• harmonises systems for quality review in healthcare and welfare
• translates ISO 9001 for Dutch health care practise
• produces schemes for certification purposes
• brings parties to agreement on quality standards
• stimulates systematic quality management
• is acknowledged by the Dutch Board of Accreditation.

HKZ stands for Harmonisation of quality review in health care and welfare, and is a Dutch initiative of health care providers, patients/clients and insurers. Its mission: harmonisation and implementation of quality management systems and external review of such systems. To achieve this goal HKZ produces ISO 9001 compatible certification schemes for various types of health care and welfare institutions. Moreover HKZ stimulates implementation of these schemes.
HKZ facilitates the Council of Experts in the Health Care Sector. All certification schemes are developed under the authorisation of this council, which is acknowledged by the Dutch Board of Accreditation.

Organisational basis
HKZ activities are for the greater part funded by the Ministry of Health. In the Board, the Council of Experts and the various projectgroups, the three main parties: providers, insurers and patients/clients are represented. This tripartite basis is a unique characteristic of HKZ.

Harmonisation model
HKZ has developed a generic conceptual framework for certification: the HKZ Harmonisation model. This framework is applicable to all subsectors in healthcare and welfare. It forms the 'blueprint' for all HKZ certification schemes. The model consists of nine headings, which all together describe the whole of organisational processes that should be subject to review. The first three headings refer to primary processes with a professional input: from intake via care delivery to evaluation. Standards in these headings are emphatically formulated from the perspective of the patient/client. This emphasis is the main characteristic of HKZ certification schemes.
The remaining six headings relate to supportive items and processes: policy and organisation, human resource management, research and development, documentation, environment and materials, and services delivered by third parties. The norms in these sections are strongly ISO related.
The framework of the nine headings in the HKZ Harmonisation model can be filled in more explicitly for a certain section, thus leading to a certification scheme that can be used for both internal and external review purposes.

Levels in a certification scheme
Within a certification scheme four levels can be distinguished. The first level regards the scope of the scheme: to what type of health care institution with what type of functions the scheme refers (e.g. home care institutions including terminal care). The second level is about the aspects of care that are relevant for external review of that particular type of institutions and thus should be taken into account (e.g. waiting time). On the third level norms and standards are introduced that refer to those aspects. These norms are derived from existing material such as guidelines from professionals, review instruments of patients, laws and so on. The fourth level regards the way in which the organisation certifies that its product (care and services) meets the norms and standards. In fact this is the quality assurance system.

HKZ stimulates implementation
Developing sector-specific norms is one thing. Implementation of these norms is another and even more important issue. This requires understanding and knowledge of how the system works and how quality management can work for an organisation. HKZ constantly seeks opportunities to develop instruments that facilitate implementation of quality management systems. In this, we closely co-operate with corporate organisations in health care and welfare. 
In Dutch care and welfare the emphasis is gradually shifting from static quality control to a dynamic system that enables quality improvements to take place continuously. There is a growing orientation on the outcomes of care and the necessity to control quality in the (clinical) pathways. The evolution of ISO 9001 is keeping up with these developments.
HKZ sees to it that its Harmonisation Model remains state of the art.

International activities
HKZ participates in a European project developing European quality guideline for healthcare services. This guideline wille be derived from ISO 9001:2000. This project is initiated and executed on CEN-level (Comitée Européenne de Normalisation). The HKZ Harmonisation model and the Dutch experience in quality management appear to be of great value in this project.

You can order the English version of the Harmonisation Model brochure from the HKZ Shop.
The sector-specific certification schemes are only available in the Dutch language.
For more information on our international activities please mail to: Eveline Gommers (e.gommers@hkz.nl)