A few years ago, specialty providers in the Netherlands began proposing minimum volume thresholds for certain procedures. This push was driven by data showing—especially for complex procedures—increased efficiencies and improved outcomes above certain volumes. The Ministry of Health and health inspection authorities subsequently endorsed these minimum volumes.
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However, these thresholds posed a particular challenge for oncology services, as most hospitals performed a small number of procedures for each type of cancer each year. With the change in policy, they would no longer be reimbursed unless they met the volume threshold for a given procedure.
This dilemma led to the formation of the Embraze Oncology Network, which now includes seven hospitals and two radiotherapy centres. Initially, members of the network informally 'bartered' for patients to meet their volume targets—for example, one member might say to another, 'If you send me your pancreatic patients, I'll send you my colon patients.' But from there, it expanded to include much broader collaboration, with dozens of initiatives to define pathways and quality metrics, as well as to pursue value-based care across the network.
Shared resources increase 'stickiness' to the network
Embraze is a participant-governed network in which the individual hospitals remain autonomous and not contractually bound. As such, it's had to get creative about how to incentivise network participation and engagement. One of the most innovative ways it does so is through collectively funding PhD students to work in network hospitals.
Each of the seven hospitals contributes money that is pooled annually into a fund totalling €200,000. They put out a call for proposals to the network for research projects, with the requirement that projects be multidisciplinary and multihospital. Each hospital has an internal competition to decide which proposal will be put forward from its hospital to the network level. The network then awards four projects with four years of funding for a junior doctor who is working on his or her PhD.
We spoke with Dr. Ernst Kuiper, the CEO of Erasmus Medical Center—the largest hospital in the network—to learn about this initiative. He shared that it has majorly boosted engagement at both the hospital and clinician level. In the Netherlands, it's particularly important for all hospitals—not just teaching ones—to conduct and publish research. It's a mark of quality and prestige. Further, if a hospital trains junior doctors, it must obtain five-year accreditation—these projects count as 'points' toward that accreditation.
Finally, because the projects are multidisciplinary and multihospital in nature, they increase collaboration across staff in the network, and build a body of research that can be used to improve the care provided in the entire network. Hospitals are less likely to ignore their overall network obligations when they are benefitting from this free resource.
Determine your network sweetener
Offering a funded PhD student might not be a shared resource you would choose as the 'sweetener' to increase participation in your network. Free rent, free waste-management services, IT support, and back office support are just a few of the many other creative ways you can entice participation. Hospitals and health systems should consider what they have to offer—or can offer in partnership with others—that would increase engagement with system activities and initiatives and advance system goals.
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