[The implementation of non-effective care - how and why].

Increasing pressure on the healthcare system makes it essential that we use limited resources efficiently. In addition to implementation of (cost-)effective care, de-implementation, the abolishment of ineffective care, is important. In two recent Dutch examples, on de-implementation of back pain care and tonsillectomies/adenotomies, it appears that de-implementation can take up to decades. Based on the literature, we describe facilitators and barriers for de-implementation: personal factors of the practitioner (e.g. knowledge), socio-political (e.g. insured care) factors, factors related to the innovation (e.g. guidelines) and organizational (e.g. healthcare procurement) factors. De-implementation can be accelerated by focusing on these factors; e.g. through further adjustment of compensation systems and improvement of (applicability of) guidelines in combination with (de)implementation activities (such as training and campaigns).