Background: As part of a large, nationwide programme to reduce healthcare costs and improve quality of healthcare, the so-called quality cycles of 30 subjects were drawn up. The cycles plotted tools and initiatives in 3 steps: describing good care; implementation; and measurement/evaluation. For each step 3 levels were reviewed: patient-doctor, institutional and macro/national.

Objectives: To get the quality circle turning by obtaining a clear picture of the subject whilst identifying which tools and initiatives already exist, what is missing, prioritising bottlenecks and developing action plans to solve these with parties across the care spectrum. The second objective was get parties to know each other and work together.

Methods: The project ran from 2015 to 2016 an a mix of methods was used. Desk research was performed to map the steps of the 30 quality cycles. Interviews were performed with patient and medical specialist associations. Interactive meetings were organised, in which various stakeholders discussed the cycle, added to and adjusted it and agreed on and prioritised the bottlenecks. For the top-5 priorities action plans were developed (stating the 5 Ws, possible funding and timing).

Results: This project yielded insight into the current state of affairs for 30 subjects. Almost 700 participants attended the meetings and created nearly 150 action plans to improve quality of care. Although many tools were available describing good care, such as guidelines and patient-decision aids, tools for implementation and evaluation were less abundant.

Conclusions: The quality cycle is suitable to identify existing tools, initiatives and bottlenecks. The meetings helped to establish contact between stakeholders, allowing a better understanding of each other's perspectives. However, greater effort is needed to get the cycle turning. Furthermore, there seems to be an emphasis on describing good care but the next steps appear to be missing. Perhaps because of lack of knowledge about implementation or change management. This means that use of tools like guidelines is suboptimal, which is a pity considering the effort and time put into them.