title: Sustainability of improvements in access to outpatient specialist care in the Netherlands.
abstract: OBJECTIVE
  To improve access to specialist outpatient clinics without adding capacity, Dutch hospitals applied the concept of 'Advanced Access'. Our aim was to determine whether initial improvements are sustained for three years and to identify the factors that influence sustainability.
  
  
  METHODS
  Qualitative case studies in 14 outpatient specialist clinics. Access measurements at the start, finish and three years after the project were compared. Analysis of sustained and new interventions. Interviews with 52 practitioners, analysed with the constant comparative method to identify general factors that influence sustainability.
  
  
  RESULTS
  Eleven out of 14 clinics were able to sustain or improve their reduced delays; two did not and for one it is uncertain. The clinics maintained the majority of the interventions and all introduced new interventions. Three generic factors emerged that influenced their ability to sustain the results: increased responsiveness to better match supply and demand; clinical leadership and incentives; and a shared belief that they can and should control access together.
  
  
  CONCLUSIONS
  Reduction of delays in access can be sustained if the way of thinking and the planning system becomes demand driven and flexible and if care providers experience benefits. Unlike previous studies, senior management support and formal training was not relevant though clinical leadership and informal socialization was. Making multidisciplinary teams responsible for improvement appears to be vital.
authors.affiliation: PhD Student, Care and Public Health Research Institute (CAPHRI), Maastricht UMC+, the Netherlands.
authors.forename: Marc R
authors.initials: MR
authors.lastname: van der Voort
authors.forename: Jeroen
authors.initials: J
authors.lastname: van Wijngaarden
authors.forename: Stan
authors.initials: S
authors.lastname: Janssen
authors.forename: Bart
authors.initials: B
authors.lastname: Berden
authors.forename: Frits
authors.initials: F
authors.lastname: van Merode
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration* / Q000592:standards; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D008511:Medicine / Q000458:organization & administration* / Q000592:standards; D009426:Netherlands / Q000453:epidemiology; D015397:Program Evaluation; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration*; D014850:Waiting Lists
keywords: management; operational research; quality improvement