[Quality of care: intensification, not new policy]

In the nineteen-eighties the introduction, use and maintenance of protocols improved the quality of care. Since then, it has become clear that this does not provide a guarantee: various studies have shown disappointing compliance with validated protocols. Therefore implementation is considered a vital aspect of quality assurance. A recent study in the USA focused on acute myocardial infarction care and compared 11 low- and top-performing hospitals in order to learn more about relevant constraints, interactions and mechanisms. Five factors, the selection of which was based on earlier research, proved to be relevant. Although the Dutch health care system is different from the American system, the outcome of this study is of some value. The homogeneity in the Dutch health care, stimulated by government policy, results in less difference between hospitals. The outcome of the analysis of the 11 hospitals confirms the value of our uniformity. Therefore this study advocates current Dutch policy.