.

Source : The Decision Group and STZ database.

2054

KPI – Number of publications

Number of publications cited from the hospitalin one year.

1979

2560

2801

3057

61

127106

340

0

50

100

150

200

250

300

350

400

Minimum Average Median Maximum

No

of

qu

ota

tio

ns

No of publications cited

N=16

The Bibliometric analysis of STZ has been used. See for a detailed explanation Ch 4 Appendices - F. Monitoring Methodology – Extended version.





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 research-

events 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).

.

See for a detailed explanation on correlations Ch. 4 Appendices page 82 and 83.

** The correlation coefficient with KSI 5 is 79,23% and with KSI 4 MKB is 39,48%.

*LTC stands for “Lokale Toetsingcommissie” which reads in English “Local Ethics Committee “




Definition Definition

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

Proposal received

KPI - Lead time of clinical trials

To get an insight in efficiency, waiting time is measured: number of days from proposal received to local

feasibility.

The date on which the request for approval of each clinical

trial has been registered.

Local feasibility to

The starting date of a clinical trial, which is considered to be

the date that the board signs the proposal.

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)




16

64

51

130

0

20

40

60

80

100

120

140


No

of

day

s

Lead time


A large variance in number of days from submission to approval is reported. The best performing hospital had a

lead time of 16 days.

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) tolocal feasibility (signature board of directors)

N=15

The figures are based on an average among reporting hospitals. See for a detailed explanation Ch 4 Appendices - F.

Monitoring Methodology – Extended version.

- Source: The Decision Group database -





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.


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.

“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* The correlation coefficient with KSI3 Professors is 12,91%.

See for a detailed explanation on correlations Ch. 4 Appendices on page 82 and 83.




New protocols and treatments

Definition

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.

KPI - No. of new protocols, treatments and guidelines

New protocols, treatments and guidelines are the result of applied research and innovation.

The plan for a course of medical treatment or for a scientific experiment.

KPI – Number of new protocols / treatments and guidelines

Number of new protocols and treatments

* For an overview of the question please see Ch4. Appendices on Monitoring Methodology – Extended version





The respondents to the survey indicated they implemented a number of 96 protocols, 106 guidelines and 67

treatments.

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.**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.

96 106

67

0

20

40

60

80

100

120

140

160

180

Protocols Guidelines Treatments

# o

f p

roto

cols

/ g

uid

elin

es /

tre

atm

ents

Protocols / Guidelines / Treatments *


Health Outlook Hospitals (n=13)

144

101

159


*Underestimated due to self reporting. Next year improvements will be made to measure this indicator.





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.


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.

See for a detailed explanation on correlations Ch4. Appendices on page 82 and 83.:

* The correlation coefficient with KSI 2 Cost of research is 38,56%.




Registered patents

Definition

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.

KPI - Number of products

Patents awarded are the confirmation that the research process was found through novel features and support the

process of innovation and valorization.

A patent is the registered, exclusive right of an inventor to make, use, or sell an invention.

KPI – Number of new products

# registered patents for which the hospital is main applicant.

* For an overview of the question please see Ch 4 Appendices - F. Monitoring Methodology – Extended version.




11

0

2

4

6

8

10

12

14

16

18

2011

No

of

pat

ents

Total number of registered patents


Health Outlook hospitals (n= 14)

0

1

2

3

4

5

6

7

8

No

of

pat

ents

Registered patents in 2011


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.

N=14

17

KPI – Number of new products

# registered patents for which the hospital is main applicant.


*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.

Individual hospitals





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

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 83.




EXTRA: KPI - Adoption Rate of New Products

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

Pieter Kievit,

Head of medical education and

research support

“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.

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




Key performance indicators - Size

• Size of clinical trials (no of patients in

trial)

• Inflow of patients outside catchment

area


Size© Rebke Klokke, Utrecht



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.

KPI - Size of clinical trials (no of patients in trial)

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 clinicaltrials, Phase II of III for Drugs or trials for medical devicesstarted during a year.




589

2067 2300

4956

296

10381155

2489

0

1000

2000

3000

4000

5000

6000

7000

8000

Ph 2 Ph 3 Medical Devices Total STZ hospitals

No

of

pat

ien

ts

Total - Size of clinical trials


Health Outlook hospitals


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.

KPI – Size of Clinical Trials ( number of patients in trial )

Total Number of target patients to be includedin clinical trials, Phase II of III for Drugs ortrials for medical devices started during a year.

N=14 N=14 N=13

885

31053455

7445

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.






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*.


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.

* The correlation coefficient with KSI 6 is 49.46%.

LS sub cluster

See for a detailed explanation on correlations Ch4. Appendices page 82 and 83.




Outside catchment area

KPI - Inflow of patients outside catchment area

If there is a high ratio of patients outside catchment area (inpatient and as well outpatient) then the hospital is

attractive.

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.

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).

Proxy

An overnight stay.

Rationale

To get a good insight in the complexity of pocedure that a

patient may undergo.




4,5%

12,0% 11,4%

29,8%

0%

5%

10%

15%

20%

25%

30%

35%


% o

f p

atie

nts

ou

tsid

e ca

tch

men

t ar

ea

First admissions

3,9%

10,4% 9,7%

26,2%

0%

5%

10%

15%

20%

25%

30%


% o

f vi

sits

ou

tsid

e ca

tch

men

t ar

ea

First outpatient visits


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.

N=11

KPI – Inflow of patients from outside catchment area

Number of unique patients outside hospitalcatchment area that got care deliveredinpatient (admissions) and outpatient visits(vert.: opnames en 1ste polikliniek bezoeken)

N=11

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.

Source: The Decision Group database -





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.


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%





Key performance indicators – Input

• Industry Investments

• Hospital investments


INPUT© Rebke Klokke, Utrecht



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.

KPI - Industry Investments

Industry investments give an approximation of the ability of hospitals to collaborate with industry in common

projects.




318

0

100

200

300

400

500

600

700

No

of

pro

ject

s

Total - Industry investments

Health Outlook hospitals (n=15) Total STZ hospitals (n= 28)

1

21 20

49

0

10

20

30

40

50

60


No

of

pro

ject

s

Industry investments


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.

N = 15

KPI – Industry Investments

Number of research projects with industrypartners, (including self-initiated healthcareresearch with industry investment) started in agiven year.


630

There is a large variation among the reported industry investments. See for a detailed explanation Appendices on Monitoring

Methodology – extended version.





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.


15.Invest in a research culture. This generates an

exciting and vibrant learning community, reinforces

the links with industry, and contributes to high-

quality 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 re-

invested 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%.




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.

KPI - Hospital investments applied research & innovation

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.




0

100000

200000

300000

400000

500000

600000

700000

800000

900000

1000000

Inve

stm

ents

in €

Ranking - Hospital investments

€ 10.000

€ 350.488€ 387.500

€ 904.500

€ 0

€ 100.000

€ 200.000

€ 300.000

€ 400.000

€ 500.000

€ 600.000

€ 700.000

€ 800.000

€ 900.000

€ 1.000.000


Inve

stm

ents

in €

Hospital investments


The hospital investments applied research & innovation vary between the hospitals in 2011. There is a huge gap

between the minimum (invested €10k) and the maximum (invested €905k).

KPI – Hospital applied research & innovation

Money invested in applied research & innovation by the hospital in a given year.

N=10


Different reporting sources were considered. See for a detailed explanation Appendices on Monitoring

Methodology – extended version: Individual hospitals





An explanation for the differences is based on the availability of internal data on investments.

Steering

The steering indicators level of expertise (KSI 3) and

participation to industry and health related events (KSI 4)

are associated* with Hospital investments.

* The correlation coefficient with KSI 3 (CGP) is 56.81% and with KSI 4 (participation to health related events is 60.50%


17.Create insight into costs and investments, to allocate

the right resources to the right activities.

See for a detailed explanation on correlations Appendices on page 82 and 83.




Appendices

A. History, development and structure of the Dutch Health Outlook

B. About the involved partners

C. Bibliography

D. Consulted experts and organizations

4




Appendix A – History, development and structure of the Dutch Health Outlook




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 ‘STZ-

ziekenhuizen’.

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

[email protected]

www.stz-ziekenhuizen.nl

The Outlook is created in cooperation withthe Grenoble School of Management, School

of Public Health, part of The George

Washington University, Stockholm School of

Economics

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)346-574942

[email protected]

www.thedecisiongroup.nl

Contact:

Prof. dr Fred van Eenennaam




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

The Nyenrode LSH | Biotech Outlook is created under supervision of prof. dr Fred van Eenennaam and Ir Maarten Koomans.

Draft – for High Profile Group review only – October 2009



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.



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

The Role of Integration into

External Informational

Environments, John R.

Kimberly, Journal of Health

and Social Behavior Vol. 19,

No. 4 (Dec., 1978),

Determinants of technological

innovation and its effect on

hospital performance, African

Journal of Business

Management Vol.5 (11), pp.

4314-4327, 4 June, 2011

ICT in Dutch Healthcare: An

International Perspective (2006)

Den Haag, Nederland

Health consumer powerhouse:

20012 EuroHealth Consumer

Index (2012)

WHO Draft Guidelines for

adverse event reporting and

Learning Systems (2005)

Denken, doen en delen: UMC’s als

regionale expertisecentra voor

onderwijs & opleiding (2007)

STZ expertisecentra in beeld.

(2011)

STZ-ziekenhuizen in het

Nederlandse

ziekenhuislandschap. (2011)



Learn

ing loop L

earn

ing lo

op

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

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.

The Outlook is created with the hospitals,

using:

• A few sources with each hospital

• Dialogue sessions

• Round table discussions

The Outlook reports to hospitals &

entrepreneurs:

• Showing progress & performance of hospitals

• Communicating needs of hospitals to policy

makers

The Health Outlook is used for monitoring and

improving:

• The key policies have direct impact on the

success of the health cluster.

To make sure the actual needs are addressed To monitor progress systematically on the

overall cluster, key business impact areas and

key policies

To have a dialogue on improvements

Learning loopLearning loop Learning loop



International Academic Advisory Council

The International Academic Advisory Council1, with the members providing advice on the development of the

Outlook, cluster policies and methodology development, is listed below.

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.

Victoire de Margerie

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.

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.

1The council meets twice a year with Prof. dr. Fred van Eenennaam as chair and Kim Bruheim, MSc. as secretary of the council.

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.



Background on Monitoring methodology

The Monitoring methodology of the Outlook consists of: 1) choices, 2) definitions, and 3) measurement of the key

performance and steering indicators.

2) DEFINITIONS

Definitions of the key performance

and steering indicators

3) MEASURING

Data collection for the key

performance and steering indicators

The key performance and steering indicators

are selected to best reflect the success of

the Dutch health cluster:

The data collection methodology is set

up to provide accurate measurements:

MONITORING METHODOLOGY

1) CHOICES

Choice 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:

© 2013 The Decision Group

DEFINITIONS MEASURINGCHOICES



What were the design considerations?

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.




Methodology development

An extensive three-step proces is followed, starting with the analysis of all hospital performance and steering

indicators extracted from key sources.

Analysis of sources to

extract a full list of

hospital performance

indicators

Step 1:

Select Key sources

Step 2

Extract all hospital

performance and steering

indicators

Step 3

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

47 key sources with 85 key

documentsOutput

Action

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

523 hospital performance

indicators

8 key performance indicators

7 key steering indicators

Key Sources All indicators Selection




Step 1 - Zooming on the key sources

47 key sources are used that report in 85 key documents on monitoring and improving hospital performance.

Key Sources

Best practice hospitals Nederlandse Vereniging van Ziekenhuizen

Karolinska Hospital Healthcare management journalsSarasota Memorial Hospital Public Sector Innovation Journal

Mayo Clinic The Academy of Management Journal

Cleveland Clinic Journal of Health and Social Behavoir

Johns Hopkins Journal of Managerial Issues

Central Manchester University Hospital BeyeNetwork

Duke University Medical Center Healthcare management review

Childrens Hospital of Philadelphia African Journal of Business Management

National Taiwan University Hospital Gesundheitswesen

Universities Healthcare management review

Stanford University Healthcare policy institutesUniversity of York World Health Organization

Harvard Business School Australian Government

The George Washington University Centers for medicare and Medicaid Services (CMS, USA)

Bocconi University U.S. Department of Health and Human Services; Food and Drug Administration (FDA)

General hospital performance Agency for Healthcare Research and Quality (AHRQ; USA)

The Advisory Board Company National Board of Health and Welfare (Sweden)

Health Evidence Network National Health Service (NHS; UK)

ScienceDaily National Quality Forum (USA)

Clinical Connection Nederlandse Zorgauthoriteit (NZA)

Life Sciences Health (LSH) Het Rijskinstituut voor Volksgezondheid en Milieu (RIVM)

Dutch Clinical Trial Foundation Dutch Ministry of Health Welfare and Sports (VWS)

Dutch hospitals Inspectie voor de Gezondheidszorg (IGZ)

Vereniging Samenwerkende Topklinische opleidingsZiekenhuizen (STZ) Raad voor de Volksgezondheid en Zorg (RVZ)

Universitair Medische Centra (UMC's) Centrale Commissie Mensgebonden Onderzoek CCMO

Nederlandse Federatie Universitair Medische Centra (NFU)




id

Monito

ring

/Impro

ving

Cat

egor

y

Nam

e of i

ndic

ator

Bes

t pra

ctic

e

hospita

ls

Hea

lthca

re

man

agem

ent jo

urnal

s

Hea

lthca

re p

olicy

inst

itute

sUniv

ersi

ties

Gen

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ospita

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perfo

rman

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Dutc

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itals

..

26 Monitoring Size Amount of IC beds 6

27 Monitoring Size Amount of papers published 15

28 Monitoring Size Amount of part-time specialists 12

29 Monitoring Size Amount of publications in top 1% segment 9,11, 13, 14

30 Monitoring Size Amount of topreferent patients 20

31 Monitoring Size Amount of translational research 13,29

32 Monitoring Size A-segment volume development 20

33 Monitoring Size A-segment volume development per type of care provider 20

34 Monitoring Size Availability of multidisciplinary infrastructure 2

35 Monitoring Size Availability of data 4

36 Monitoring size Availability of necessary departments 2

37 Monitoring Size Availability of necessary supporting specialties 2

38 Monitoring Size Availability of quality, expertise and key opinion leaders in clinical trial research 29

39 Monitoring Size Average population per hospital 6

40 Monitoring Size Average risk residents w ith pressure ulcers 14

41 Monitoring Size Avoidance of unnecessary care 3

42 Monitoring Size Brute force indicator (product of the total number of publications in a period, multiplied by the f ield-

normalized impact score (CPP/ FCSm)

15

43 Monitoring Size Care is offered by (sub)specialized experts in that area (approved by the association narrow

(sub)specialties)

2

44 Monitoring Size Care is proceeding according to tested protocols 2

45 Monitoring Size Central line bundle compliance 14

46 Monitoring Size Citation score 9,11,13,14, 15

47 Monitoring Size Clinical hospitalizations 6

48 Monitoring size Clinical trial phases covered 3 3

49 Monitoring Size Collaboration of CRO (Contract Research Organization) and pharmaceutical industry w ith hospitals and

hospital boards (to overcome collaboration bottlenecks)

29

50 Monitoring Size Contribution to the 20/10/5/2/1 % most frequently cited research papers w orldw ide 15

Step 2 - Zooming on all available indicators

523 performance and steering indicators are available.

1 Monitoring Input Budget by law A-segment 6

2 Monitoring Input Budget by law B-segment 6

3 Monitoring Input Budget of Medical faculty (ministry of education, culture and science) 10

4 Monitoring Input External grants/funding (for research) 7 7

5 Monitoring Input Free market competition health care budget (insurers) 10

6 Monitoring Input Health care budget (insurers) 10

7 Monitoring Input Healthcare budget (Ministry of Health, Welfare and Sport and health insurers) Including government

grant for tertiary care and innovation

27

8 Monitoring Input Hospital R&D investments 1

9 Monitoring Input Industry investments

10 Monitoring Input Research grants 7, 10 7

11 Monitoring Input Revenues: Ministry of Education, Culture and Science 27

12 Monitoring Input Rx subsidy % (The percentage of total prescription drug sales paid by subsidy) 18

13 Monitoring Input Third-party revenues: medical research council, charities, contract research 27

14 Monitoring Size Absentee rate 2

15 Monitoring Size Access times for outpatient clinics 3

16 Monitoring Size Accidental puncture or laceration 14

17 Monitoring Size Activeness of medical staff in their f ield or administrative and/or in the health care 2

18 Monitoring Size Amount of adverse events during the length of the research 16

19 Monitoring Size Amount of approved METC projects 9

20 Monitoring Size Amount of beds 6

21 Monitoring Size Amount of biomedical research 29

22 Monitoring Size Amount of citations per article 9

23 Monitoring Size Amount of citations per publication (excl. Self citations) 15

24 Monitoring Size Amount of citations per publication (inc. Self citations) 15

25 Monitoring Size Amount of Clinical research 13,29

id

Monito

ring

/Impro

ving

Cat

egor

y

Nam

e of i

ndic

ator

Bes

t pra

ctic

e

hospita

ls

Hea

lthca

re

man

agem

ent jo

urnal

s

Hea

lthca

re p

olicy

inst

itute

sUniv

ersi

ties

Gen

eral h

ospita

l

perfo

rman

ce

Dutc

h hosp

itals

..




Step 3 - The selection of indicators

The key performance and steering indicators have been selected so that they can lie within the focus of the Life

Sciences and Health Outlook.

•79

© 2013 The Decision Group

1. Including clinical phase II,III and Medical Devices

2. Self-initiated healthcare research

3. Adoption of new products and treatments

Focus:

Focus of the Health Outlook




Remarks

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 www.healthoutlook.nl

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”.




Information about the survey

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 2013Survey onderzoekers en medisch specialisten

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: [email protected]

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?

1. Delen van best practices in onderzoek

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.

Antwoord:

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

2. Partnering met derden

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 3

2.2 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?

3. Ontwikkeling van nieuwe producten, protocollen, richtlijnen, behandelingenDit onderdeel gaat over uw bijdrage aan innovaties; het ontwikkelen van nieuwe producten,

behandelingen, richtlijnen of protocollen.

Antwoord:

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?


B)Nee

3.3 Heeft u nieuwe behandelingen ontwikkeld die in 2011 op (inter)nationaal niveau zijn

geimplementeerd?


B)Nee

Hartelijk dank voor uw deelname aan deze vragenlijst. Mocht u geinteresseerd zijn in de uitkomsten van het onderzoek, vult u dan graag even uw e-mail adres in, dan houden

we u op de hoogte. E-mail adres:

* 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 57.

*




Information about correlations (1/2)

To compute the correlation between KPIs and KSIs the statistical software package STATA version 11 was used.

kpi9treatm~s 0.3287 0.5441 0.1891 -0.0690 -0.0534 0.2041 -0.0068 -0.1402 0.2224 0.4341 -0.1179 1.0000kpi9protoc~s 0.1217 0.1489 0.0320 0.4602 -0.0216 0.1670 0.1671 0.0361 -0.0034 0.2271 1.0000 kpi7 0.3257 0.5463 0.6811 0.0926 -0.3999 0.3321 0.7233 -0.0353 0.2834 1.0000kpi5_11_md~1 0.0221 -0.0340 0.4747 0.4255 0.1530 0.1271 0.3388 0.1223 1.0000kpi5~3_part1 0.0631 -0.3014 -0.1166 -0.3896 0.4471 0.1258 -0.1830 1.0000kpi4_11_ou~1 0.5180 0.5615 0.7626 0.2751 -0.1787 0.6379 1.0000kpi4_11_outp 0.9335 0.6586 0.3697 0.0481 0.3160 1.0000 kpi3_11_md 0.3057 0.0771 0.1621 0.1558 1.0000 kpi3_11_ph3 0.1374 0.0117 0.4342 1.0000 kpi3_11_ph2 0.3358 0.5500 1.0000kpi1_11_proj 0.6130 1.0000 ksi3_11_emp 1.0000 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 kpi9tr~s

Source: The Decision Group database – STATA print out.

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.

kpi9treatm~s 0.4341 0.2224 -0.1508 -0.1179 -0.3536 1.0000kpi9guidel~s 0.0168 0.3983 -0.2665 -0.0833 1.0000kpi9protoc~s 0.2271 -0.0034 0.2132 1.0000 kpi8 0.1793 0.1017 1.0000kpi5_11_md~1 0.2834 1.0000 kpi7 1.0000 kpi7 ~d_part1 kpi8 kpi9pr~s kpi9gu~s kpi9tr~s




Information about correlations (2/2)

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 –.




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.

Data validation (1/2)

Several steps have been taken to check the consistency of 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.

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 .

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.




Data validation (2/2)

….. 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.




Appendix B – About the involved partners




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 commissioned by the ‘Life

Sciences & Health’ innovation program.

Contact: Willem de Laat, MD, PhD

Annemiek Verkamman

+31(0)71-3322033

[email protected]

www.lifescienceshealth.com

Driven by the cluster and empowered by

the Ministry of Economic Affairs, the LSH

program has the objective to improve the

life sciences innovation and investment

climate in the Netherlands. The Outlook

is part of the four-year work plan.

The Outlook is commissioned by the

‘STZ- ziekenhuizen’.

Contacts:

Maarten Rook

[email protected]

www.stz-ziekenhuizen.nl

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.



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

Contacts:

ir. Maarten Koomans

+31(0)346-574942

www.vbhc.nl

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.

Value Based Health Care Center Europe



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.

Contacts:

Prof. dr. Fred van Eenennaam,

Ir. Maarten Koomans

Kim Bruheim, MSc.

Bogdan Toma, BA, BSc.

+31(0)346-574942

[email protected]


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.



Appendix C – Bibliography




Key documents (1/6)

1. Chen, M. F. (2011). Interview Pharma Focus Reports.

2. Clinical Trials Management System (CTMS) . (n.d.). Retrieved 10 06, 2011, from Mayoresearch: http://mayoresearch.mayo.edu/mayo/research/clinical-trials-

management-system/

3. ctr clinical research. (n.d.). Retrieved 10 06, 2011, from Sarasota memorial health care system: http://home.smh.com/sections/services-procedures/clinical_trial-

research/ctr_clinical_research.html

4. Hopkins, J. (n.d.). Johns Hopkins Medicine Clinical Trials. Retrieved 10 06, 2011, from http://www.hopkinsmedicine.org/quality/patients/clinical_trials

5. Nederlandse Federatie van Universitair Medische Centra, Acute Zorg: Een beschrijving van het niet te plannen deel van de ziekenhuiszorg (2010), Utrecht, NL.

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7. Nederlandse Federatie van Universitair medische Centra, Bibliometric study on Dutch Academic Medical Centers 1998-2008 (2009), Utrecht, NL, p.6.

8. 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.11-14.

10. 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, p15

11. 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. 3.

13. 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. 39

15. Nederlandse Federatie van Universitair Medische Centra, Report on the research management of the University medical centers in the Netherlands (2005), p

.13,15,16,17,23,28.

16. 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.

Best practice hospitals



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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, p39

23. 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, p42.

24. Nederlandse Federatie van Universitair Medische Centra, Wetenschap gewaardeerd (2008), Utrecht, NL, p.17

25. Nederlandse Federatie van Universitair Medische Centra, Wetenschap gewaardeerd (2009), Utrecht, NL, p.17.

26. 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, p40.

27. 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. 3

29. Research & Clinical Trials - Cleveland Clinic, Clinical Connection. (n.d.). Retrieved 10 06, 2011, from Cleveland Clinic: www.clinicalconnection.com

30. Shaw C (2003) How can hospital performance be measured and monitored? Copenhagen, WHO Regional Office for Europe (Health Evidence Network report;

http://www.euro.who.int/document/e82975.pdf, accessed 29 August 2003)

31. Sibley, C. (2011). Our performance. Retrieved 10 06, 2011, from Central manchester university hospitals: http://www.cmft.nhs.uk/research-and-innovation/our-

performance.aspx

32. Tidd, J., Bessant, J., & Pavitt, K. (2005). Case_studies. Retrieved 11 14, 2011, from Managing innovation: http://www.managing-

innovation.com/case_studies/Karolinska%20Hospital.pdf

Best practice hospitals

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)

Universities



Key documents (3/6)

35. Research & Clinical Trials - Cleveland Clinic, Clinical Connection. (n.d.). Retrieved 10 06, 2011, from Cleveland Clinic: www.clinicalconnection.com

36. 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)

General hospital performance studies

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 2012

46. Nederlandse vereniging van ziekenhuizen. (2010). Retrieved 10 20, 2011, from ziekenhuis transparant:

http://www.ziekenhuizentransparant.nl/toon.php?hm=11006&sm=11979&id=762

Dutch hospitals


http://www.ziekenhuizentransparant.nl/toon.php?hm=11006&sm=11979&id=762


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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);119-35.

48. 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. 361-373

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3 (Jun., 1997), pp. 673-696

52. 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. 689-713

53. Porter, M. (1996). What is Strategy? Harvard Business Review, November-December 1996: 59-78

54. 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. 4314-4327, 4 June, 2011

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A. Digman; Journal of Managerial Issues, Vol. 8, 1996

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(Mar 2011)

57. Vera A, Salge TO,Hospital innovativeness and organizational performance: evidence from English public acute care. Health Care Manage Rev. 2009 Jan-

Mar;34(1):54-67.

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59. Agency for Healthcare Research and Quality. Framework for Considering Study Designs for Future (2011), Rockville, United States, p.10,11.

60. Agency for Healthcare Research and Quality. Project Title: Comparative Effectiveness of Screening for Methicillin-Resistant Staphylococcus Aureus (MRSA)

(2011), Rockville, United States, Published online: www.effectivehealthcare.ahrq.gov

61. 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: www.effectivehealthcare.ahrq.gov

62. 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.8

66. 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):903-12.p.13

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70. Socialstyrelsen: Quality and Efficiency in Swedish Health Care Regional Comparisons (2010), Ordförrådet AB, p. 300

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76. De Centrale Commissie Mensgebonden Onderzoek: Onderzoek met proefpersonen 2006 –2010, 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

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84. Preventie, Ziekte & Zorg: medische technologie . (sd). Opgeroepen op 10 20, 2011, van Het rijksinstituut voor volksgezondheid en milieu:

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ne_ZKH

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ct_ZKH

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Healthcare policy institutes



Appendix D – Consulted experts and organizations




Consulted experts (1/2)

The help and insights of many cluster experts were essential in realizing the Dutch Health Outlook 2013.

First Name Last Name Position Organization

Bianca Baten Trial coördinator Rijnstate Ziekenhuis

Bart Berden Voorzitter raad van bestuur St. Elisabeth Ziekenhuis

Bibi Blijham Kwaliteitsmedewerker Wetenschap Medisch Centrum Alkmaar

Geke Blok

Coördinator medische vervolgopleidingen en

wetenschap Reinier de Graaf Groep

Frank Bosch 1. President, 2. Nederlandse Internisten Vereninging

2. Lid bestuur, 2. DCTF

3. MD PhD 3. Rijnstate Ziekenhuis

Bianca Boxma Research Coordinator Maasstad Ziekenhuis

Richard Brohet Head of Department Scientific Research Spaarne Ziekenhuis, Kennemer Gasthuis

Angelique Dierick Implementatiefellow Catharina Ziekenhuis

Joep Dille Manager R&D Isala Klinieken

Lea M Dijksman Coördinator wetenschapsbureau, epidemioloog Onze Lieve Vrouwe Gasthuis

Cecile Duindam Teamcoördinator Dialys St. Antonius Ziekenhuis Nieuwegein

Ingeborg Dusseldorp, van Hoofd Kennis- en Informatiecentrum Medisch Centrum Leeuwarden

Astrid

Duin-Outmaijjer,

vanWetenschapsfunctionaris

Meander Medisch Centrum

Willem Geerlings Voorzitter raad van bestuur Medisch Centrum Haaglanden

Norbert Groenewegen Directeur STZ

Niels Gorp, van Business Intelligence Business Specialist VGZ

Bernt Grimm Coördinator Research Leerhuis Atrium Medisch Centrum

Silke Groot, de Projectmedewerker van de Onderzoeksschool Sint Lucas Andreas Ziekenhuis



Consulted experts (2/2)

The help and insights of many cluster experts were essential in realizing the Dutch Health Outlook 2013.

First Name Last Name Position Organization

Diana Grootendorst Coordinator wetenschap en senior epidemioloog MC Haaglanden

Mark Houdenhoven, van Lid raad van bestuur HagaZiekenhuis

Judith Hegeman Trialcoordinator / Projectmanager Rijnstate Ziekenhuis

Henk Hendrix Directeur Brabant Medical School St. Elisabeth Ziekenhuis

Ide Heyligers

Hoogleraar aan de Faculty of Health Medicine and Life

Sciences van de Universiteit van MaastrichtAtrium Medisch Centrum

Hedi Kan, van Directiesecretaresse STZ

Harrie Kemna Senior beleidsadviseur NVZ

Pieter Kievit Hoofd medische educatie en research support Medisch Centrum Alkmaar

Hedwig Neefs Seniorsenior beleidsadviseur opleiding en onderzoek STZ

Pieternel Pasker Science Officer Meander Medisch Centrum

Dana Ploeger Communicatie STZ

Marc Rinkes Manager Wetenschap en Kennis Rijnstate Ziekenhuis

Maarten Rook Voorzitter bestuur STZ

Martin Schipperus Stafbestuurder, hematoloog HagaZiekenhuis

Hedwig Slot Directeur Landsteiner Instituut (MCHaaglanden)

Henk Sluiter 1. Internist-nefroloog 1. Deventer Ziekenhuis

2. Opleidingscoordinator 2. Deventer Ziekenhuis

3. Bestuurslid 3. STZ

Willy Spaan Voorzitter raad van bestuur Jeroen Bosch Ziekenhuis

Peter Spronk Intensive care arts Gelre Ziekenhuis

Paul Nat, van der Senior Advisor to the Board of Directors St. Antonius Ziekenhuis

Reinier Veenhoven 1. Medisch manager 1. Linneaeusinstituut

2. Kinderarts 2. Spaarne Ziekenhuis

Inge Veltman Staffunctionaris wetenschapsbureau Jeroen Bosch Ziekenhuis

Rimke Vos Wetenschapscoördinator HagaZiekenhuis

Margot Wermeskerken, van Research Coordinator Onze Lieve Vrouwe Gasthuis



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