Dutch Health Outlook 2013vF

7/28/2019 Dutch Health Outlook 2013vF

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1see also www.healthoutlook.nl

Dutch Health Outlook2013

The Dutch Health Outlook is created under the supervision ofProf. dr. Fred van Eenennaam and Ir. Maarten Koomans. It is supported by the International Academic Advisory Council

-Academic partners--Developer-

From Bench to Bed

Moni tor ing Appl ied Research,

Inn ovat ion and Valor izat ion

-Since 2013-

-Partners-

-The First Edition-
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Acknowledgement

Thanks to al l par t ic ipat ing hospi ta ls and i ts data col lectors.

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 involvedplease refer to page(s) 98 and 99.

1Albert Schweitzer ziekenhuis, Dordrecht

2Amphia Ziekenhuis, Breda

3Atrium 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 Mxima 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
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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 individualhospitals 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) STZhospitals are used interchangeably.

Context

Providing

affordable

and high

quality care.

Health

Wealth

Aims
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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 % admissions10.4 % 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


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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 plansto 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: Init iate, 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.


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Contents of the Dutch Health Outlook 2013

Key outcomes Dutch Health Outlook 2013

Executive summary 8

Background (Shaping Defining Measuring) 9Data 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 misinterpretat ions 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 th is version bu t avai lable for downlo ad at www.heal thout look.n l

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


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Should you like to make a decision based on:

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

expe2 -.000369 .0001039 -3.55 0.000 -.0005726 -.0001654expe .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 = .67525Adj R-squared = 0.9768Residual 4956.30251 10870 .455961593 R-squared = 0.9768

Model 208692.045 18 11594.0025 Prob > F = 0.0000F( 18, 10870) =25427.59Source 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,
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Key outcomes Dutch Health Outlook 2013

Rebke Klokke, Utrecht

Executive summary

Background (Shaping Defining Measuring)

Data & Key Conclusions

Key best practices

1


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Need for a shift in productivity

In order to make the Dutch heal thcare system susta inable, a shi f t is needed in i ts produc t iv i ty front ier : opt imiz ing

value per Euro spent

DEFINING MEASURINGSHAPING

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

Currentsituation

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


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Enhancing applied research, innovation and development

byimproving cooperat ion between the L i fe Science cluster and the Health cluster and enhancing at the same

time applied research, innov ation 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


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

On the c ross-over of Li fe Science & Health (product supp ly market) the four m ain players each have

their own point o f view on the current si tuat ion of coo perat ion.

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

Ofcourse, 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


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Monitoring the cross-over

The Health Out loo k measures and mon itors appl ied research, innovat ion, valor izat ion and coop erat ion annu al ly to

contr ibute to a s uccessfu l and inn ovat ive Li fe Science & Health clus ter .

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 progressShowcasing 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 tocompare and optimize their outcomes.


BACKGROUND


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Definition of the Dutch Health Outlook 2013

The focus of the Dutch Li fe Sciences & Health Out look 2013 is the performance of the innov at ive core of the

cluster of both the industry and part of the teaching and specia l ized care and cure provid ers.

Fundamental ResearchNGI, Hubrechts Institute

R&D

companies

Drugs and MedicalDevice companies

(Pharma, Biotech,Medical

Engineering)

Specialized Risk CapitalVC Firms, Angel Networks

Specialized Research

service providers

ContractManufacturingOrganizations,

Contract ResearchOrganizations

Clinical studiesSynthesis services

Specialized Business

ServicesBanking, Accounting, Legal

Health InsuranceLaboratory, Clinical Testing

Laboratory

Equipment

Analysis Software

Diagnostic

Substances

Containers and

Packaging

Medical Equipment

Ophthalmic Goods

Educational InstitutionsUniversities

Cluster OrganizationsNiaba, Nefarma,Biofarmind, LSH

Chemical products

Bioelectronics,

Bioinformatics

RegulationCCMO, METCs, FDA, EMA

Translational ResearchTiPharma, BMM, CTMM

Marketing & Sales

Reimbursement

Healthcare InsuranceCompanies, VWS

Manufacturing

Distribution

Specialized

Research suppliers

Suppliers Value Chain Service Providers

The cluster map shows boththe value chain and the

supporting industries in the

Dutch LSH cluster. The

cluster map is in the processof international recognition

Care and Cureproviders

Core Value Chain,referred to top-sectorplan 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


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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, Deventer7 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 Mxima 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, Delft22 Rijnstate, Arnhem

23 Sint Franciscus Gasthuis, Rotterdam

24 Sint Lucas Andreas Z iekenhuis, 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 of91 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 includ e among others al l Top-clin ical hospi ta ls of the Nether lands that

per form appl ied research.

In 2014, the definition

may broaden to:

1. More STZ hospitals

2. Specialty hospitalsand UMCs may beincluded.

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

Qualityofcare

* 16 out of 28 STZ hospitals are included


BACKGROUND
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Applied Research Hospitals - Activities

The Health Out loo k 2013 focuses on the value chain of th e heal th cluster and i ts related act iv i t ies to appl ied

research for the top m edical teaching ho spi ta ls.

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


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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 d eveloped a methodo logy to establ ish the f i rst Heal th Out look, monitor ing appl ied

research.


BACKGROUND


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Monitoring, Improving & Sharing Best Practices

9 Key Performance Indicators and 7 K ey Steer ing Indicators have been developed to mon itor and imp rove appl ied

research and to sh are (next) Best Practices.

Keyperformance

indicators

Keysteering

indicators

ImprovingMonitoring

Best Practices

OUTPUT

Number of publications cited

Lead time of clinical trials

Number of new products

Number of new protocols, guidelines andtreatments

Adoption rate of new products*

SIZE

Size of clinical trials (number of patients

in trial)

Inflow of patients from outsidecatchment area

INPUT

Industry investments

Hospital R&D investments

Number of best practices sharedamong hospitals

Costs of research projects

Level of expertise

Staff responsiveness

Participation of staff in thedevelopment, undertaking and use ofresearch

Presence of research support officesand transfer facilities in each hospital

Cooperation relationships of hospitalresearch

*At this momentadoption rate of new products is not measured. Next year we aim to find and determine the right definition and to collect d ata on this specific performance indicator

Key Performance Indicatorsmonitor the success of a cluster or set

of organizations. Typically, performance

indicators cannot be influenced directly

by policy.

Key Steering Indicatorscan 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


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Building and expanding the Health database

A n ew database was bui l t to analyze data of the ho spi ta ls and based on a su rvey of wh ich the answers w ere

careful ly central ized.

Per hospital data

Data on Key Performanceand Key Steering Indicators

HagaZiekenhuis

St. Antonius Ziekenhuis

Rijnstate

Catharina ZiekenhuisM.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 years Health Outlook

. . . . . . . . . . . . . . .

neurolog Rijnstate ja nee c a a a a a

Rijnstate nee c a a a a a

kinderarts Rijnstate ja b c a a a a a

Rijnstate nee b a a a b a

internist-intensivist Rijnstate ja nee d a a a c a

kinderarts/medisch manager zorg Rijnstate nee c a a a a a

she arts Rijnstate nee b a a a a a

medish specialist Rijnstate nee b b a a a a

klinisch geriater MC Alkmaar ja ja b b a a a a

gynaecoloog MC Alkmaar ja nee b b a a a a

radioloog Rijnstate nee c a a b a a

anesthesioloog Rijnstate nee c a a b a a

SHE Rijnstate ja nee c a a b b a

chirurg Rijnstate j a 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 j a 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 Ditetiek 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 j a ja a d b a b a c

internist-oncloog MC Alkmaar j a nee e b a b b c

researchverpleekundige MC Alkmaar ja nee b b a a a e

hoofd expertisecentrum Laboratorium MC Alkmaar ja nee c b a a b e

MKA-chirurg Rijnstate nee d b a b d e

longarts Haga ja ja b c b b a b

neurolog Rijnstate ja nee b b a c b

locatiemanager MC Alkmaar ja ja c c b a b c c

project leader clinical research Spaarne ja nee b a b a

anesthesioloog Rijnstate nee d b b a a a

neurolog Rijnstate nee a a

o rth ope di sh chi ru rg R ij nstate ja nee c b a b c c

reumatolog Rijnstate ja ja b c b a a a

o rth ope di sh chi ru rg R ij nstate ja c b a a b

Centralization of survey answers

Monitoring methodology to assess performance:

The methodology approach is based on the WorldEconomic 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 InternationalAcademic Advisory Council.


BACKGROUND
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Experiences during data collection

Data col lect ion i tsel f resul ts in b ui ld ing n ew infrastructures and gain ing ins ight in th e processes and p rocedures.

New ideas develop which improve the p erformance and the ef f ic iency o f appl ied research.

Data registration, in general, is insufficient in hospitals, not only atresearch 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 ofresearch projects differs between hospitals; how data is registereddiffers 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 todifferent ways of registering data and thus, collecting data.

The functionality of research offices is developing in a different waybetween 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

KwaliteitsmedewerkerWetenschap


BACKGROUND

DATA & KEY CONCLUSIONS


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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 clusterHealth cluster

*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% admissions10.4% outpatient visits

INPUT

Industry investments: 630 research projects **

Hospital R&D investments: 10,8 m **


For more info please see www.healthoutlook.nl

For more info please see www.lifesciencesoutlook.com



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2

Key conclusions

Hospitals seem to vary heavily in their ability to be relevant in applied researchwhich 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




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0

5

10

15

20

25

30

35

40

Noofresearchprojects

Hospitals

No. of Industry InvestedProjects

Position ofindividual

hospitals

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

Variat ion in size, input and outpu t is o bserved amon g the h ospi ta ls, showing d i f ferences in performance and

coop erat ion 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

Meannormalizedcitationscore




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Multiple affecting factors1

Factors su ch as size, level of expert ise (numb er of professo rs, PhDs, GCP-cert i f ied), research sup port capacity ,

conn ect ion with ind ustry and o penness to sh are best pract ices, seem to matter .

0 1000 2000 3000 4000 5000 6000

Employees

Individualhospitals

Total employment

0 2 4 6 8

Professors

Individualhosp

itals

No. of Professors

As for the number of professors I dare to say that this is partlythe 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 anddisciplines.

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




24/100


Performance of hospitals

The best performing h ospi ta ls measured by outpu t : the number of p ubl icat ions, products, protocols, guidel ines

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

0 20 40 60 80 100 120 140No of days

IndividualHospita

ls


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

2




25/100


Relationship performance & cooperation with industry

col laborate more than average with industry based on ind ustry inv ested research projects and s taf f

respon siveness to ext ernal 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




26/100


Applied research is core business

Publ ish ing and performing app l ied research is clearly par t of the co re business of hosp i ta ls. A to ta l of

7445 patients are enrolled in clin ical tr ials, with a to tal of 3057 citat ion s.

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


BEST PRACTICES


27/100


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 theirown department.

(Next ) Best Practices - Expertise & Internal structures

Via various internal structures, such as research su pport o f f ices and research comm it tees the supp ort can be

organized. A g ood d atabase and informat ion infrastructure faci l i ta tes decis ion making.

1

BEST PRACTICES

BEST PRACTICES


28/100


(Next ) Best Practices - Relationships with Industry

Create a f lywheel for appl ied research b y invest ing in the relat ionships with industry. Part ic ipate in mult i -

discip l inary studies and industry related events to share and have access to know ledge.

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 whichis attracting more industry

investments which in turn will fund

large projects, etc.

2

S C C S

BEST PRACTICES


29/100


(Next ) Best Practices - Culture & Commitment

An ambit ious cul ture and commitment is one of the internal keys of suc cess. Research and inno vat ion ideas

shou ld be su pported, shared and encouraged to create an opt imal research environm ent.

Everything starts with an ambition and a

specialists 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 scientif ic

research.

Next to patient care, the hospitals

have committed themselves to

perform applied scientificresearch and stimulate health

care innovation.

3


BEST PRACTICES


30/100


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

Hospi ta ls are more suc cessfu l when they operate in a cluster with a strong local dynamic . Share best pract ices,

t reatments, guidel ines with par tner hospi ta ls to create leverage and enhancement of inn ovat ion.

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 researchpossible

Source: STZ, Bibliometric analysis of STZ-hospitals

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

Hospital structureand strategy

4


31/100


Health Outlook 2014: Learn, Share and Inspire

The Health Out look aims to fu r ther improving. Learn from it , sh are it , get inspired and jo in the Li fe Sciences Out look

2014 and Health Outlo ok 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


32/100


Guide to read the data

A roadmap

2



33/100


Monitoring & ImprovingThe Radar

The performance of the heal th cluster can be steered and improved by focusing on three themes: business

know ledge, cluster bui ld ing and inv estment cl imate, 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 progressbased on Key Performance Indicators

Monitoring


34/100


Extrapolation

The Health Outlo ok 2013 aims to repo rt the applied research of all hosp itals. So far the data has been built us ing

the repor ts of 16 out of 28 ho spi ta ls.

* 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 timeof clinical trials

-Inflow of patients from outsidecatchment 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

publicationscited

- 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


35/100


Short management summaries

Every key performance indicator wi l l have a s hort m anagement summary: explanat ion on the rat ionale

(def in i t ions) , the resul ts (measur ing) and b est pract ices ( improving) .

DEFINITION MEASURING IMPROVING


36/100


Interpreting the graphs

For each indicator several scores are presented. Hospi ta ls can c ompare their own resul ts in th eir indiv idual

hospi ta l -specif ic Out look .

The average, median, minimum and maximum value reported by hospitals is depicted, as well as the number of hospitals reporting (n). A separate graph

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

KPI Information

On every slide the specific KPI or KSI is

explained.*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


37/100


Monitoring

TWU

Key performance indicators (Definition Measuring Improving)

3



38/100


Key per formance ind icators - output

Number of Publications


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


39/100


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 high er number of publ icat ions ci ted indicates that a hosp i ta l or member of a hospi ta l is more vis ib le on the

international research stage. The B ibl iometr ic analysis of STZ is used in th e Health Out look 2013.


KPI Number of publications cited

Number of publications cited from the

hospital in one year.


40/100


1320 1389

16311833

2035659 665

929

968

1022

0

500

1000

1500

2000

2500

3000

3500

2007 2008 2009 2010 2011

Noofcitations

Total no of publications cited

Total STZ hospitals (n=28)

Health Outlook hospitals

(n=16)


On average the numb er of citat ions o f a hosp ital is 127 times a year. Compared to 2010, the total num ber of

citat ion s inc reased by 9.14% (from 2801 to 3057) in 2011.

Source : The Decision Group and STZ database .

2054

KPINumber of publications

Number of publications cited from the hospital

in oneyear.

1979

2560

2801

3057

61

127106

340

0

50

100

150

200

250

300

350

400

Minimum Average Median Maximum

Noofquota

tions

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.



41/100



The high scor ing hosp i ta ls per form more research projects with indu stry, indicat ing the impo rtance of

cooperat ion.

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 berealized 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 explanat ion 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



42/100


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 ef f ic iency, wait ing t ime is m easured: numb er of days from p roposal received to local

feasibi l i ty.

The date on which the request for approval of each clinical

trial has been registered.

Local feasibilityto

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 IIIfor drugs and for medical devices)

Number of days from Proposal Received

(regardless of completeness of proposal) to local

feasibility (signature board of directors)



43/100


16

64

51

130

0

20

40

60

80

100

120

140


Noofdays

Lead time


A large var iance in numb er of days from subm ission to approv al is repor ted. The best per forming hos pi ta l had a

lead time of 16 days.

KPILead 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

localfeasibility (signature boardof 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 -


d i f li i l i l


44/100



In addi t ion, per forming mo re industry invested research p rojects has a po si t ive relat ion on performance, in case of

eff iciency : lead time of clinic al tr ials.

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, asuniversities 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 explanat ion on correlations Ch. 4 Appendices on page 82 and 83.


KPI N f t l t t t d id li


45/100


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 protoco ls, treatments and g uidel ines are the resul t of appl ied research and inno vat ion.

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

KPINumber 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


KPI N f t l t t t d id li


46/100



The respon dents to the su rvey indicated they implemented a number of 96 protoc ols, 106 guidel ines and 67

treatments.

KPINumber 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 adetailed explanation on correlations Ch4. Appendices on page 82 and 83.

96106

67

0

20

40

60

80

100

120

140

160

180

Protocols Guidelines Treatments#ofprotocols/guidelines

/treatments

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.


KPI N f t l t t t d id li MEASURING IMPROVING

DEFINITION


47/100



In f rastructure to sup port research as wel l as part ic ipat ion in m ult icenter research studies increases the number of

new protoc ols 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%.


KPI N mbe of p od cts MEASURING IMPROVING

DEFINITION


48/100


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 conf i rmat ion that the research process was fou nd th rough novel features and sup port the

process of inn ovat ion and valor izat ion.

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

KPINumber 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.


KPI Number of products MEASURING IMPROVING

DEFINITION


49/100


11

0

2

4

6

8

10

12

14

16

18

2011

Noofpate

nts

Total number of registered patents


Health Outlook hospitals (n= 14)

0

1

2

3

4

5

6

7

8

Noofpatents

Registered patents in 2011


In 2011, Health Outloo k ho spitals repo rted to have registered 11 new p atents. 7 of them w ere reported b y the same

hosp i ta l . Two o ther hospi ta ls registered two patents.

N=14

17

KPINumber 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


KPI Number of products MEASURING IMPROVING

DEFINITION


50/100



The number of new produc ts might inc rease by enlarg ing high sk i l led labor force and incent iv ize staf f to be more

open and co operat ive with o ther hospi ta ls.

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% andwith KSI 7 (multicenter investigator initiated studies) is 19,36%.

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


EXTRA: KPI Adoption Rate of New Products MEASURING IMPROVING

DEFINITION


51/100


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

r ight def in i t ion and to col lect data on this s peci f ic per formance 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 thanon 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 scores most importantsignal

is: Demanding attention. Marc Rinkes & Pieter Kievit



52/100


Key performance indicators - Size

Size of clinical trials (no of patients in

trial)

Inflow of patients outside catchment

area


Size Rebke Klokke, Utrecht

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

MEASURING IMPROVING

DEFINITION


53/100


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.


The number of patients are representative for the size of th e clinical tr ials assessed.

KPISize of Clinical Trials ( number of patients in trial )

Total Number of target patients to be included in clinical

trials, Phase II of III for Drugs or trials for medical devices

started during a year.


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

DEFINITION


54/100


589

20672300

4956

296

10381155

2489

0

1000

2000

3000

4000

5000

6000

7000

8000

Ph 2 Ph 3 Medical Devices Total STZ hospitals

Noofpatients

Total - Size of clinical trials


Health Outlook hospitals


Hospi ta ls have a focu s o n phase 3 (2067 pat ients) and medical devices tr ia ls (2300 pat ients) , compared to phase 2

(589 patients). Per total 7445 patients were enrolled in c linical tr ials.

KPI Size of Clinical Trials ( number of

patients in trial )

Total Number of target patients to be included

in clinical trials, Phase II of III for Drugs or

trials formedicaldevices started duringa 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.



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

DEFINITION


55/100


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

A larger presence of research sup port act iv i t ies wi l l help h ospi ta ls to manage the pat ients in cl in ical tr ials.

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.


KPI - Inflow of patients outside catchment area

MEASURING IMPROVING

DEFINITION


56/100


Outside catchment area

KPI Inflow of patients outside catchment area

If there is a hig h rat io of p at ients o uts ide catchment area (inpat ient and as wel l o utpat ient) then the h ospi ta l is

attract ive.

DefinitionThe 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 specificinstitution.

Inpatient and outpatient

DefinitionInpatient: 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 areaNumber 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.

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

patient may undergo.


KPI - Inflow of patients outside catchment area MEASURING IMPROVING

DEFINITION


57/100


4,5%

12,0% 11,4%

29,8%

0%

5%

10%

15%

20%

25%

30%

35%


%ofpatientsoutside

catchmentarea

First admissions

3,9%

10,4% 9,7%

26,2%

0%

5%

10%

15%

20%

25%

30%


%ofvisitsoutsidecatchmentarea

First outpatient visits


In 2011, the Health Outloo k ho spitals repo rted that on average 14.5 % of total admis sion s and 10,3% of out patient

vis i ts w ere from pat ients located ou ts ide the catchment area.

N=11

KPI Inflow of patients from outside

catchment area

Number of unique patients outside hospital

catchment area that got care delivered

inpatient (admissions) and outpatient visits

(vert.: opnamesen 1ste polikliniekbezoeken)

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 -


KPI - Inflow of patients outside catchment area MEASURING IMPROVING

DEFINITION


58/100



Expert ise of emp loyees might at t ract pat ients from ou ts ide catchment area to the hosp i ta l .

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 ofclinical trials and inflow of patients outside catchment

area. Further research has to validate the hypothesis

that inflow of patients with clinical trials may affect the

inflow of patients for admissions and outpatient visits.

* The correlation coefficient with KSI 3 PhD is 8,83%.and KSI Prof is 44,08%

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

SU G O GO


59/100


Key performance indicators Input

Industry Investments

Hospital investments


INPUT Rebke Klokke, Utrecht

KPI - Industry Investments MEASURING IMPROVING

DEFINITION


60/100


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.

y

Indus try investments give an approximat ion of the abi l i ty of hospi ta ls to col laborate with ind ustry in co mmo n

projects.


DEFINITION


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318

0

100

200

300

400

500

600

700

Noofproje

cts

Total - Industry investments

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

1

21 20

49

0

10

20

30

40

50

60


Noofprojects

Industry investments

y

In 2011, the indu stry in vested in, on average, 21 research pro jects per ho spit al with a maxim um o f 49 research

projects . In to tal 630 research projects w ithin th e hosp itals were started.

N = 15

KPIIndustry Investments

Number of research projects with industry

partners, (including self-initiated healthcare

research with industry investment) started in a

given year.


630

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

Methodology extended version.


DEFINITION


62/100


y

Hospi ta ls that are part ic ipat ing act ive ly in mult i center studies at t ract mo re industry investments. Furthermore,

ambit ious specia l is ts 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, tostimulate multicenter studies.

Another hospital clarified:

Our main departments have own research

coordinators who facilitate in bringing in multicenter

studies.

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

*The correlation coefficient with KSI 7 is 83.66%.

KPI - Hospital investments applied research & innovation MEASURING IMPROVING

DEFINITION


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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.

p pp

Hospi ta ls that invest in appl ied research & inn ovat ion create a breeding ground for inno vat ion.

KPI

Hospital applied research & innovationMoney invested in applied research &

innovation by the hospital in a given year.

KPI - Hospital investments applied research & innovation MEASURING IMPROVING

DEFINITION


64/100


0

100000

200000

300000

400000

500000

600000

700000

800000

900000

1000000

Investmentsin

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


Investmentsin

Hospital investments

The hospi ta l investments appl ied research & innovat ion v ary between the hosp i ta ls in 2011. There is a huge g ap

between the minimum ( invested10k) and the maxim um (invest ed905k).

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

KPI - Hospital investments applied research & innovation

MEASURING IMPROVING

DEFINITION


65/100


An explanation for the di f ferences is b ased on the avai labi l i ty 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 coeff icient 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.


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Appendices

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

B. About the involved partners

C. Bibliography

D. Consulted experts and organizations

4



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


Partners to create the Health Outlook 2013


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STZ and The Decis ion Group proudly present the f i rst edi t ion of the yearly Out look 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]

The Outlook is created in cooperation with

the Grenoble School of Management, Schoolof Public Health, part of The GeorgeWashington University, Stockholm School ofEconomics

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 EenennaamIr. Maarten Koomans,Kim Bruheim, MSc.Bogdan Toma, BA, BSc

+31(0)[email protected]

Contact:

Prof. dr Fred van Eenennaam

Background of the Health Outlook 2013 (1/2)
http://www.grenoble-em.com/accueil.aspx?lg=enhttp://www.grenoble-em.com/accueil.aspx?lg=en


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The Life Sciences Outlooks and the recent STZ publications have created the bases for the Health Outlook 2013

Nyenrode LSH | Biotech Outlook2010

Moni tor ing and improving

the red biotech cluster

The Nyenrode LSH| Biotech Outlookiscreated undersupervision of prof. drFred van EenennaamandIrMaarten Koomans.

Draft forHigh Profile Group reviewonly October2009

Background of the Health Outlook 2013 (2/2)


70/100


which aims to register, monitor and report the outcomes (valorization) of research and cooperation with the

industry and appl ied research ho spi ta ls uni formly.

Approach of the Health Outlook 2013 (1/2)


71/100


The Out look bui lds on exist ing and available repor ts to leverage and im prove on the current data posi t ion 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, Volume15(1), 2010, Article

The Role of Integration into

External Informational

Environments, John R.Kimberly, Journal of Healthand Social Behavior Vol. 19,No. 4 (Dec., 1978),

Determinants of technological

innovation and its effect on

hospital performance, AfricanJournal of BusinessManagement 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 ConsumerIndex (2012)

WHO Draft Guidelines for

adverse event reporting and

Learning Systems (2005)

Denken, doen en delen: UMCs als

regionale expertisecentra voor

onderwijs & opleiding(2007)

STZ expertisecentra in beeld.

(2011)

STZ-ziekenhuizen in het

Nederlandse

ziekenhuislandschap. (2011)

Approach of the Health Outlook 2013 (2/2)


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Learning

loop L

earningloop

The needs of research and innovat ion that address the pat ient value in the Dutch Health cluster wi l l be al igned by a

systemat ic yearly c luster dia logue, based o n:

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 forcluster-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 formonitoring andimproving: 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

LearningloopLearningloopLearningloop

International Academic Advisory Council


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The Internat ional Academic A dvisory Counci l1, wi th the members provid ing advice on the development of the

Out look, cluster pol ic ies and m ethodolog y development, is l is ted below.

Gran Lindqvist

Principal Associate at the Center for Strategy andCompetitiveness (CSC) at the Stockholm School ofEconomics and Cluster Observatory projectmanager. His research focuses on agglomerations,clusters, cluster initiatives, and cluster policy.

Robert E. Burke

Professor at the George Washington UniversityProfessor Burke is a medical sociologist and anationally known expert in long-term care, withextensive experience in developing, evaluating andimplementing health care policy and managingmultidisciplinaryprofessional staff.

Leonard H. FriedmanProfessor at the George Washington UniversityDr. Leonard Friedman is an expert on themechanisms of organizational change and strategicdecision-making in health service organizations.

Victoire de Margerie

Profess

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