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Objectives: Investments in health research should lead to improvements in health and health care. This is also the remit of the main HTA program in the Netherlands. The aims of this study were to assess whether the results of this program have led to such improvements and to analyze how best to assess the impact from health research. Methods:We assessed the impact of individual HTA projects by adapting the "payback framework" developed in the United Kingdom. We conducted dossier reviews and sent a survey to principal investigators of forty-three projects awarded between 2000 and 2003. We then provided an overview of documented output and outcome that was assessed by ten HTA experts using a scoring method. Finally, we conducted five case studies using information from additional dossier review and semistructured key informant interviews. Results: The findings confirm that the payback framework is a useful approach to assess the impact of HTA projects. We identified over 101 peer reviewed papers, more than twenty-five PhDs, citations of research in guidelines (six projects), and implementation of new treatment strategies (eleven projects). The case studies provided greater depth and understanding about the levels of impact that arise and why and how they have been achieved. Conclusions: It is generally too early to determine whether the HTA program led to actual changes in healthcare policy and practice. However, the results can be used as a baseline measurement for future evaluation and can help funding organizations or HTA agencies consider how to assess impact, possibly routinely. This, in turn, could help inform research strategies and justify expenditure for health research.

This paper reports on the refinement of constructive conflict methodology (CCM) combining Q methodology and stakeholder dialogue workshops for gas futures for the Netherlands. Since the end of the 1950s, natural gas exploration and exploitation has been a major focus of the Dutch energy policy. Discussions about the future of energy in the Netherlands tend to focus either on pro-gas or pro-renewable energy. Using Q methodology we have constructed more nuanced perspectives on the future of energy in the Netherlands. We used these perspectives in a stakeholder dialogue, in which the participants further detailed the perspectives and discussed future policy options. Analysis of the outcomes of this process teaches us that the Netherlands remain gas-focused, that renewable energy sources are as much a dogma as nuclear power was in the 1960s, and that the prospect of an austere future is a non-debatable issue. From a methodological perspective it can be concluded that the refined methodology contributed to diversity in views, opened up the dominant discourse and led to learning among participating stakeholders.

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In times of restructuring governmental policies and resources, the need for strategic asset management is growing. Maturity models offer organisations a structure to assist them in improving their asset management performance. We present the results of a repeated maturity measurement based on the Infrastructure Management Maturity Matrix (IM³) in Rijkswaterstaat, a Dutch public infrastructure organisation. The IM³ distinguishes five maturity levels from ad hoc to optimised, and seven asset management dimensions: information management, internal coordination, external coordination, market approach, risk management, processes & roles, and culture & leadership. The results show significant progress on all dimensions, and continued learning and widespread awareness of asset management in the organisation. In the discussion we reflect on the findings and possible future developments for the organisation. We also discuss the potential impact of infrastructure maturity models for the professionalization of other asset intensive organisations.