Supervision by the Dutch Healthcare Inspectorate.

The Dutch Healthcare Inspectorate's (Inspectie voor de Gezondheidszorg) supervisory activities are based on proportional use of the instruments. The primary instruments it uses are advice and encouragement. If these do not achieve the desired result, it can implement corrective action by, for example, enhancing its supervision or through agreements limiting the ability to practise a profession. Recourse to disciplinary or administrative measures can be sought, if necessary. There is a tendency to use statutory instruments, which means greater equality before the law and greater legal certainty. It is important in this respect for the Inspectorate to make its considerations more uniform, transparent and predictable.

Adverse events and potentially preventable deaths in Dutch hospitals: results of a retrospective patient record review study.

OBJECTIVE: This study determined the incidence, type, nature, preventability and impact of adverse events (AEs) among hospitalised patients and potentially preventable deaths in Dutch hospitals. METHODS: Using a three-stage retrospective record review process, trained nurses and doctors reviewed 7926 admissions: 3983 admissions of deceased hospital patients and 3943 admissions of discharged patients in 2004, in a random sample of 21 hospitals in the Netherlands (4 university, 6 tertiary teaching and 11 general hospitals). A large sample of deceased patients was included to determine the occurrence of potentially preventable deaths in hospitals more precisely. RESULTS: One or more AEs were found in 5.7% (95% CI 5.1% to 6.4%) of all admissions and a preventable AE in 2.3% (95% CI 1.9% to 2.7%). Of all AEs, 12.8% resulted in permanent disability or contributed to death. The proportion of AEs and their impact increased with age. More than 50% of the AEs were related to surgical procedures. Among deceased hospital patients, 10.7% (95% CI 9.8% to 11.7%) had experienced an AE. Preventable AEs that contributed to death occurred in 4.1% (95% CI 3.5% to 4.8%) of all hospital deaths. Extrapolating to a national level, between 1482 and 2032 potentially preventable deaths occurred in Dutch hospitals in 2004. CONCLUSIONS: The incidence of AEs, preventable AEs and potentially preventable deaths in the Netherlands is substantial and needs to be reduced. Patient safety efforts should focus on surgical procedures and older patients.

Practice of the statutory disciplinary system for health care psychologists in the Netherlands.

A statutory disciplinary system for health care psychologists in the Netherlands was introduced in 1998. To provide an indication of the contribution of this system to monitoring the quality of health care psychology all complaints dealt with in the period 1999-2002 were studied. Questionnaires were sent to all 388 members of the disciplinary boards (response 89%) and 43 practicing lawyers (response 65%). The regional disciplinary boards dealt with 68 complaints about health care psychologists. A sanction was imposed 16 times (25%), mainly for sexual intimacies or a sexual relationship, violation of professional secrecy or incorrect statement or reporting. The statutory disciplinary system appears to be an important corrective instrument for serious forms of professional misconduct for health care psychologists.

[Disciplinary measures for healthcare practitioners in the Netherlands 1983-2002]. / Tuchtrechtspraak voor de gezondheidszorg in Nederland; 1983-2002.

OBJECTIVE: To gain insight into disciplinary proceedings for healthcare practitioners in the Netherlands. DESIGN: Descriptive, retrospective study. METHOD: We examined all first verdicts pronounced by disciplinary boards during the period 1983-2002 involving physicians, dentists, pharmacists and midwifes. The following information was studied: year of the verdict, number and nature of complaints, plaintiff characteristics, types ofpractitioners accused, verdicts and number ofcases appealed and their outcomes. RESULTS: Disciplinary boards addressed 13,228 complaints during the study period (average 661 per year). The number of complaints increased more rapidly than the number of practitioners. Most complaints concerned physicians (92%). The complaint density was highest for physicians; it was higher for general practitioners than specialists and generally higher for surgical specialists than non-surgical specialists. Half of the complaints concerned 'lack of care or inadequate care' or 'incorrect treatment'. The number of complaints that resulted in sanctions decreased during the study period (average 18%). The sanction density remained constant throughout the study period (0.25 sanctions per 100 practitioners). The sanction density was highest for physicians and higher for general practitioners than for specialists. Overall, 45 practitioners were permanently struck from the register or had their licence to practice revoked. CONCLUSION: There was a slight increase in the number ofcomplaints over the past 20 years. The corrective effects of the disciplinary code are obvious from the number of individuals who were permanently struck from the register or had their license to practice revoked. An increased impact on the quality of care should be sought through prevention and education. Disciplinary jurisprudence warrants more attention in training and continuing educational courses. Publishing verdicts may also increase attention.

The disciplinary code for nurses and its contribution to the quality of nursing care in the Netherlands.

AIM: To obtain insight into the contribution of the disciplinary code for nurses to monitoring the quality of nursing care in the Netherlands. METHODS: Complaints dealt with in the period 1998-2001 were studied. Questionnaires were sent to 3200 nurses (71%), all 388 members of the disciplinary boards (89%) and 43 lawyers (65%). RESULTS: There was an increase in the number of nurses who were accused (20 in 1998, 12 in 1999, 54 in 2000, and 56 in 2001) and also in the annual percentages of sanctions imposed (0% in 1998, 8% in 1999, 13% in 2000 and 16% in 2001). The disciplinary code appears to be an important corrective instrument for serious professional misconduct.

[Publication practice and policy for disciplinary proceedings regarding health care in the Netherlands]. / Publicatiepraktijk en -beleid van de tuchtrechtspraak voor de gezondheidszorg.

OBJECTIVE: To provide insight into practice and policy regarding the publication of disciplinary verdicts in Dutch health care. DESIGN: Descriptive. METHOD: The study covered all of the verdicts issued by disciplinary boards and courts of justice that were published in the Dutch the Staats-courant (Government Gazette) during the period 1995-2002. The following attributes were recorded for each verdict: year of publication and verdict, the disciplinary board concerned, the accused professional, the type of complainant, the nature of the complaint and verdict, and the journals that were offered the decision. The published verdicts were related to the total number of verdicts and cases during the study period. Questionnaires were used to investigate the publication policy of the disciplinary boards. RESULTS: A total of 4% of all verdicts were published in the Dutch Government Gazette (323/8902). The central disciplinary board decided to publish more often than the regional disciplinary boards (8% and 2%, respectively). There were considerable differences between the various regional disciplinary boards (range: 1-5%). Per professional group the percentage of verdicts in cases that were published ranged from 2% to 23%. The decisions were offered to over 20 journals, but mainly to the Tijdschrift voor Gezondheidsrecht [Dutch Journal of Health Law] (TvGR; 92%) and Medisch Contact [Medical Contact] (MC; 88%). The TvGR published almost two-thirds of the verdicts offered (63%), and the MC published almost three-quarters (74%). In the decision to publish, the disciplinary boards differed in their interpretation of the concept of 'general importance'. CONCLUSION: If disciplinary proceedings are to achieve the desired quality-promoting effect on professional practice, then more attention will need to be paid to the publication policy, and the disciplinary boards will have to develop a joint code of practice. More verdicts could be published, also in professional journals.

[No improvement of disciplinary jurisprudence since the implementation of the Individual Health Care Professions Act (IHCP Act)]. / Tuchtrechtspraak niet verbeterd sinds de invoering van de Wet op de Beroepen in de Individuele Gezondheidszorg (Wet BIG).

OBJECTIVE: To compare the number and nature of the complaints, the complainants, the accused health professionals and the sanctions imposed by the disciplinary boards before and after the Individual Health Care Professions Act (IHCP Act) came into effect at the end of 1997. DESIGN: Descriptive, retrospective. METHOD: The authors examined all 4980 verdicts pronounced by the disciplinary boards in the first instance during the period 1995-1997 (before the IHCP Act) and then during the period 1999-2001 (after the IHCP Act), together with the resulting appeal procedures involving physicians, dentists, pharmacists and midwives. The following were noted: the year of the verdict, the number and nature of the complaints, the types of complainants, the categories of professionals accused, the nature of the verdicts, and the number of appeal procedures. RESULTS: During the first period, 2453 complaints were brought before the disciplinary board, compared to 2527 during the second period. Most of the complaints were made against physicians (92% in both periods). The number of complaints that were declared to be justified fell from 19% to 15% (p < 0.001). In both periods, approximately half of the complaints concerned 'lack of care or inadequate care' or 'incorrect treatment', the most frequent verdict was a warning (67% and 72%, respectively), and appeals were lodged against almost one-third of the verdicts. The number of complaints submitted by the Inspectorate for Health Care decreased from 47 to 19. CONCLUSION: In any important aspects, the IHCP Act did not lead to improvement in the disciplinary jurisprudence. The decrease in the number of complaints that were declared to be justified could be explained by the change in composition of the disciplinary boards prescribed by the IHCP Act (more lawyers and less fellow professionals). Informing citizens about disciplinary jurisprudence and other procedures for lodging complaints may increase the number of justified complaints and hence the number of 'justified' verdicts. There is a need for further clarification of the tasks and responsibility of the Inspectorate for Health Care in case of complaints to the disciplinary boards.