Dutch hospitals are embarking on an ambitious effort to systematically reduce what clinicians and patients alike recognize as unnecessary care. Dubbed “Less is more,” the initiative aims to streamline healthcare delivery by eliminating procedures and tests that offer minimal benefit, freeing up resources and improving the patient experience. This isn’t a top-down cost-cutting measure, but a groundswell of change originating from within the medical community itself, driven by a desire to focus on interventions that truly make a difference. The core principle is simple: fewer interventions with limited value mean more time and attention for those who genuinely need it.
The movement gained momentum during the COVID-19 pandemic, when disruptions to routine care revealed that many long-standing practices didn’t necessarily impact patient outcomes. This realization sparked a broader conversation about the value of certain procedures and the potential for reducing unnecessary burdens on both patients and the healthcare system. The initiative, formally launched in 2025, is currently focused on 17 specific areas of care, with a target completion date for guideline adjustments by the end of 2026, a notably accelerated timeline compared to traditional guideline development processes.
A Shift in How Guidelines are Viewed
Traditionally, medical guidelines are updated based on new scientific evidence. “Less is more” takes a different approach, re-examining existing practices and questioning the evidence – or lack thereof – that originally supported them. Many procedures have remained standard practice for years without robust supporting data, and the pandemic provided a natural experiment demonstrating that delaying or eliminating some of these practices didn’t harm patients. As Ilsalien Bakker, a medical advisor and project leader with the Netherlands’ Program for Healthcare Evaluation & Appropriate Use (ZE&GG), explains, “For many of these procedures, the added value has long been minimal. We didn’t want to wait years for more research before making a change.”
The initiative involves twelve scientific associations within the medical specialist care sector (MSZ), working closely with patient organizations to identify and implement changes. These proposals were funded by ZE&GG, and the resulting guideline adjustments are expected to be incorporated into the national MSZ implementation agenda beginning in 2027. This agenda dictates the priorities for hospitals across the country, ensuring widespread adoption of the new standards within two years.
Endoscopy Reductions: An Early Success Story
One of the most prominent examples of “Less is more” in action is within gastroenterology. For years, patients diagnosed with low-risk Barrett’s esophagus – a condition that can increase the risk of esophageal cancer – routinely underwent endoscopic examinations. When COVID-19 temporarily halted these screenings, researchers found no evidence of negative consequences for patients. This led to a revised guideline that significantly reduces the frequency of these endoscopies.
The change is already having a tangible impact. Thousands of patients are now spared unnecessary procedures, and hospitals are experiencing reduced wait times for those who truly require endoscopy. “This example clearly demonstrates the effect of the entire movement towards appropriate care,” Bakker notes. “When you stop doing something that adds little value, space is created, and that space is now being filled by addressing the long waiting lists.” The Dutch Federation of Medical Specialists (Federatie Medisch Specialisten) has also developed guidance for formulating clearer, more specific recommendations in medical guidelines, moving away from vague suggestions like “consider” towards definitive recommendations for action or inaction.
Expanding Beyond Gastroenterology
The scope of “Less is more” extends far beyond endoscopy, encompassing a diverse range of medical specialties. In surgery, there’s a growing trend towards treating uncomplicated cases of acute appendicitis with antibiotics rather than immediate surgical intervention – a practice that has gained public attention and, in some cases, patient demand. Neurologists are exploring the possibility of safely managing patients with mild strokes at home, avoiding unnecessary hospital admissions. And across various oncological disciplines, follow-up care is being streamlined, recognizing that intensive monitoring doesn’t always translate to improved outcomes but can significantly increase patient burden.
Implementing these changes requires careful consideration, and communication. While new patients can be immediately informed about revised care pathways, existing patients need clear explanations about why their treatment plans are changing. The Patiëntenfederatie Nederland (Netherlands Federation of Patients’ Organizations) is actively involved in all stages of the process, providing input on content, drafting communication materials, and serving as a sounding board for patient concerns.
A Cultural Shift in Healthcare
Even before the new guidelines are finalized, hospitals are reporting a growing awareness of the “Less is more” initiative. Patients are asking questions about procedures they’ve seen discussed in the news, and some departments are already experiencing a shift in demand for certain services. Hospital project groups are proactively revising care pathways, updating protocols, and coordinating with supporting teams like nurse specialists and triage personnel.
The long-term benefits of reducing unnecessary care are expected to include improved access to essential services and a reduced burden on patients. “If less time is spent on procedures without added value, more time becomes available for patients who need it,” Bakker explains. “This applies to both outpatient clinics and diagnostics and admissions.” minimizing unnecessary tests and procedures can reduce patient anxiety and disruption to daily life.
The initiative is not simply about cutting costs; it’s about fostering a more thoughtful and patient-centered approach to healthcare. It represents a fundamental shift in how medical professionals view guidelines and care processes, creating a mindset where interventions are carefully evaluated for their true benefit. As Bakker emphasizes, “We are starting something bigger than this list of topics. We are creating a way of thinking where care that adds no value is no longer taken for granted.”
Disclaimer: This article provides general information about healthcare practices and should not be considered medical advice. Always consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
The next key milestone for “Less is more” is the finalization of the revised guidelines, expected in early 2027. The subsequent implementation phase will be closely monitored to assess the impact on patient care and healthcare resource allocation. We encourage readers to share their thoughts and experiences with this evolving approach to healthcare in the comments below.
