What is a focus clinic?

By Maarten Zoomers · July 14, 2026 · 5 min read

Dunes with marram grass, seen from above

Run a morning outpatient clinic as a specialist and you see a bit of everything in a few hours: a new referral, three follow-ups for different conditions, a patient calling in between, and the admin around it all. Every patient gets attention, but nobody gets a care pathway designed entirely around them. A focus clinic turns that around.

A focus clinic is an outpatient clinic built around a single condition, or a small group of related conditions. One stable team treats those patients along one protocol and measures the outcomes. Because everything is designed for that one group, care can be faster and better, with less overhead than a general outpatient department.

We believe a lot of chronic care can be improved this way: faster for the patient and better to work in for the specialist. That is why at Seeve we are building exactly this kind of clinic. The idea itself is not new, by the way. Below you can read where it comes from, how a focus clinic differs from a hospital outpatient clinic and an independent treatment centre, and where the model works and where it does not.

Where the idea comes from

Focus in health care is not a new idea. Shouldice Hospital in Canada has done nothing but repair abdominal wall hernias since 1945. Its surgeons each perform fifteen to twenty repairs a week, and Shouldice has one of the lowest recurrence rates in the world.

In 1974 Harvard professor Wickham Skinner gave the principle a name: the “focused factory”. A plant that tries to serve too many products and markets at once performs worse than one that concentrates on a few. In the late 1990s Regina Herzlinger, also at Harvard, applied the idea to health care. She described teams organised around one chronic disease, bringing together every discipline that patient needs. Her example was diabetes: internist, cardiologist, podiatrist and lifestyle support in a single team.

In practice, focus has so far mostly been applied to procedures. In the Netherlands you see this in independent treatment centres (ZBCs) for cataracts, knees or varicose veins. There, focus is mainly about one thing: making the best possible use of an expensive operating theatre and an expensive team.

We believe the biggest gains lie in chronic outpatient care, which is what Herzlinger was already talking about. There, it is less about pure production and more about a well-designed care pathway, a stable team and good follow-up, often for years. For us that is the core: care is organised around the patient group and the specialist who knows that group best, not around an expensive operating theatre that has to be booked as full as possible.

Focus clinic, ZBC or hospital outpatient clinic?

Legally, an independent focus clinic in the Netherlands is usually simply an independent treatment centre (zelfstandig behandelcentrum, ZBC), with its own licence under the Healthcare Providers Admission Act (Wtza) and its own AGB code (the Dutch healthcare provider code). The difference lies in how the clinic is set up and for which patient.

	Hospital outpatient clinic	Classic ZBC	Focus clinic inside a hospital	Independent focus clinic
Built for	All patients of a specialty	Planned procedures	One condition, within the hospital	One condition or a small group
Typical care	Broad, from simple to complex	Cataracts, knees, varicose veins, endoscopy	For example reflux or IBS	Chronic care: diagnosis, treatment and follow-up
Overhead	High, designed for acute and complex care	Low to moderate	The hospital’s	Low
Team	Varies with the rota	Surgeon plus support staff	Fixed team within the department	Fixed team: specialist, physician assistants, junior doctors, nurses

An example of the third column is Medisch Spectrum Twente, a hospital in the east of the Netherlands, with focused clinics for reflux and irritable bowel syndrome.

At the focused clinic, the wait is a quarter of that at the general clinicWait for a first appointment, Medisch Spectrum Twente. Each block is one week.

General gastroenterology clinic12 weeks

Focused clinic for reflux and IBS3 weeks

Source: Medisch Spectrum Twente, waiting times gastroenterology and FocusPoli.

That shows focus already works within a hospital. There is evidence from outside the hospital as well. Studies have compared independent clinics with hospitals for the same treatments.

Clinics cost slightly less per treatment, with the same or better qualityIndependent clinics compared with hospitals, for comparable treatments

3.8–5.4%lower cost per treatment for cataracts, hip osteoarthritis and skin cancer

Same or betterquality of care at the clinics, on the outcomes measured

Source: comparative studies of independent clinics and hospitals (2022). A literature review by the Dutch Health and Youth Care Inspectorate (IGJ, 2022) found quality at ZBCs no better than in hospitals, but not plausibly worse either.

Those studies cover procedures. For chronic care, comparisons like these hardly exist yet, and that is exactly what we are looking at. An independent focus clinic does the same as the focused clinic, but without hospital overhead and with more freedom to design the care pathway and the systems around it. That is also why we think it can work especially well outside the hospital: the specialist decides what the care looks like, and everything else is organised around that. Our aim is explicitly the care that currently falls between the cracks: patients with a chronic condition and years of follow-up, for whom hospitals struggle to find room and whom independent clinics have so far rarely focused on. That way we take on work that genuinely relieves the hospital, rather than the simple procedures it handles well itself.

Which conditions does it work for?

I think a focus clinic works best when a condition has four features:

Outpatient. It needs little or no theatre time, admission or heavy equipment. Where a step in the pathway does require a hospital, it can be arranged with one nearby.
Chronic or long-term. Patients stay in care for years, with regular follow-up. That is where a stable team and a good pathway add the most.
Enough volume. There are enough patients to dedicate a whole team to them.
A clear protocol. There is a guideline or treatment sequence that can be written down, so tasks can be shared between specialist, physician assistant and junior doctor.

Inflammatory bowel disease, inflammatory arthritis, osteoporosis, sleep disorders and menopause care are examples that fit.

There are limits too, and they matter. Patients with many conditions at once need a generalist who keeps the overview, not five separate focus clinics. And a clinic that takes only the simple patients and sends the rest back makes the hospital’s job harder, not easier. Clear agreements with hospitals and GPs about who goes where are therefore part of the model.

Do you recognise a condition in your own field that fits this description, and do you see how its care could be better? Then I would like to hear from you. At Seeve we build clinics around one condition, with the specialist in charge and our platform for everything else. Feel free to email me at maarten@seeve.ai.

Frequently asked questions

What is a focus clinic? An outpatient clinic dedicated to one condition or a small group of related conditions, with a fixed team, one protocol and measured outcomes.

What is the difference between a focus clinic and a ZBC? Legally, an independent focus clinic is usually a ZBC. Classic ZBCs mainly focus on planned procedures. A focus clinic covers all the care for one condition, often chronic care with years of follow-up.

What is a focus outpatient clinic in a hospital? A clinic within a hospital that focuses on one condition, such as the focused clinics for reflux and IBS at Medisch Spectrum Twente.

Where does the idea come from? From Wickham Skinner’s “focused factory” (Harvard Business Review, 1974), later applied to health care by Regina Herzlinger.

Which conditions suit a focus clinic? Conditions that are mainly treated in outpatient care, stay in care for a long time, have enough patients and follow a clear protocol.