Technical Skills Workshop - Royal College of Physicians...
Transcript of Technical Skills Workshop - Royal College of Physicians...
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V.A.J. Slenter, CEO ACMMP (Capaciteitsorgaan)
Québec City, May 6th 2013.
Technical Skills Workshop
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Fact sheet Dutch system for determining medical work force
1. Models used and developed so far
2. Monitoring geographic regions
3. Supply, demand, and its modifiers
4. Documentation
--------------------------------------------------
Translation into policy- and decision-making
5. Stakeholders
6. Engagement strategy
7. Future on jurisdiction
Technical aspects
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Inhabitants: 16.700.000
Registered clinical specialists: 20.863
Registered general practitioners: 11.608
Registered physicians social medicine: 5.331
Registered specialists elderly/mentally disabled: 1.630
Registered “basic physicians”: 28.200
Fact sheet 1: The Netherlands 2012
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Fact sheet 2: Flows to medical specialisms
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1999: Excel spreadsheet modelling demand, supply, and working
proces developed and put in place to determine inflow
numbers
2008: I-Think model based on developedExcel spreadsheet, being in
use for discussion and policy analysis in Chambers
1. Models used and developed so far
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6 Estimated demand year X
Changes available supply until year X+t
Changes in demand until year X+t
Available supply in X+t Available supply year X
Connection
in year X
Connection in
year X+t
Forecasted demand in year X+t
Supply in
persons (M/F)
Available supply
in fte
Fte per
person
(M/F)
Unmet
demand
Needed demand
in fte
Supply in
Persons (M/F)
Outflow from current supply
gender specific for chosen year Available supply
In fte
Fte per
person (M/F)
chosen year)
Inflow from abroad
(M/F)
Retention
abroad(M/F)
# in training (M/F) in time
yield (M/F) in time External retention (M/F) in time
Forecasted
demand in fte
(all scenario‟s
Demographic changes for chosen
year (all scenario‟s)
Unmet demand
or excess
(per scenario)
Extra # needed in training /
chosen year (per scenario)
Non-demografic
developments
“Combination”-
scenario‟s
Socio-
cultural
develop-
ments
Epide-
miologic
develop
-ments
Vocational
develop-
ments
Horizontal
substitution Efficiency
Labor time
develop-
ments
scenario‟s
Vertical
substitution
scenario‟s
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I-think model
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1. Expanding modelling to other academic and non- academic
professions;
2. Integrating different specialisms in the model;
3. Modelling on regional scale
Horizon scanning “Capaciteitsorgaan”
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2. Geographic regions and population sectors
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Geographic differences in supply: modest
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3. Mechanics of modeling techniques
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Table 1: review assumptions per parameter
Profession: MSRC specialismen
MSRC specialismen
Starting y ear / Adjusting y ear / Trend y ear 2010 2012 2020
Balance y ear 1 and 2 2022 2028
SUPPLY IN 2010 AND DEVELOPMENT UNTIL 2030 Male Female Total
Number of practising specialists in 2010 11.449 5.901 17.350
Gender frequencies practising specialists in the y ear 2010 66,0% 34,0% 100,0%
Av erage fte per practising specialist in the y ear 2010 0,935 0,818 0,895
Av erage fte per practising specialist in the y ear 2015 0,935 0,819 0,886
Av erage fte per practising specialist in the y ear 2020 0,935 0,819 0,880
Av erage fte per practising specialist in the y ear 2025 0,935 0,819 0,875
Av erage fte per practising specialist in the y ear 2030 0,936 0,820 0,873
Retirement of practising specialists until 2015 17,3% 7,6% 14,0%
Retirement of practising specialists until 2020 34,3% 15,8% 28,0%
Retirement of practising specialists until 2025 53,5% 29,3% 45,3%
Retirement of practising specialists until 2030 70,8% 48,3% 63,1%
DEMAND IN 2010 AND DEVELOPMENT UNTIL 2030 Low Medium High
Unfulfilled demand per 1-1-2010 2,6% 2,6%
Demografic change in demand until 2015 5,6%
Demografic change in demand until 2020 11,2%
Demografic change in demand until 2025 16,7%
Demografic change in demand until 2030 21,0%
Annual epidemiological change 0,36% 0,36%
Annual sociocultural change 1,11% 1,11%
Annual professional/v ocational change 0,00% 0,00%
Annual change due to efficiency measures -0,22% -0,22%
Annual change due to horizontal substitution 0,00% 0,00%
Annual change due to v ertical substitution -0,46% -0,46%
Annual change due to w orking hours alteration 0,21% 0,21%
Paramater v alues
HAVING ENTERED VOCATIONAL TRAINING UNTIL 2010 Male Female Total
Av erage number in training per annual cohort on 1-1-2010 447,8 607,9 1.055,7
Gender frequencies trainees per 1-1-2010 42,4% 57,6% 100%
Duration v ocational training for trainees hav ing entered before 2010 5,4 5,4 5,4
Yield of v ocational training for trainees hav ing entered before 1-1-2010 98,0% 98,0% 98,0%
Percentage practising 1 y ear after completing training until 2010 98,0% 96,8% 97,3%
Percentage practising 5 y ears after completing training until 2010 94,7% 92,7% 93,6%
Percentage practising 10 y ears after completing training until 2010 93,7% 89,6% 91,3%
Percentage practising 15 y ears after completing training until 2010 89,1% 84,4% 86,4%
ENTERING VOCATIONAL TRAINING FROM 2010 UNTIL 2012 Male Female Total
Av erage number entering training annually in 2010/2011 503,6 692,9 1.196,5
Gender frequencies for influx in 2010/2011 42% 57,9% 100%
Duration v ocational training for trainees entering in 2010/2011 5,4 5,4 5,4
Yield of v ocational training for trainees entering in 2010/2011 91,8% 91,4% 91,6%
Percentage practising 1 y ear after completing training hav ing entered in 2010/2011 98,0% 96,9% 97,3%
Percentage practising 5 y ears after completing training hav ing entered in 2010/2011 94,4% 92,3% 93,2%
Percentage practising 10 y ears after completing training hav ing entered in 2010/2011 93,3% 89,3% 91,0%
Percentage practising 15 y ears after completing training hav ing entered in 2010/2011 88,7% 83,7% 85,8%
ENTERING VOCATIONAL TRAINING AS OF 2012 Male Female Total
Ex pected number entering training as of 2012 503,6 692,9 1.196,5
Gender frequencies for influx as of 2012 42,1% 57,9% 100%
Duration v ocational training for trainees entering as of 2012 5,4 5,4 5,4
Yield of v ocational training for trainees entering as of 2012 91,8% 91,4% 91,6%
Percentage practising 1 y ear after completing training entering as of 2012 98,0% 96,9% 97,3%
Percentage practising 5 y ears after completing training entering as of 2012 94,4% 92,3% 93,2%
Percentage practising 10 y ears after completing training entering as of 2012 93,3% 89,3% 91,0%
Percentage practising 15 y ears after completing training entering as of 2012 88,7% 83,7% 85,8%
IMMIGRATION MEDICAL SPECIALISTS AS OF 2010 Male Female Total
Annual immigration as of 2010 0,0 0,0 0,0
Gender frequencies immigration 59,2% 40,8% 100%
Yield immigration 60,0% 60,0% 60,0%
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• Estimated for each of the 27 clinical specialisms, the 6 other medical
specialisms, and 8 medical “profiles” based on 1 model;
• Estimated for dentists and oral hygiënists;
• Estimated for clinical (neuro) psychologists, psychotherapists, health
psychologists, and NP mental health
• Utilisation data, age and gender specific;
• Netherlands forecasts (“Volksgezondheids Toekomst Verkenningen)
by government agencies on demographics and epidemiology;
• Policies of governement, health insurance companies, and universities
• Research issued by ourselves;
• International data;
• Expert opinions.
Estimation future demand for health
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13 Estimated demand year X
Changes available supply until year X+t
Changes in demand until year X+t
Available supply in X+t Available supply year X
Connection
in year X
Connection in
year X+t
Forecasted demand in year X+t
Supply in
persons (M/F)
Available supply
in fte
Fte per
person
(M/F)
Unmet
demand
Needed demand
in fte
Supply in
Persons (M/F)
Outflow from current supply
gender specific for chosen year Available supply
In fte
Fte per
person (M/F)
chosen year)
Inflow from abroad
(M/F)
Retention
abroad(M/F)
# in training (M/F) in time
yield (M/F) in time External retention (M/F) in time
Forecasted
demand in fte
(all scenario‟s
Demographic changes for chosen
year (all scenario‟s)
Unmet demand
or excess
(per scenario)
Extra # needed in training /
chosen year (per scenario)
Non-demografic
developments
“Combination”-
scenario‟s
Socio-
cultural
develop-
ments
Epide-
miologic
develop
-ments
Vocational
develop-
ments
Horizontal
substitution Efficiency
Labor time
develop-
ments
scenario‟s
Vertical
substitution
scenario‟s
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Future demand=
(present demand + unmet demand) * (demografics*epidemiology*
sociocultural changes)
Working proces=
(efficiency + productivity + professional developments + horizontal
substitution)
Supply=
((present fte – decay) + (inflow from future vocational training – decay) +
(inflow from abroad – decay))* vertical substitution*labour time
changes
Demand
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One of the “unmet demand” indicators
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2.5
3.0
3.5
4.0
4.5
jan/10 apr/10 jul/10 okt/10 jan/11 apr/11 jul/11 okt/11 jan/12 apr/12 jul/12 okt/12 jan/13 apr/13
Average interval (weeks) between applying and attending ambulatory hospital care (all specialisms)
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Evaluation
studies
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1. The 2010 recommendations for medical specialist training
2. Factors influencing long term dynamics of health care supply and
demand; Smits, M; Roos, E.; Proceedings of the European
Conference on Information Systems ESADE, Barcelona, 2012. Paper
685, pages 1-12
3. Improving Workforce Planning in Health Care. Proceedings of Bled,
Slovenia, June 2012
4. Ten years of health workforce planning in the Netherlands: a tentative
evaluation of GP planning as an example; Malou Van Greuningen*,
Ronald S Batenburg and Lud FJ Van der Velden. Human resources
for health 2012
4. English papers on model
Capaciteitsorgaan
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5. Stakeholders included in modeling
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1. Health insurance companies
2. Professionals
3. Training institutes/ hospitals and universities
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Chambers: participative policy analysis
• Discussing research data
• Discussing policies of professionals and governement
• Commenting on research done on behalf of Capaciteitsorgaan
• Studying effects of policy changes
• Giving expert opinion on gaps in data
• Reaching consensus on 35 parameters
• Constructing advice in concept
Board: strategic choices/ communication with government
• Approving and finalizing advices to government
• Writing accompanying letter, adressing strategic themes
• Meeting with ministry at least twice a year
6. Engagement strategy
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• Model put into place in increasing number of non- medical professions
• “ Capaciteitsorgaan” slightly hesitant about applying method to other
disciplines
• Regional planning for assisting personel in hospitals feasible
• Integrating different professions in one model with interlinkages
• Advise on other parameters besides inflow in medical school/
vocational training
7. Need to move and invest in planning
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Evaluaties
Capaciteitsorgaan
Een overzicht van uitgevoerde evaluaties sinds 2009
Presentatie Kamer huisartsen 18 mei 2011
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Opbouw presentatie
1. Achtergronden evaluaties
2. Overzicht uitgevoerde evaluaties
3. Resultaten per evaluatie
4. Conclusies
5. Acties
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1. Beweegredenen evaluaties
1. Cirkel van Deming
2. Wetenschappelijke nieuwsgierigheid
3. Onzekerheid bij partijen
4. Behoefte aan legitimering
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2. Overzicht uitgevoerde evaluaties
1. Februari 2010: UvT integraal
2. Februari 2010: NIVEL huisartsenzorg
3. Februari 2010: NIVEL model doorrekening
4. September 2010: Regioplan: afnemers
5. Januari 2011: CPB plausibiliteitstoets
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3.1 Evaluatie Universiteit van Tilburg
Vraagstelling Bureau
1. Werkt het bestaande Excel model correct?
2. Werkt het proces voor raming en advisering correct
en naar tevredenheid van partijen?
3. Moet het model worden aangevuld of vervangen?
4. Moet de methode worden aangepast:
1. Getrapte besturing;
2. Extra expertgroepen;
3. Omschakeling naar vraaggestuurde zorg
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3.1 Evaluatie Universiteit van Tilburg
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3.1 Evaluatie Universiteit van Tilburg
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3.1 Evaluatie Universiteit van Tilburg
Resultaat/ advies
1. Rekenmodel en methode zijn gedateerd, maar moeten met een aantal aanpassingen voorlopig gehandhaafd blijven;
2. Ontwikkel een systeemdynamisch model en valideer dat;
3. Ontwikkel beslismethoden gebaseerd op interactieve simulaties en besluitvorming
4. Overweeg beleidsvariabelen in het model onder te brengen en beleidsrijker te ramen
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3.2 Evaluatie NIVEL: huisartsenzorg
Vraagstelling Bureau
• Reconstrueer met behulp van het
rekenmodel 2008 retrospectief de
ontwikkeling van het aantal huisartsen
sinds 1998 en vergelijk dit met de
werkelijkheid;
• Geef een advies over de eventuele
consequenties van deze analyse voor het
model
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3.2 Evaluatie NIVEL: huisartsenzorg
Resultaat/ advies
1. Traditionele huisartsen: - 0,6%
2. Waarnemers: + 7,4%
3. HIDHA „s: -
17,7%
Gewogen gemiddelde: -1,8%
• Geen systematische trends
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3.2 Evaluatie NIVEL: huisartsenzorg
0
2.000
4.000
6.000
8.000
10.000
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Aantal huisartsen: Zelfstandigen
5-jaarsprognose: Mannen en Vrouw en
realiteit: Mannen en Vrouw en
-3,0%
-2,5%
-2,0%
-1,5%
-1,0%
-0,5%
0,0%
0,5%
1,0%
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Aantal huisartsen: Zelfstandigen
% Verschil prognose tov . realiteit: Mannen en Vrouw en
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3.2 Evaluatie NIVEL: huisartsenzorg
0
100
200
300
400
500
600
700
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Aantal huisartsen: Waarnemers
5-jaarsprognose: Mannen en Vrouw en
realiteit: Mannen en Vrouw en
-20,0%
-10,0%
0,0%
10,0%
20,0%
30,0%
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Aantal huisartsen: Waarnemers
% Verschil prognose tov . realiteit: Mannen en Vrouw en
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3.2 Evaluatie NIVEL: huisartsenzorg
0
200
400
600
800
1.000
1.200
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Aantal huisartsen: HIDHA's
5-jaarsprognose: Mannen en Vrouw en
realiteit: Mannen en Vrouw en
-35,0%
-30,0%
-25,0%
-20,0%
-15,0%
-10,0%
-5,0%
0,0%
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Aantal huisartsen: HIDHA's
% Verschil prognose tov . realiteit: Mannen en Vrouw en
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3.2 Evaluatie NIVEL: huisartsenzorg
0
2.000
4.000
6.000
8.000
10.000
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Aantal huisartsen: Werkzaam
5-jaarsprognose: Mannen en Vrouw en
realiteit: Mannen en Vrouw en
-3,0%
-2,5%
-2,0%
-1,5%
-1,0%
-0,5%
0,0%
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Aantal huisartsen: Werkzaam
% Verschil prognose tov . realiteit: Mannen en Vrouw en
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3.3 Evaluatie NIVEL: model doorrekening
Vraagstelling Bureau
1. In hoeverre is het Excel model een
volledige vertaling van het conceptuele
model?
2. Hoe betrouwbaar zijn de gehanteerde
parameters?
3. Hoe kunnen de experts beter worden
benut?
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3.3 Evaluatie NIVEL: model doorrekening
Resultaten/ advies
1. In conceptuele model géén verschil tussen
nu en later
2. In conceptuele model wordt zorgaanbod
in uren gemeten
3. In conceptuele model wordt zorgvraag ook
in absolute waarde bedacht
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3.4 Evaluatie Regioplan
Vraagstelling Regioplan aan afnemers
• Zijn ramingen bruikbaar voor toewijzen
instroomplaatsen?
• Zijn ramingen bruikbaar voor toewijzen
opleidingsplaatsen naar functie afnemer?
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3.4 Evaluatie Regioplan
• 1e tranche • Medisch specialisten excl. psychiatrie (26)
• 2e tranche A • Arts voor Verstandelijk Gehandicapten
• Maatschappij en Gezondheid (8)
• Psychiaters
• Specialist Ouderengeneeskunde
• SEH arts
• 2e tranche B • Psychotherapeut
• Klinisch (neuro) psycholoog
• Gezondheidszorgpsycholoog
• Verpleegkundig specialist GGZ
![Page 42: Technical Skills Workshop - Royal College of Physicians ...ihwc.royalcollege.ca/imwc/IHWC2013_presentation_sl... · Technical Skills Workshop 1 . Fact sheet Dutch system for determining](https://reader035.fdocuments.in/reader035/viewer/2022070722/5ee3a3dcad6a402d666d5e24/html5/thumbnails/42.jpg)
42
3.4 Evaluatie Regioplan
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3.4 Evaluatie Regioplan
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3.4 Evaluatie Regioplan
Verdeling geënqueteerden
74
144
58
79
31
68
128
43
1
24
0
20
40
60
80
100
120
140
160
1e én 2e
tranche
opleidingen
1e tranche 2e tranche A
opleidingen
2e tranche B
opleidingen
Overige 2e
tranche
opleidingen
Aan
tal
Respondenten
Vraag beantwoord
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3.4 Evaluatie Regioplan
Verdeling bij totaal respondenten (n= 264)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Weet niet
Niet bruikbaar
Onvoldoende bruikbaar
Voldoende bruikbaar
Goed bruikbaar
![Page 46: Technical Skills Workshop - Royal College of Physicians ...ihwc.royalcollege.ca/imwc/IHWC2013_presentation_sl... · Technical Skills Workshop 1 . Fact sheet Dutch system for determining](https://reader035.fdocuments.in/reader035/viewer/2022070722/5ee3a3dcad6a402d666d5e24/html5/thumbnails/46.jpg)
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3.4 Evaluatie Regioplan
1e tranche opleidingen
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
rechtstreeks betrokken
bij opleiding
bestuurder overige rollen
weet niet
niet bruikbaar
onvoldoende bruikbaar
voldoende bruikbaar
goed bruikbaar
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3.4 Evaluatie Regioplan
2e tranche A opleidingen
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
rechtstreeks betrokken
bij opleiding
bestuurder overige rollen
weet niet
niet bruikbaar
onvoldoende bruikbaar
voldoende bruikbaar
goed bruikbaar
![Page 48: Technical Skills Workshop - Royal College of Physicians ...ihwc.royalcollege.ca/imwc/IHWC2013_presentation_sl... · Technical Skills Workshop 1 . Fact sheet Dutch system for determining](https://reader035.fdocuments.in/reader035/viewer/2022070722/5ee3a3dcad6a402d666d5e24/html5/thumbnails/48.jpg)
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3.4 Evaluatie Regioplan
Resultaat/ advies
1. Huidige systematiek goed tot voldoende
bruikbaar volgens 60% à 70%
ondervraagden
2. Verschillen tussen eerste en tweede
tranche in onderzoek
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3.4 Evaluatie Centraal Planbureau
Vraagstelling VWS aan CPB
• Zijn de ramingen van het Capaciteitsplan
plausibel?
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4. Conclusies
• Evaluaties scheppen vertrouwen
• In Excel model marginale onzekerheden
• Praktijktest bij huisartsen geruststellend
• Aandachtspunten zijn vraagdefinitie en uren
• De onderzochte partijen zijn intuïtief positief
over de bruikbaarheid van het model
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5. Acties
• Uitvoeren aanbevelingen uit onderzoeken
UvT en NIVEL
• Verder onderzoek naar aspecten model en
verbeteren/ uitbreiden functionaliteit
• Nadenken over participatieve
beleidsontwikkeling
• Klantentoets in eigen regie nemen?