Abstract
Dear Editor:
Networks are emerging as a new innovative organizational form in palliative care with a variety of different tasks.1–8 Within the health care system of the Netherlands, the first initiatives to build up networks for palliative medicine were taken in the last 2 decades. Meanwhile, the pioneer phase has been finished and we would like to share our observations with the reader of the Journal of Palliative Medicine.
Main goals of the first Dutch networks were to facilitate and improve the collaboration among individual providers of palliative care such as hospices, hospitals, home care providers, and general practitioners. These networks were designed for the care of patients with multiple and complex medical, psychosocial, and spiritual problems within palliative medicine. The Dutch government has stimulated as well as funded the development of the networks of palliative care and has determined the general conditions.
The actual responsibility, however, for the realization was completely placed on the individual networks with a huge freedom of action. Thus, individual networks could determine their own priorities to a large extent. This specific task assignment resulted in a variety of concepts among individual networks. Within one decade a total of 70 networks were built up (Table 1); all Dutch citizens can be assigned to one specific network of palliative care. The number of inhabitants related to a specific network range between 60,000 (Goeree Overflakkee) and 774,000 (Amsterdam) with a median of 185,000 inhabitants.
Meanwhile, the initial build-up phase has been completed and networks have defined their own tasks. We were interested in the priorities and asked all 70 networks of palliative care of the Netherlands to indicate their projects for their annual business plan of 2010.
Interestingly all networks responded and indicated that education of patients, relatives, and colleagues (70%) plays a major role, followed by research and innovation (43%), process management (40%), and quality management (32%), whereas other tasks such as spiritual care (3%), ethnicity (3%), and in-hospital care (5%) played a minor role at this moment.
To continue in a next phase of development more information is needed about the optimal dimensions of a network (number of inhabitants/area) and the pros and cons of the policy to give networks a maximum of freedom to set their priorities. We would like to share our observations and considerations with the readers of Journal of Palliative Medicine because they might be of interest for other networks within other countries taking the next step from the pioneer phase toward further professionalism within palliative care.