BMJ Qual Saf doi:10.1136/bmjqs-2011-000540
  • Viewpoint

Knowledge implementation in healthcare practice: a view from The Netherlands

  1. Roland Friele3,4
  1. 1Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
  2. 2Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
  3. 3NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
  4. 4Tranzo, Tilburg University, Tilburg, The Netherlands
  1. Correspondence to Professor M Wensing, Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands; m.wensing{at}
  1. Contributors Each author led one component of the analytical report underlying this paper. MW drafted the paper and prepared the revised version. RB and RF provided substantial input.

  • Accepted 18 November 2011
  • Published Online First 23 December 2011


In this contribution we discuss some pertinent issues regarding knowledge implementation in the Netherlands, focusing on the largest public funding agency for health research in the Netherlands (ZonMw). The commentary is based on a report, which includes a structured analysis of 79 projects funded by ZonMW, a survey of published implementation research covering 141 systematic reviews, and qualitative study of the implementation infrastructure in the Netherlands. Five themes were identified. First, the term ‘knowledge implementation’ may be better replaced by more specific terms in some situations. Second, contextual factors need to be taken more systematically into account when planning and evaluating implementation programs. Third, knowledge may change when implemented and this needs to be considered in projects. Fourth, we observed that implementation has developed into a specific world, separated from both healthcare practice and scientific research. It is important to guard against the risk of isolation from the practical and societal needs that the field is meant to address. Finally, we suggest that the strong focus on ‘doing projects’ and limited opportunities for structural funding may reduce substantial improvement in the field. Many good activities are underway, but the policies regarding knowledge implementation appear to need some adjustment. In its policy plan for the coming years, ZonMW has partly taken up the lessons from our advisory report.


  • Funding ZonMw funded the report underlying this paper, but had no role in the writing of the manuscript or in the decision to submit for publication.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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