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The evaluation of the Healthcare Quality, Complaints and Disputes Act (Wkkgz) shows that the Act certainly contributes to the achievement of the goals set, namely strengthening the legal position of the client and facilitating the quality of care. However, the evaluation also shows that there are still areas for improvement.
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The legal evaluation focused on the themes: scope, quality and safety, the right to complain and supervision on the implementation of the law. The evaluation was carried out by Rolinka Wijne and Johan Legemaate in collaboration with Nivel, and subsidized by ZonMw. The evaluation report, which was presented to the Dutch House of Representatives by Minister Van Ark for Medical Care and Sport, contains 32 recommendations for improving the law and practice.

Basic principles are widely supported

On 1 January 2016, the Wkkgz replaced the Healthcare Institutions Quality Act (Kwz) and the Healthcare Sector Clients Complaint Act. The biggest difference in comparison to its predecessors is the scope: the Wkkgz applies to more healthcare providers. As far as facilitating the quality of care is concerned, the Wkkgz leaves the system of the Quality Act intact. The importance of a low-threshold handling of complaints is now more emphasised than in the Healthcare Sector Clients Complaint Act, in order to find a satisfactory solution for the complainant and healthcare provider without escalation, if possible. These principles of the Wkkgz are widely supported. Moreover, the law effectively contributes to facilitating the aims of the law.

Better alignment with differences and new developments

However, there are parts that require further critical reflection. The Wkkgz relates to healthcare sectors that differ greatly in terms of familiarity with previous legislation and in structure. Not every sector is equally advanced in designing its working method in order to meet the requirements of the Wkkgz. It also appears that these requirements are less suitable for smaller healthcare providers. Furthermore, the Wkkgz is not always in line with more recent developments in healthcare, such as network care or working with franchise constructions.

Reporting obligations are time-consuming and not always effective

The goal of the Wkkgz, that quality and safety are primarily the responsibility of the healthcare provider, is an effective starting point. When reporting calamities, a lot of attention is paid to the correct way of reporting and subsequent investigation, which entails the risk that less attention is paid to the learning process. The duty to report "dismissal in the event of serious shortcomings" and the associated "duty to verify" are aimed at preventing a non-functioning professional from starting elsewhere. Although the importance of this is great for individual patients, the combination of these two obligations does not seem to work in practice.

Dispute settlement body was judged less positively by patients

The choice of the emphasis on low-threshold handling of complaints in the Wkkgz provides a good starting point for effective handling of complaints. The manner in which this was subsequently designed did not achieve what the legislator had in mind on several essential aspects. For example, we see that setting deadlines leads to undesirable formalization of low-threshold handling of complaints. Also, the opportunity to learn from complaints remains underused. Many critical observations concern the dispute settlement body, certainly also from the perspective of patients. They are less often positive about the disputes body than about the former complaints committees. Remarkably, patients rate the disputes body much less often as independent compared to the former complaints committee.

About the research

The evaluation was carried out by combining legal and empirical research. First of all, an analysis was made of the goals of the law and the instruments that the Wkkgz offers to realize those goals. It has also been analysed which points of discussion are addressed in the legal literature on the Wkkgz. Subsequently, the practice of the Wkkgz was discussed. To this end, five case studies were carried out, concerning hospitals, general practitioner care, dental care, care for people with intellectual disabilities and lastly, the group of the providers of alternative and cosmetic care and self-employed care providers. These case studies were complemented with further research on the right of complaint. The the most important results of the case studies were presented to a broad representation of patients, lawyers, professionals and institutions from other sectors. Finally, questions about the functioning of the Wkkgz were submitted to the Health and Youth Care Inspectorate (IGJ). The results of the legal and empirical research provided to be a basis for the conclusions and recommendations.

Mr. dr. R.P. (Rolinka) Wijne

Lecturer in Health Law

Prof. J. (Johan) Legemaate

Professor in Health Law