Frits Van Merode

Maastricht University | UM · CAPHRI School for Public Health and Primary Care

Background An increased interest in medical liability claims has been noticed. Nevertheless, detailed data on subject of claims and possible factors that contribute to litigation and indemnity payments are scarce and relatively dated. Insight into these data may provide valuable information to prevent both incidents and malpractice claims. Objecti...

Background/Objectives: The nursing work environment is a critical element in healthcare delivery and a strong predictor of both patient and nurse outcomes. Understanding the complexity and multifaceted nature of this environment is essential for improving nursing practices and optimizing healthcare systems. This study aimed to gain insights into th...

The healthcare and education sectors suffer from shortages of nurses and teachers. Extending their working hours has often been proposed as a solution to this. In this study, we conduct a discrete choice experiment (DCE) in the Netherlands to elicit nurses’ and teachers’ preferences for different jobs and working conditions. We present both nurses...

The Hidden Reserve of Nurses and Teachers in the Netherlands* Like in many other high-income countries, the Netherlands experiences significant staff shortages in both healthcare and education. The key shortage occupations in these sectors are nurses and teachers. Both occupations suffer from high retirements rates and encounter difficulties in att...

A lack of nurses is a prevalent and persistent problem in many countries [...]

Worldwide, nurse shortages constitute a problem, including in the Netherlands. Every region in the country has a shortage of all types of nurses. At the same time, there are large hidden reserves: persons who have been trained as a nurse but do not work in the healthcare sector. The size of the hidden reserve exceeds the shortage of nurses. Until n...

Het onderwijs kampt met aanzienlijke personeelstekorten, maar tegelijkertijd kent de sector een aanzienlijke stille reserve. Het tekort kan volledig worden opgelost als circa een vijfde van de stille reserve weer voltijds in het onderwijs aan de slag gaat.

Healthcare systems are facing a shortage of nurses. This article identifies some of the major causes of this and the issues that need to be solved. We take a perspective derived from queuing theory: the patient–nurse relationship is characterized by a scarcity of time and resources, requiring comprehensive coordination at all levels. For coordinati...

In this study, we consider the human body and the healthcare system as two complex networks and use theories regarding entropy, requisite variety, and network centrality metrics with resilience to assess and quantify the strengths and weaknesses of healthcare systems. Entropy is used to quantify the uncertainty and variety regarding a patient’s hea...

De zorg kent aanzienlijke personeelstekorten. Tegelijkertijd werken veel mensen die als verpleegkundige of verzorgende mogen werken niet of maar weinig uren. Door hen in te zetten zouden de personeelstekorten in de zorg opgelost kunnen worden. IN HET KORT • Er zijn nu 14.400 vacatures voor verpleegkundigen tegenover meer dan 24.000 afgestudeerden...

A redesign of hospitals (i.e., partitioning departments and delegating decision authority) may be needed to deal with variable demand. Uncertain demands and throughput times often need short reaction times. In this study, we develop quantitative methods to guide a redesign through an information-processing approach. To demonstrate how the methods c...

Lean Thinking and clinical pathways are commonly used concepts to improve healthcare. However, little is known on how to use Lean Thinking for the optimization of pathways or the quantification of both concepts. This study aims to create a framework to analyze pathways with Lean Thinking on a system level, by quantifying the seven wastes, flow and...

Purpose: To examine the difference in post-operative visual outcomes of cataract surgeries between a tertiary and secondary centre at Aravind Eye Hospitals in Tamil Nadu, India. Methods: Our retrospective cross-sectional study analysed cataract surgeries at a secondary centre and its associated tertiary centre in 2021. Our main outcome measures...

Objective: We aim to assess the effectiveness of a cataract surgery outcome monitoring tool used for continuous quality improvement. The objectives are to study: (1) the quality parameters, (2) the monitoring process followed and (3) the impact on outcomes. Design and procedures: In this retrospective observational study we evaluated a quality imp...

Background Quality strategies, interventions, and frameworks have been developed to facilitate a better understanding of healthcare systems. Reporting adverse events is one of these strategies. Gynaecology and obstetrics are one of the specialties with many adverse events. To understand the main causes of medical errors in Gynaecology and obstetric...

Background The concept of value-based healthcare is being used worldwide to improve healthcare. The Intervention Selection Toolbox was developed to bridge the gap of value-based healthcare, between insights in outcomes and actual quality improvement initiatives. In this study we aimed to evaluate the use of the Intervention Selection Toolbox in dai...

Organizational structure enables organizations to achieve their goals. The chosen organizational structure determines, to a large extent, the flow of information streams and the manner and extent to which roles, power, and responsibilities are delegated and coordinated to achieve the organization’s goals. In this study, we applied information theor...

Long waiting times in outpatient clinics have multiple adverse effects on patients and their attendants, staff and hospital management. Several approaches practiced to manage the cycle time have been proposed. The purpose of this study was to evaluate the impact of implementing closed-loop based multiple approaches together. This study was conducte...

Long waiting times in outpatient clinics have multiple adverse effects on patients and their attendants, staff and hospital management. Several approaches practiced to manage the cycle time have been proposed. The purpose of this study was to evaluate the impact of implementing closed-loop based multiple approaches together. This study was conducte...

There is an alarmingly high growth in breast and cervical cancers in low-and-middle-income countries. Due to late presentation to the doctors, there is a lower cure rate. The screening programs in low-and-middle-income countries are not comprehensive. In this paper, we systematically analyse the barriers to screening through an accessibility framew...

Purpose: To examine the difference in post-operative visual outcomes of cataract surgeries between a tertiary and secondary centre at Aravind Eye Hospitals in Tamil Nadu, India. Methods: Our retrospective cross-sectional study analysed cataract surgeries at a secondary centre and its associated tertiary centre in 2021. Our main outcome measures wer...

Abstract: Recent data on number of claims, final judgement of claims and their costs are scarce. This study analyzes 15 years of malpractice claims in the Netherlands. All claims filed, and all claims closed by two insurance companies (which insure approximately 95% of all hospitals in the Netherlands) between 2007–2021 are included. Trends in numb...

Background: The concept of value-based healthcare is being used worldwide to improve healthcare. The Intervention Selection Toolbox was developed to bridge the gap of value-based healthcare, between insights in outcomes and actual quality improvement initiatives. In this study we aimed to evaluate the implementation process of the Intervention Sele...

Objectives We aimed to systematically map the extent, range and nature of research activity on value-based healthcare (VBHC), and to identify research gaps. Design A scoping review with an additional cited reference search was conducted, guided by the Joanna Briggs Institute methodology. Data sources The search was undertaken in PubMed, Embase an...

The combination of increasing demand and a shortage of nurses puts pressure on hospital care systems to use their current volume of resources more efficiently and effectively. This study focused on gaining insight into how nurses can be assigned to units in a perinatology care system to balance patient demand with the available nurses. Discrete eve...

Purpose This study explores how a hospital works, which is important for further enhancing hospital performance. Following the introduction of a Hospital Planning Centre (HPC), changes are explored in a hospital in terms of integration (the coordination and alignment of tasks), differentiation (the extent to which tasks are segmented into subsystem...

Evolutionary algorithms, such as genetic algorithms have been used in various optimization problems. In this paper, we propose to apply this algorithm to obtain the layout design/redesign in order to improve the patient flow in an outpatient clinic. Layout designs are planned considering long-term requirements whereas the layout keeps modifying as...

Background Clusters of COPD patients have been reported in order to individualize the treatment program. Neither co-morbidity clusters, nor integrated respiratory physiomics clusters contributed to a better prediction of outcomes. Based on a thoroughly assessed set of pulmonary and extra-pulmonary traits at the start of a pulmonary rehabilitation (...

De inzichten van het WRR-rapport ‘Kiezen voor houdbare zorg’ worden breed gedeeld. De onhoudbaarheid van de uitgavengroei wordt overtuigend aangetoond. De aanbevelingen zijn echter zwak; eigenlijk weten de opstellers ook niet echt wat er moet gebeuren. De keuzes van de WRR mogen scherper.

Leadership roles in the specialist digital health workforce are incredibly heterogeneous. No one single career pathway suits all aspiring leaders and as society and healthcare become increasingly digitised, the opportunities for new careers grow. Content and methodological expertise form solid foundations for leaders, combined with clear organisati...

Research efforts that aim to develop methodological support for the redesign of business processes in the healthcare domain are fragmented and performed in different domains. Due to these characteristics, it can be expected to be difficult to establish the state-of-the art with respect to this body of knowledge. This paper presents a research proto...

Objective The COVID-19 pandemic emphasises the need to use healthcare resources efficient and effective to guarantee access to high-quality healthcare in an affordable manner. Surgical cancellations have a negative impact on these. We used the Lean Six Sigma (LSS) methodology to reduce cardiac surgical cancellations in a University Medical Center i...

In het kader van de Agenda van de toekomst van Beweging 2025 interviewt Jaap Jan Brouwer een diverse groep deskundigen. Dit keer vertelt Frits van Merode, hoogleraar logistiek en operations management in de zorg aan Maastricht University en tot juli 2018 lid van de raad van bestuur UMC+. Hij bestudeert de Nederlandse gezondheidszorg vanuit zijn vak...

The performance of outpatient clinics is measured through waiting times and resource utilization and the reasons for low performance is often viewed as operations issues: planning, scheduling and coordination between resources and patients. In this study, we show that layout design also contributes towards operations management. Here we propose wor...

Purpose: Integration, that is, the coordination and alignment of tasks, is widely promoted as a means to improve hospital performance. A previous study examined integration and differentiation, that is, the extent to which tasks are segmented into subsystems, in a hospital's social network. The current study carries this research further, aiming t...

Ziekenhuizen worden tegenwoordig uitgedaagd om de beperkte capaciteit aan te passen aan de groeiende vraag. In dit hoofdstuk worden het organisatieontwerp en het bijbehorende proces besproken om te zorgen voor voldoende capaciteit voor patiëntenzorg. We presenteren voorbeelden van verschillende capaciteitsbeslissingen en hun complexiteit bij elke p...

Het bieden van goede en efficiënte patiëntenzorg vraagt onder andere inzicht in procesvariabelen zoals capaciteit, capaciteitsbenutting, beïnvloedbaarheid en sturingsmogelijkheden. Capaciteitsbenutting meten we door het berekenen van de bezettingsgraad. In dit hoofdstuk definiëren we allereerst begrippen met betrekking tot capaciteit en de benuttin...

Poliklinieken van ziekenhuizen zijn een essentieel en omvangrijk element van het Nederlandse zorgsysteem. Om met gelimiteerde capaciteit een gewenst niveau van zorg te kunnen leveren, is capaciteitsmanagement cruciaal. Er bestaat echter geen one size fits all-blauwdruk van capaciteitsmanagement voor de polikliniek. In de zorg is een bepaalde mate v...

In dit hoofdstuk wordt het managen van capaciteit in de zorginstelling geïntroduceerd, mede in relatie tot zorglogistiek. Het biedt een raamwerk voor het aanpakken van vraagstukken die bij capaciteitsmanagement spelen. Daarbij wordt het belang beschreven van coherente relaties tussen capaciteitsmanagement en andere beleidsgebieden van de zorginstel...

Hospital systems are under constant pressure to provide quality care despite limited resources. However, traditional capacity management in hospitals is often not effective enough. One reason for this is the variability and uncertainty in the healthcare field that has to be managed. Another reason is the observation that hospitals are open loop sys...

Het uitgangspunt van dit boek is goede patiëntenzorg, kostenbeheersing en aantrekkelijk werkgeverschap. Zorg wordt geleverd door mensen. Een tevreden of ontevreden patiënt oordeelt vooral op basis van de inzet en het handelen van zorgverleners. Een zorginstelling bestaat, voor alles, uit medewerkers en niet uit apparatuur, stenen of (gratis) parkee...

Objectives Radiological lung changes in COVID-19 infections present a noteworthy avenue to develop chest X-ray (CXR) -based testing models to support existing rapid detection techniques. The purpose of this study is to evaluate the accuracy of artificial intelligence (AI) -based screening model employing deep convolutional neural network for lung i...

Scheduling of resources and patients are crucial in outpatient clinics, particularly when the patient demand is high and patient arrivals are random. Generally, outpatient clinic systems are push systems where scheduling is based on average demand prediction and is considered for long term (monthly or bimonthly). Often, planning and actual scenario...

Background: Integration, the coordination and alignment of tasks, has been promoted widely in order to improve the performance of hospitals. Both organization theory and social network analysis offer perspectives on integration. This exploratory study research aims to understand how a hospital's logistical system works, and in particular to what e...

weg naar een nieuwe coalitie tussen de top van de organisatie en de werkvloer Frits van Merode; 7 juli 2020 De coronacrisis heeft laten zien dat onder druk de zorg heel anders georganiseerd kan worden en ook in de praktijk heel anders kan uitwerken. Wat waren de meest opvallende veranderingen en hoe kunnen we ze vasthouden. Dat is de uitdaging voor...

Objectives The current management of chronic obstructive pulmonary disease (COPD) largely ignores its heterogeneous pulmonary and extrapulmonary manifestations in the individual patient. This study aimed to identify clusters of patients with COPD based on a thorough traits assessment. Design An observational, prospective, single-center study. Set...

Background Integration, the coordination and alignment of tasks, is widely promoted in order to improve the performance of hospitals. Both organization theory and social network analysis offer perspectives on integration, but studies using a system-wide perspective are rare. This exploratory study describes the tasks that are performed in arranging...

Background Integration, the coordination and alignment of tasks, has been promoted widely in order to improve the performance of hospitals. Both organization theory and social network analysis offer perspectives on integration. This exploratory study research aims to understand how a hospital’s logistical system works, and in particular to what ext...

Background Integration, the coordination and alignment of tasks, has been promoted widely in order to improve the performance of hospitals. Both organization theory and social network analysis offer perspectives on integration. This exploratory study research aims to understand how a hospital’s logistical system works, and in particular to what ext...

This study addressed the problem of scheduling walk-in patients in real time. Outpatient clinics encounter uncertainty in patient demand. In addition, the disparate departments are locally (department-centric) organized, leading to prolonged waiting times for patients. The proposed integral patient scheduling model incorporates the status and infor...

Purpose: To study the number of disruptions in patient processes in a radiotherapy centre after the replacement of an Electronic Health Record (EHR), integrating information tools for patient care and billing. Methods: Our self-made Electronic Medical Record was replaced by a new EHR, including clinical path and workflow-management. A social-tec...

Objective: To analyse the quantity and size of health care claims per medical specialty in the past 10 years. Design: Descriptive, evaluative and comparative study. Method: Anonymised damage claim data from Centramed and MediRisk were used for this study. The numbers and sizes of the claims per specialty have been analysed over a ten-year peri...

The value agenda involves measuring outcomes that matter and costs of care to optimize patient outcomes per dollar spent. Outcome and cost measurement in the value-based health care framework, centered around a patient condition or segment of the population, depends on data in every step towards healthcare system redesign. Technological and service...

Healthcare transformation is necessary to address rising costs of care. Operational Excellence can optimize care processes and create more value for each patient with the same resources. Operational Excellence uses different optimization tools in a continuous improvement (DMAIC-)cycle to optimize processes. In this regard, process mining can play a...

In order to improve the quality and efficiency of hospitals, they can be viewed as a logistical system in which integration is a critical factor for performance. This paper describes the results of a scoping study that identifies the logistical parameters mentioned in international research on hospitals and indicates whether literature reflects sys...

Purpose In hospitals, several patient flows compete for access to shared resources. Failure to manage these flows result in one or more disruptions within a hospital system. To ensure continuous care delivery, solving flow problems must not be limited to one unit, but should be extended to other departments - a prerequisite for solving flow proble...

The implementation of innovations is considered necessary in healthcare, both for improving patient outcomes and services and to reduce costs. Two problems can occur during the implementation process: innovations that have not been properly evaluated in terms of patient outcomes or cost-effectiveness can sometimes spread quickly, whereas innovation...

Rationale While theoretical frameworks for optimization of the outpatient processes are abundant, practical step‐by‐step analyses to give leads for improvement, to forecast capacity, and to support decision making are sparse. Aims and objectives This article demonstrates how to evaluate and optimize the triad of demand, (future) capacity, and acce...

Objective: To investigate the number and extent of claims concerning hospital care at a national level, thereby affording insight to the profession. Design: A quantitative, descriptive and comparative study. Method: We used anonymised data on all claims for damages from regular hospital care that were submitted to Centramed and MediRisk betwee...

Background and context Resource planning is performed ahead of time within outpatient clinics (OPC). Due to local control of operations (department-centric decision-making) and limited resources, OPCs cannot handle high variability and uncertainty in demand. There is always a difference between planning and reality, and this leads to operational pr...

Objectives: To analyse how often innovations in healthcare are evaluated regarding output, especially in radiotherapy. Output was defined as either survival, toxicity, safety, service, efficiency or costeffectiveness. Methods: A systematic literature review was conducted, using three search strategies: 1) innovations in general healthcare; 2) ra...

The introduction of Operational Excellence in the Maastricht University Medical Center (MUMC+) has been the first of its kind and scale for a university hospital. The policy makers of the MUMC+ have combined different elements from various other business, management, and healthcare philosophies and frameworks into a unique mix. This paper summarize...

For efficient utilization of operating rooms (ORs), accurate schedules of assigned block time and sequences of patient cases need to be made. The quality of these planning tools is dependent on the accurate prediction of total procedure time (TPT) per case. In this paper, we attempt to improve the accuracy of TPT predictions by using linear regress...

Objective: To study the implementation of innovation activities in Dutch Radiotherapy centres in a broad sense (product, technological, market and organizational innovations). Methods: A descriptive cross-sectional study was conducted in 15 Dutch radiotherapy centres. A list of innovations implemented from 2011-2013 was drawn up for each centre...

Objective: To study the efficiency of research implementation in a large radiotherapy institute, in either an internal review board-approved clinical trial or clinical routine. Methods: Scientific publications of the institute were listed. We asked clinicians from tumour expert groups whether the study had been implemented yet in a clinical tria...