The role of dissimilar values in guideline development in the Netherlands

Runtime: 2019-2023
Client: National Health Care Institute (Zorginstituut Nederland)

Project description

The number of arguments taken into account in processes of guideline development in the Netherlands has increased in the last three decades. This rise is caused by various aspects such as the shift of decision-making by the government towards the physician’s room, the strengthened position of patients in clinical decision-making and the increased emphasis on taking into account other forms of evidence beyond data derived from clinical trials. Finally, the focus on strict regulation and accountability of healthcare providers is gradually making way for local variation and a focus on learning and reflection.

Not only are the arguments that come to the fore in processes of guideline development topic of study in this project. In particular, the dissimilar values underlying those arguments will be assessed. We are interested in how those values are weighted by various stakeholders such as insurers, providers and patient associations, and in the role of the Quality Council of The National Health Care Institute (Zorginstituut Nederland, ZIN) in these processes. The overarching goal is to come up with theoretically informed recommendations to improve processes of weighting dissimilar values in guideline development.

To explore the roles of various parties in guideline development throughout the last decades, the first part of this study consists of a literature review. An overview of discourses in scientific publications around guideline development will be provided to embed the further ethnographic research at ZIN. This research will center on the work of the Quality Council to gain a thorough understanding of their role in guideline development. In a subsequent study, two historic processes will be reconstructed based on interviews with participants and document analysis. Finally, the insights gained from the previous studies will lead to the formulation of a policy intervention for the improvement of weighting dissimilar values in guideline development.


Jolien van de Sande (PhD Candidate), Dr. Bert de Graaff, Prof. dr. Antoinette de Bont.