Healthcare organisations deserve more trust (and must have their business operations in order)

By Health, News

The bankruptcy of both MC Slotervaart and MC Zuiderzee has dominated the news in recent weeks. Although the care system in the Netherlands is one of the best in the world, the two hospitals are symbolic of the chaotic business operations plaguing this sector. Healthcare organisations are also companies, which should not shy away from healthy competition, and should, in general, implement well-thought-out rationalisation and positioning plans. And this comes with (financial) risks.

Every care manager has to deal with it; health insurers that interfere with substantive procedures in hospitals, authorities that would rather impose extra rules than discuss them, and specialists who want to staunchly defend their crucial position within the hospital. Cooperation is hard to find; everyone seems to be acting out of self-interest. ‘Bubbles’ is what Femke Keijzer calls them. The Healthcare Director at IG&H recently spoke to about 30 different Dutch health care managers on this subject for her book ‘Fit Health Care, the step towards healthy management’.

“Corporate responsibility is a disliked point: it is not at all among everyone’s top three interests to act upon,” she says. The metaphor of an ice hole in the care pond came into being: good concrete plans are there, but who has the courage to take the plunge and really make the transformation. The financial pressure is inadequate and if you jump you take risks. And that while you also get a lot healthier as you come up.

‘We must strive for connection’

Keijzer realises it is not an easy situation to break through. “The rules of the game no longer suffice. As long as we do not change them, we will not solve this problem. If we want to keep our care affordable, we must first repair the roof before we furnish the house. The management must be fit. This is only possible from a basis of trust, instead of just another system change”, she says.

“Regardless of what happens in a sector; the customers must be central. They have no interest in slow internal processes, but want to be helped quickly and effectively. Close to home with as few inconveniences as possible. Therefore, break down the walls between specialists, departments, and external organisations, and only focus on performance”, says Keijzer.

When you do that, you can then make better-informed choices as a healthcare institution. “You also know which ‘buttons’ you have to push, for example, to achieve a shorter walk-through time or to increase patient satisfaction. You also save, because you prevent medicine intake, or surgery is not necessary.”

Playing to win

It requires quite a lot from a care organisation. We often hear now that the business operations must be in order: this is about administrations and ICT, correct information, and your financial risks. It is necessary that the direction of the organisation fits well with this.

“Value-based healthcare sounds great, but if we do not know whether it is profitable from a financial point of view or if the use of, for example, medical specialists and ORs is not optimal, then you should put the priority there first”, says Keijzer. “And then a playing to win mentality can come in handy.” Consistent leadership with a strong dose of guts and the involvement of a leading coalition makes it a success.

No more external pressure

But what should we do with authorities, insurers and regulations that increase the pressure on healthcare institutions in the hope of saving costs? Initially I say: abolish, according to the Health Director. “Research has shown that external parties do not generate a sense of urgency among healthcare administrators. All this pressure only distracts, and costs both time and money. It also makes no sense to point out to managers that they have a social responsibility.” So letting the market operation continue to work is a good plan.

If we want to prevent hospitals from collapsing, health insurers to see their costs rise, and the patient ultimately having to pay for the bill, we need to give hospital administrators more freedom. “They are now ready to change the care landscape, so give them the space and the financial resources. The required margins in healthcare must, for example, be realistic. Within the partnership with the health insurer, a hospital must have time: return does not always come in the first year. That is why long-term vision and planning are crucial.” And then the hospitals choose overturn themselves because care in the region is better organised.

Who should pick up the ball? (And where do they start?)

What is needed is that we appeal to everyone’s social responsibility in combination with a healthy dose of realism. Give healthcare administrators the confidence to take this responsibility and help them to make decisions. Join us if you are a medical specialist and are open to change. We have seen hospitals take the first good steps: follow them, and do not be too arrogant: you can learn something from everyone. And that you yourself can do better than the other is the right goal to have for the next few years, and also the challenge.

Book ‘Fit healthcare’ released: author Femke Keijzer’s ‘how,’ ‘what,’ and ‘why’

By News

In the 16 years that I have been active in the field of healthcare, it increasingly struck me that performance management is not that obvious in this sector. A question I regularly encountered was: Why would you get started with it? I found this so astonishing that I decided to perform research – together with Paulina Snijders, former financial director at the Erasmus MC. We incorporated our findings and recommendations in our book Fit healthcare: the step towards healthy control. In this blog, I’d like to tell you more about it.

Development: why write a book on performance management in healthcare?

Where is the urgency? This was the first question that arose. My hypothesis: it is socially responsible to improve performance management. But usually, this doesn’t rank in the top 3 reasons. Common motives include financial improvement and entrepreneurship (directors or teams with an ambition to improve). Understandable, but also a pity. Because in my opinion, the social issue shouldbe a primary motivation.

Furthermore, a lot is involved in implementing performance management and going through with it. Oftentimes, for example, it is accompanied by a culture change. In practice, going from ambition to realization isn’t always that easy.

Moreover, few has been written on this subject in the past 10 years, while there is a great need for it.

The decision to write our own book about it was quickly made. After all, there are still plenty of opportunities to improve performance management in healthcare, and I would like to contribute my bit.

Approach: from interviews to healthy business operations

In the fall of 2017, I conducted a range of interviews using a structured questionnaire. I talked to directors and supervisory board members, but also to health insurers and scientists. The main question: How do they think hospitals should act?


It turned out that many didn’t know exactly how a hospital manages performances and what impact performance management has. So if you ‘press a button,’ such as productivity, it is often unclear where it leads. What I noticed was that people really live in a bubble. Not only health insurers, but also medical specialists sometimes operate in enitrely different worlds. This is incredibly complex for directors.

The Erasmus MC, where I worked on a major process in the field of performance management, played an important role in the development of the book. Former financial director Paulina Snijders provided more case histories. Together, we succeeded in putting the case into words. In addition, we established a theoretical framework for managing healthcare performance as well as for healthy business operations.

Intended outcomes: how will you benefit from the book?

On the one hand, I hope that you will recognize the problems you encounter as an administrator or decision-maker in healthcare. In that case, you can use the recommendations on points you need to tackle. Also, you should realize that it doesn’t have to be complicated: often, it’s a matter of cold feet. The business case is always positive. On the other hand, I would like to say: be astonished and take the message to your organization. I aim to start a debate, so we will jointly get a sense of social responsibility. This can create the space required to act collectively and take the next step towards good, affordable healthcare.

Finally, I hope to provide insight into the interconnection between existing bubbles, the status quo, and the steps to be taken. The book contains a model that provides guidance. When you use this, you will see that performance management really doesn’t have to be that complicated.

Author: who am I and what is my vision?

As an expert in the field of (the transformation of) financial management in healthcare, I consult on complex issues in the areas of funding, control, and performances. I help implement and realize structural changes. With over 16 years of consulting experience within healthcare, I can definitely call myself a sector insider.

After months of intensive work on the book, I can draw one firm conclusion: it is high time for all hospitals, health insurers, and regulators to start working on this subject concretely, and there is no one best-fitting solution that will work for all hospitals. To write the book, I entered into a dialogue with several people. I would like to continue along this line, especially now that the book has been written. Here’s why this is important to me. When I started writing, I’d arrived at a point in my life where it was crucial to me that I could really make a difference as a consultant. I believe that I owe it to the sector to share my knowledge and experience. And hopefully, I will stimulate everyone sufficiently to actively strive for more healthy business operations and performance management.

In my eyes, this message is only logical. What is your vision? Read the book and form your own judgment!

For more information contact: Femke Keijzer,