Dissertation defense From acute care labyrinth to acute care network

November 10, 2022

Acute care institutions in the Netherlands are overburdened, and this is causing major problems. That is why doctor and researcher Naomi Minderhout has been doing research at Health Campus The Hague into how to improve acute care in the Netherlands at all levels in order to keep this care accessible to all. On Wednesday, 9 November, she defended her dissertation.

Together with her team at the Health Campus, Minderhout has made a good start at untangling the acute care labyrinth and moving towards a comprehensible and common-sense acute care network. The various studies that she and her fellow researchers conducted lead to the general conclusion that making acute care in the Netherlands future-proof will require a concerted approach from the whole system: from health skills and triage to electronic patient files and financing. ‘Future-proof urgent care must be more collective and population-oriented,’ Minderhout says.

A shared dream

In one of her studies during the COVID-19 pandemic, Minderhout discovered that stakeholders at different acute care institutions are actually all pursuing the same, shared dream. But the road to it appears to be strewn with obstacles. ‘In the interviews, everyone described an integrated acute care network in line with the vision of Ernst Kuipers: one number, one triage, and most importantly, everything very cohesive. But no one knows exactly how to get there,’ Minderhout says. During the pandemic, the researchers identified many barriers in the organisational dimension, such as lack of clear policy, unsolved problems that lead to mistrust, and incorrect coordination of priorities between the various organisations. The functional aspects, such as shared or openly communicating electronic patient files (EPDs) and adequate financing, were simply not there. In every instance it became clear that all individual organisations have to work more closely together in order to offer the best acute patient care.


No optimal acute care

Another factor that has led to overburdening of the acute care sector is that the care is, all too often, not being used optimally. ‘Some patients rely on acute care even though with their issues, they could also be getting care from their GP during regular hours.’ Self-referral is still regularly leading to improper use of urgent care facilities. Similarly, care users also frequently find themselves at the wrong place simply due to lack of knowledge. In the past, many patients internalised the term ‘EHBO’ (‘first aid’) and are prone to confusing this with urgent care and emergency room services. Minderhout says that essential to improving acute care in the future will be keeping people better informed from current information sources through the right channels. Here, younger participants in the research challenged the researcher to think outside the box in terms of information channels. These participants weren’t looking for information in the form of brochures but would be better served by hearing it through an influencer on YouTube, for example.

Is this the way through the labyrinth?

‘No, in practice, the real information package has to come from all of us choosing to go for it,’ says Minderhout. But at least the labyrinth is a little easier to navigate now. And Minderhout intends to go further with this in the coming years. ‘First, I’m going to finish my medical training this year, and I intend to be first and foremost a practising GP. But I do hope to stay involved in all the developments around acute care. After I defend my dissertation, I hope that a lot of good things are going to come my way.’