title: Optimal use of external demands in hospitals - a Delphi study from the Netherlands.
abstract: BACKGROUND
  Regulatory authorities focus on promoting compliance of hospitals with a variety of external demands. Due to the amount of these external demands, hospitals might prioritise to cope with the external demands. In this study, we explore to what extent a risk-based prioritisation system developed by one Dutch hospital, is applicable in other hospitals as well. The specific research question was: can a risk-based prioritisation system help hospitals cope with the pressures of external demands?
  
  
  METHODS
  We conducted a Delphi study, containing three rounds with seven quality and safety managers. All participants were experienced in coping with external demands in Dutch hospitals in general and their own hospital specifically. These experts were granted access to a sample selection of a database containing about 1500 external demands (January 2014). Prior to the Delphi study, a baseline measurement was carried out, where all participants answered open-ended questions aimed at identifying existing practices, possible challenges concerning external demands and to prepare the survey for the group Delphi study.
  
  
  RESULTS
  We identified a high level of consensus during our Delphi research. The experts agreed that at present, Dutch hospitals do not cope with external demands systematically. The participants agreed that the database and the risk-based prioritisation system are useful tools to cope with the amount of external demands and indicated that they would also like to use these tools themselves in the future.
  
  
  CONCLUSIONS
  In this study, the participants agreed that the database and the risk-based prioritisation system are both applicable and useful tools to cope with the amount of external demands. Further research addressing the use of the risk-based-priority system for specific subsets of external demand is also needed.
authors.affiliation: Zuyderland Medisch Centrum, Postbus 5500, 6130 MB, Sittard-Geleen, Netherlands. l.blume@atriummc.nl.|Tilburg School of Social and Behavioural Sciences, Tranzo, Scientific Center for Transformation in Care and Welfare, Tilburg University, P.O. Box 90153, 5000 LE, Tilburg, Netherlands. l.blume@atriummc.nl.
authors.forename: Louise H K
authors.initials: LH
authors.lastname: Blume
authors.affiliation: Q! B.V., Annie Romein-Verschoorlaan 11, 6532 SN, Nijmegen, Netherlands. nico.vanweert@QKwaliteitsadvies.nl.
authors.forename: Nico J H W
authors.initials: NJ
authors.lastname: van Weert
authors.affiliation: Zuyderland Medisch Centrum, Postbus 5500, 6130 MB, Sittard-Geleen, Netherlands. J.Busari@atriummc.nl.
authors.forename: Jamiu O
authors.initials: JO
authors.lastname: Busari
authors.affiliation: Tilburg School of Social and Behavioural Sciences, Tranzo, Scientific Center for Transformation in Care and Welfare, Tilburg University, P.O. Box 90153, 5000 LE, Tilburg, Netherlands. DDelnoij@zinl.nl.|National Health Care Institute (Zorginstituut Nederland), Postbus 320, 1110 AH, Diemen, Netherlands. DDelnoij@zinl.nl.
authors.forename: Diana
authors.initials: D
authors.lastname: Delnoij
mesh_terms: D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D032921:Consensus; D003697:Delphi Technique; D005260:Female; D058016:Health Facility Administration; D006302:Health Services Research; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017751:Safety Management / Q000458:organization & administration*