Intended for healthcare professionals


Can patient centred care plus shared decision making equal lower costs?

BMJ 2019; 367 doi: (Published 15 October 2019) Cite this as: BMJ 2019;367:l5900
  1. Gemma Venhuizen, journalist
  1. Amsterdam, Netherlands
  1. gemma.venhuizen{at}

Gemma Venhuizen visits the cutting edge Dutch hospital Bernhoven, where the results of a five year trial are promising

On a late summer’s day, bees are buzzing near Bernhoven Hospital, attracted by the flowers near the entrance. Bright green bikes are parked next to the revolving door—patients and their friends and families are free to use them to explore Maashorst, the nearby nature reserve. The hospital, situated in the southern part of the Netherlands, is clearly living up to its own slogan: Bernhoven Natural.

The most unique selling point of Bernhoven, however, is not about nature. In fact, it is not even visible from the outside. You see it as you enter the hospital—a poster that says, “Better healthcare starts with a good conversation—in this hospital, we decide together.” This is what makes Bernhoven famous among hospitals around the globe: its hospital-wide, patient centred approach.

Bernhoven is situated near Uden, a town in the province of Noord-Brabant. One of around 85 hospitals in the country, it is medium sized with 380 beds, 18 000 admissions per year, and 2250 employees (including 140 medical specialists).

Like most Dutch hospitals during the past few decades, Bernhoven has struggled with increasing costs. In order to avoid a future scenario in which more efficiency would lead to less time for patients, the hospital decided to cut costs another way. In 2014, Bernhoven began its five year strategy Better care by less care, in which unnecessary consultations, intakes, and operations are avoided as much as possible.

The numbers are good

The first results were promising: overall there was a 17% decline in healthcare costs between 2014 and 2018. The number of patients ending up in expensive hospital beds has decreased by approximately …

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