Our work examines how policy commitments, definitions of value and institutional arrangements shape decisions and outcomes.
Across European policy, healthcare access and service delivery, we develop approaches that connect strategic analysis with institutional and operational design.
The selected examples below illustrate the challenges we engage with, the questions guiding our work and the contributions we make.
European rare disease policy involves multiple institutions, governance levels and implementation responsibilities. Strategic commitments do not automatically produce coordinated national action.
The challenge is not simply determining what Europe should prioritise, but establishing how those priorities can be translated into coherent institutional responsibilities and practical delivery arrangements.
How can European coordination be connected more effectively to national implementation without unnecessarily duplicating existing institutional structures?
Development of a proposed policy and delivery framework examining how European and national mechanisms can be better aligned, responsibilities clarified and implementation strengthened.
The approach focuses on the institutional architecture required to translate strategic commitments into action.
Decisions concerning orphan medicines must navigate clinical uncertainty, patient need, economic considerations, evidence requirements and institutional responsibilities.
These considerations can operate according to different definitions of value, creating challenges for predictable, accountable and timely access.
How can competing rationales of value be addressed within a policy and reimbursement framework that is credible, operationally feasible and responsive to the realities of rare diseases?
Co-development of a proposed system-level approach to orphan medicine access in the Netherlands, examining how therapeutic uncertainty, financial and system-level risk, evidence requirements and patient-relevant considerations can be addressed within a more coherent assessment and decision-making pathway.
The work focuses on connecting competing perspectives of value with practical policy and access considerations, supporting a more structured approach to navigating uncertainty and informing decisions concerning orphan medicines.
Complex healthcare decision-making involves multiple institutions and stakeholder groups, each contributing different forms of knowledge, evidence and perspective.
Yet participation alone does not ensure that these contributions are retained, integrated or made relevant to decisions. Fragmented interactions, unclear responsibilities and discontinuity between assessment stages can undermine the coherence of the overall process.
How can governance be structured to integrate stakeholder contributions across a complex decision-making pathway while preserving institutional independence, accountability and existing decision-making authority?
Development of a conceptual governance architecture and its operational translation for the Orphan Track model within the Dutch healthcare context, informed by an independently designed and facilitated governance reflection session with patient representatives.
The framework defines stage-specific governance interactions, stakeholder roles, coordination requirements and safeguards across the assessment and access pathway.
A central feature is the design of a system-level integration function intended to maintain continuity between stakeholder contributions and formal decision-making processes without introducing an additional institutional layer.
These questions inform how we approach institutional challenges across different policy and decision-making environments.
We work with organisations seeking to rethink how decisions are made, how value is understood and how institutional systems can function more effectively.