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On Your Own Feet

Three research projects

Publication date: 01 April 2004

The ‘Transitions in Care’ research group, part of Research Centre Innovations in Care of Rotterdam University of Applied Sciences, initiated a research project focused on adolescents with chronic conditions, called On Your Own Feet.


'On Your Own Feet Ahead'

The Action and Implementation Programme 'On Your Own Feet Forward!' (2008-2012) aimed at introducing improvements in the content and organisation of care for youth with chronic somatic conditions. The main goal was to improve the self-management support during their transition to adulthood, and contribute to better organization of transitional care.

For the implementation of the Action and Implementation Programme, the Breakthrough Methodology was used. The American Institute for Healthcare Improvement developed the Breakthrough Series to help health-care organizations make "breakthrough" improvements in quality while reducing costs. This is a proven method of accelerating the introduction of improvements in healthcare practice.

In a Breakthrough Project, multidisciplinary teams from different institutions work towards optimising the care of a particular topic or care process. Proven examples of good practice collected in the field together with experts and then made available for wider distribution are used. Participating teams are supervised by a team of consultants and experts in the field. More information about the Breakthrough Series can be found on the IHI website.

Our Action Programme 'On Your Own Feet Ahead!' was developed and tested in three rounds (2008, 2010, and 2011). A total of 30 multidisciplinary teams from different healthcare organisations such as hospitals and rehabilitation centres from all over the country participated. Each team formulated their own mission and goals for improving their practice in adolescent medicine and their transitional care arrangements within one year. A common framework for the improvement of transitional care was developed, and interventions were collected and tested. After the Action Programme was completed in 2012, these were all put together in a digital Transition Toolkit.


The Action Programme is an initiative of the Transitions in Care research group at the Rotterdam University of Applied Sciences and the CBO, and was funded by the Innovation Fund of Health Care Insurers. The Dutch National Diabetes Action Programme, the Dutch Association of Paediatricians, the Dutch Rehabilitation Foundation and the National Innovation Programme Child Rehabilitation all wholeheartedly supported the goals of the program.

An independent evaluation study was carried out by the Erasmus School of Health Policy and Management (Erasmus University Rotterdam). The report concludes that the teams' participation in the programme resulted in improved quality of transitional care. The programme inspired teams to improve transitional care, provided them with several good practices and tools, and facilitated the implementation process. However, substantial improvements as reported by adolescents mostly show up in the long run. Almost all teams succeeded in sustaining the implemented new work practices and some of them further developed transitional care after the programme was ended.

The full summary of the report can be downloaded here.

List of publications related to the Action Programme 'On Your Own Feet Ahead':

  • Sonneveld, H.M., Strating, M.M.H., Staa A.L. van, Nieboer, A.P. (2013) Gaps in transitional care: What are the perceptions of adolescents, parents and providers?Child: Care Health Development. 39(1):69-80. doi:10.1111/j.1365-2214.2011.01354.x.
  • Nieboer, A.P., Cramm, J.M., Sonneveld, H., Roebroeck, M.R., Staa, A.L. van, Strating, M.M.H. (2014). Reducing bottlenecks: professionals' and adolescents' experiences with transitional care delivery. BMC Health Services Research 14:47.
  • Cramm, J.M., Strating, M.M.H, Nieboer, A.P. (2014). The role of team climate in improving the quality of chronic care delivery: a longitudinal study among professionals working with chronically ill adolescents in transitional care programmes. BMJ Open, 2014; 4. Doi: 10.1136/bmjopen-2014-005369.