Operational excellence in hospitals

More than two decades ago, health-care institutions in Western countries started riding the wave of market liberalization and engaged in professionalizing health-care management. During that time, health-care processes were poorly designed and indubitably not characterized by “freedom of deficiencies” (Institute of Medicine, 1999). As a result, health-care costs were high and patients’ satisfaction was low. This was also the case in the Netherlands. Even before 2000, the Dutch Government seriously urged on reducing health-care costs by a mix of cost-containment policies and efforts to create more competition among health-care providers (Schut and Van de Ven, 2005). These efforts were market-oriented reforms preconditioned to establish a regulated competition in health care, which allows equal access to health care while containing costs. The Netherlands is one of the countries that closely meets the necessary preconditions of a regulated competition. These preconditions revolve around equality of risk selection, efficiency, safety and affordability of care (Van de Ven et al., 2013; Maarse et al., 2016). The Netherlands has the advantage that the same paying system is implemented in all hospitals and other health-care organizations. The fee-for-service system predictably led to a continuous rise of health-care costs due to the financially driven priority on output of care, not necessarily accompanied by higher quality levels.