Quality and safety

Quality is a broad concept. For us, it concerns patient-centered care, patient safety, efficacy, timeliness, accessibility, efficiency, innovation, and transparency. We work towards these goals as follows:

• We measure and assess the quality of all aspects of our care throughout the entire hospital through our quality management system. This system has been set up to support us in finding things that can be improved, implementing these improvements, and safeguarding them in our daily work.
• We find information on things that could be improved in our analyses (nature, severity, and frequency) of complaints, incidents, calamities, complications, infections, and deaths.
• We justify the quality of our care to our patients, insurance providers, professional associations, health care inspectors, and auditors.
• We effectively collaborate to organize our care with the patient at its center. By working in multidisciplinary teams, we continuously improve the quality of our care.
• We consult patients and patient organizations to monitor the results of our care together with them and to aim towards further improvements. 
• We offer transparency about the quality of our care by sharing information on our website.

Patients can rely on our continuous focus on patient safety at the NKI. Our staff is vigilant about the protection of this safety. Despite our efforts, there is still a risk of side effects, complications, and other unwanted effects during a hospital stay. To minimize potential risks, the NKI specifically focuses on the following topics:

• Non-oncological care and care for vulnerable patients: we guarantee basic care for general conditions like cardiovascular diseases, diabetes, neurology, in collaboration with specialists at the surrounding hospitals.
• Risk-focused approach: we have functional procedures for calamities, incidents, complications, and more. We involve our patients in risk signaling, and if necessary, measures to minimize them.
• Optimal medication safety: we aim to prevent incidents involving medication through medication verification during hospital admission and discharge, and for patients receiving outpatient care. 
• Infection prevention: our complex treatments may affect our patients' immune systems, making them more susceptible to infections. These infections are treated with antibiotics. We monitor the prevention of infectious diseases at the NKI every day.
• Safe introduction of innovations: the NKI is an innovative hospital. Patient safety is of the utmost importance in the implementation of these innovations. We have ascertained this through the safe introduction of medical technologies. Medical technology includes medical machinery, medical information technology (such as eHealth applications), and medical consumables.
• Patient-centered transfer and coordination: most treatments are complex and involve multiple health care professionals, who have always worked together by means of our multidisciplinary team meetings. We also collaborate with professionals outside of the NKI, such as general practitioners who receive the transfer during difficult moments in the patient's care. 

Our staff aims to provide the safest care possible, every single day. If something does (almost) go wrong, we would like to learn and grow as a hospital. That's why we report all incidents, so the reports can be investigated. An incident is something that goes wrong in health care. Sometimes these incidents have far-reaching consequences, which we call a calamity. The definition of a calamity is an unforeseen or unexpected event concerning the quality of care that has resulted in the death or serious physical harm of the patient or client.

When we expect such a calamity, the concerning patient (or their survivor(s)) are notified immediately, and a report will be made with the Health and Youth Care Inspectorate (IGJ).

The calamity committee at the Netherlands Cancer Institute conducts methodological research into these possible calamities. The members doing this research were not involved in the calamity itself. The committee talks to the patient and/or family members involved as well as the concerning staff. This creates a clear picture of the events, what led up to them, and what we can learn from this as a hospital. The investigation always aims to avoid similar things happening in the future and isn't focused on culpability.

In consultation with and according to the wishes of the patient or their legal survivor(s), the results of the investigation will be shared with them. We use the learnings to create and implement plans for improvement. We often assess the status of these plans for improvement. This allows us to continuously work towards improved patient care.

Incidents and calamities in 2020

In 2020, 441 almost incidents and 2033 incidents were reported by health care professionals. 43 reports are still being investigated. A large number of these reports included a (potential) small risk. Seven reports had serious consequences for the patients. The Board of Directors has notified the Health and Youth Care Inspectorate (IGJ) of these potential calamities. 

An internal investigative committee has looked into the seven reports sent to IGJ. The purpose of these investigations is to be able to learn from these events and to avoid repetition. The committee has concluded that two reports do not show a (plausible) connection between the quality of care delivered and the undesirable course of the treatment. These two events are not calamities. The committee concluded that the other five events can be considered calamities. In two of these calamities, the patients passed away.

Research showed that the causes of these reports mainly concerned the quality of our protocols, collaboration between NKI and its partners, and internal communication. The plans for improvement have resulted in an adjustment of the protocols, better coordination with collaborative partners, and improved filing.

The IGJ has concluded that the investigative committee has sufficiently and meticulously handled every report and that sufficient measures towards improvement have been taken. The IGJ has taken the conclusions of the investigated committee on board for every investigation.

The Netherlands Cancer Institute has been awarded the following accreditations:

• Organization of European Cancer Institutes (OECI)
• Veiligheidsmanagementsysteem (VMS)
• Nederlands Instituut voor Accreditatie in de Zorg (NIAZ) voor Radiotherapie
• Joint Accreditation Committee ISCT & EBMT (JACIE)
• RVA ISO 15189:2012 accreditatie
• RVA ISO 15189:2012 accreditatie
• BVO Darmkanker Noord-West
• Registratiecommissie Geneeskundig Specialisten- opleidingsvisitatie COC
• Harmonisatie Kwaliteitsbeoordeling in de Zorgsector (HKZ) – MDL, Patiëntveiligheid
  voor endoscopieafdelingen
• HACCP
• Green Deal
• Milieuthermometer
• Convenant brandveiligheid in de zorg
• Good Clinical Distribution (GDP), ISO 9001:2008
• Good Manufacturing Practices (GMP), fabrikantenvergunning
• Good Manufacturing Practices – ziekenhuizen (GMP-z)
• Good Laboratory Practices　(GLP, OECD)

Hospitals in the Netherlands are required by law to publish their mortality rates. These rates are calculated in accordance with the Hospital Standardized Mortality Ratio (HSMR). This HSMR is based on 50 diagnostic groups that amount to 80% of in-hospital mortality. The NKI is a specialized hospital treating only patients with cancer. This distorts the HSMR rate compared to other hospitals. The HSMR is "only" calculated in 13 out of 50 diagnoses at the NKI. A special internal investigative committee analyzes potentially avoidable damage in the cause of all mortalities. The results of these investigations are published here every year:

In 2020, 159 mortalities were registered at the Netherlands Cancer Institute, in 8353 hospital admissions in total. This is 1.9% of all admitted patients.