Setting up the organization of the Princess Máxima Center: “Streamlining countless structures”

By | Healthcare, News

“It’s a good thing you don’t know what you’re getting yourself into, that’s a pro”, Dieneke Mandema says facetiously looking back on the last year and a half. As President of the Organization and HR, she was one of the people responsible for setting up the Princess Maxima Center.

The center, that is specialized in care, research and education in the field of pediatric oncology, opened its doors for the first time on 18 May. When Mandema took the job, there was no building, and hardly any staff or structure. Unheard of in the current market and a challenge, especially due to the staff shortages in the healthcare sector. “And what is better than being able to work on the mission to cure all kids with cancer while maintaining their quality of life?”

“We started with a blank piece of paper in November 2016. We needed new staff, nurses for example. At the same time, we didn’t have an existing company structure to fall back on. There wasn’t even a building. We were faced with the challenge of starting a center within one year and developing the foundation of the organization at the same time. We also had the opportunity to reinvent the wheel quite often thanks to the innovative character of the brand-new center and adapt it to the needs of kids and their parents”, Mandema says.

Marketing campaign to attract staff

Healthcare professionals are a rare commodity these days. To still be able to fill all positions, we deployed a so-called ‘recruitment factory’, linked to a labor market campaign. “We sold the vacancies like they were products.” The hospital played into the experience of nurses and put children at the center of the campaign. These were then brought to people’s attention via social media. It turned out to be a huge success. “When the campaign went live on Christmas Eve, we had hundreds, thousands of replies within several hours. We definitely didn’t count on that, so we all had to jump in to answer all the questions.”

‘This hospital has a unique company structure’

Hiring people is one thing but having them land in the organization is another. “The biggest groups started on 1 and 18 May. Until then, we were working for the Princess Maxima Center in five different locations. We had a construction trailer, a floor at the UMC Utrecht (Wilhelmina Children’s Hospital) and worked from an office building in Zeist”, Mandema says.

Basing the hospital’s structure entirely on an existing organization wasn’t an option, she explains. “Our basic organization is completely different. With us, the kids don’t go to the doctors, the doctors come to the kids. The entire logistical process of the hospital revolves around the child. That is unique.”

To make sure this ambitious plan wouldn’t strand in chaos, Mandema also decided to hire IG&H. “I really see them as a business partner that thinks along with us and is great at developing processes. They have a pleasant way of looking at what is necessary; they’re action-oriented, but with a human dimension. A business consultant merely making decisions, isn’t going to make it. That doesn’t fit with our center.”

Mapping out structures so processes run smoothly

Mapping out processes, which had an extra layer of complexity due to all the different locations and help systems, was a challenge. “I can still see Anouk standing there with an overview of all the HR and recruitment milestones: ‘No, no wait! I have something else! Guys, be quiet for a minute'”, recalls Mandema. It didn’t take long until several rooms were covered in post-its.

“It also didn’t take long before the document was meters long”, adds Anouk Baars, Health consultant at IG&H. “The starting hospital was using several technical systems, amongst which that of the UMCU. But we also had to reinvent the wheel for ourselves a few times. There was no insight into these processes yet, so we wrote everything down first. Then it became clear that about thirty things had to be in place before someone could start providing healthcare for some jobs.”

That way we figured out which members of staff were trained where, what the team structure looked like and where they could take their questions. “Everyone wants everything to run smoothly, but there needs to be a system for that first. The IT department was recruiting people themselves, for example. The same went for the medical teams. To make sure everyone has the right training, there needs to be someone taking the lead and overlooking all of this”, she says.

Trial and Error

Every week, Baars and Mandema sat around the table with a team to structure. What are we running into, how are we going to take this on and who is responsible for this process?, were the main questions Mandema asked. “It was a challenge for everyone, because no one had experience with a similar project.”

“Sometimes we had to do things the old-fashioned way. I regularly had to walk to and from the UMC Utrecht 5 or 6 times a day to sort out IT- or HR-related cases”, Baars says. The team had an issue with digital authorizations, for example. Which doctors have access to which files? It turned out no one had taken responsibility and it had to be sorted out fast. In this case we had to take care of the problem right away. Definitely important, because children would come to our hospital at the same time as their doctors. Nothing was allowed to go wrong.”

Practical solutions for complicated problems

To prevent any issues, Mandema and Baars ran around like headless chicken the last few months before the opening. “In May, our list of priorities was huge. We realized how complex the situation really was. The fastest way to make sure all new staff could start working right away, was to implement everything they needed into an excel sheet manually. That is why I did that once. I locked myself up for an entire week to make an inventory of things every employee needed and whether they had received it or not. After the opening, we turned this into a structural process”, Baars says.

This challenging time also caused some tension between the teams. “IG&H was definitely a good mediator. They brought people together, especially if something wasn’t taken care of right away. To prevent these situations to become worse, they only looked at the content. Who needs what and how do we arrange that as quickly as possible? Afterwards we looked at how the teams involved could take their responsibilities, so these structures matched the practical applications”, says Mandema .

‘To do lists are getting shorter and shorter’

By now, the center has been open for half a year already. Dozens of children are treated and supported by doctors, nurses and pediatricians daily. They come by for a day treatment or stay at the hospital longer for the more difficult parts of the treatment. For each room the kids stay in, there is an adjoining room to for the parents, a parent-child-unit.

Baars’ and Mandema’s to do lists are getting shorter and shorter. “We are currently determining how the organizations can pick up things themselves. We are past the real hurdles; everyone is helped by the right team and are able to ask their questions to the right person. The hospital has its own routine now.”

What would happen if innovative parties work together using a new mortgage platform?

By | Banking, News

Imagine one-stop-shop for everything you need for your mortage…

Finding your dream home on the first try and immediately having all the documents for your mortgage application at hand. It sounds like a dream scenario, something that people will enjoy in the distant future. However, this dream scenario is actually much closer than you think. Various innovative parties are already individually working on parts of this process. What would happen if they all worked together?

We have created a fictitious scenario in order to show the possibilities:

Step 1 | The search
Your dream home, based on personal data

As a consumer, your knowledge of the housing market is still limited. Suppose you want detailed advice based on your personal preferences and behavior: whether you should rent, sell/buy or renovate, where to live? By linking various data sources such as your travel time, CBS for demographic development and even your LinkedIn for the best chance of finding work; you will quickly find which home best suits your lifestyle.

As a consumer?

Finding the perfect location will be a better investment and also create a higher quality of life.
Innovative parties already offering solutions: Buurtkompas, Suburbia.

Step 2 | Bidding
Peace and security through personal digital support

This is where it gets exciting. Arranging everything when it comes to a new property or mortgage is always a hectic process, even if it is made as easy as possible. Doubt often can take the upper hand. Am I really making the right decision? Technological progress has made the whole process much simpler. Augmented reality tells you everything about the house and the neighborhood. A smart algorithm helps you to make the ideal bid, so that you are able to buy a house without overpaying. Once you have made the bid, you will be digitally (but personally) at the time and place that suits you best.

As a consumer?
No longer pay an average of €4,000 – €5,000 too much for your dream home.
Innovative parties already offering solutions: Blippar, 24 Sessions, Carevoice

Step 3 | Funding
Instant mortgage process based on source data

Applying for a mortgage is a complex process. It would be nice if lenders immediately knew who you are, so that the risk for all parties involved, from bank to seller, is reduced to a minimum. By basing the mortgage process on source data, working with standard credit scores and using block-chain technology, the costs of the current mortgage process for customer and lender can be reduced by more than 50%. You, as a consumer, immediately know where you stand.

As a consumer?

Faster mortgage process at less than 50% of the cost and effort.
Innovative parties already offering solutions: Handig!, Credit.com, iWize, Ockto

Step 4 – Renovating
Easily arrange everything through one platform

At the moment your keys are handed over to you, uncertainty flares up again. All of a sudden, you are faced with countless choices and you want to use your budget and time as efficiently as possible. Where can you find a good plasterer? Which carpenter has an agenda that fits with yours? How do you ensure that you set the right priorities? If a mortgage lender is able to connect a customer to the right contractors for the job using a new, special platform, it will save 20-25% of the customer’s money, not to mention the time saved.

As a consumer?
Being able to do more in your home by intelligent expenditure of the  20-25% of the saved time and remodeling budget.
Innovative parties already offering solutions: OSRE, Klushulp Centraal Beheer

Step 5 | Living
Get everything out of it effortlessly

Your house has become your home and your life keeps on changing. Before you know it, each month you’re paying 10-25% too much for your insurance, mortgage or energy bills. Based on a smart set of questions, you will receive personalised tips from your mortgage lender at an advantageous time, which you can then validate at the click of a button. For example, you can automatically adjust the value of your home, which in turn can immediately lower your monthly costs.

As a consumer?
Save money for enjoyable things, by reducing your monthly fixed costs by 10 to 25% through smart tips.
Innovative parties already offering solutions: De Energiebespaarders, Nationale Hypotheekbond

 

Creating an effective consumer journey is now of the essence, as mortgage lenders still often think using the possibilities of their own mortgage platform. As you can see, technology is not a limiting factor, but rather an enabler.

With a unique combination of sector expertise and the Technology, Analytics and Organization Transformation competence teams, IG&H is well-positioned to connect the many separate initiatives into an integrated, customer-centric view and to turn them into a valuable and memorable customer experience. The first organization that takes this step, will gain a substantial (extra) part of the Dutch morgage market.

Would you like to know more about the possibilities? We will gladly assist you.

Bas de jong                   Jules Hoppenbrouwers

Manager Banking            Manager Digital Customer Experience
b.dejong@igh.nl              j.hoppenbrouwers@igh.nl

Last-mile delivery model under pressure; paradigm shift inevitable

By | News, Retail

Rising e-commerce sales are driving up demand for parcel deliveries. Good times for logistics carriers, you might think. However, the parcel delivery sector has been under pressure for some time now: PostNL saw its operating results drop in the third quarter. In Germany, DHL made a significant (downwards) revision to its profit forecast for 2018. Where have things gone wrong, and is there a way up?

Currently, most parcel carriers are facing major operational challenges. For example, delivery personnel (mostly freelancers and subcontractors) regularly complain about high working pressure and underpayment. Yearly events such as Black Friday and Singles Day cause enormous spikes in delivery volume, which are in turn difficult to process on time. In Chinese postal depots, we saw parcels literally flying around. The danger of strikes always lurks. Recently, in the Netherlands, there were threats of strike action by delivery personnel around the time of the Dutch Sinterklaas festivities. Read More

Three opportunities for more chemistry between hospital and MSB

By | Healthcare, News

Now that the participation model does not seem to take hold, the following question arises: what can we as hospital and MSB do to join forces? “To date, the introduction of integrated funding has not meant that the hospital and MSB jointly manage healthcare in a smarter and more efficient manner”, is one of the conclusions from the ‘Integrated Fidelity Monitor’ recently published by the NZa. Three concrete opportunities in this article.

Why is it so difficult? An important reason why this objective does not get off the ground is the calculation system between hospital and MSB, which in many cases is primarily driven by volume. In some cases there are additional agreements about quality outcomes that are included in the settlement. Whatever the case, doctors who work for the MSB, are not affected by the incurring costs related to their choices – for example medicines, length of stay and diagnosis. The smart and efficient organization of healthcare in times of staff shortages remains the main concern of the managers and directors of the hospital organization.

Professional interlocutor. With the arrival of the MSB, a single point of contact has arisen for the hospital management, in which there is a joint sense of responsibility and a certain alignment of interests. This offers potential when it comes to joint performance management. How to redeem this potential as a hospital organization?

  1. Starting point: shared and concrete future vision.
    The healthcare landscape is changing, it’s clear that the role and position of the hospital is changing too. What the healthcare landscape looks like and what this actually means for the hospital and the different departments within the MSB, is to be agreed upon. It’s easy to see that directors are already on a different planet, while the MSB are occupied with production ceilings, internal calculation models and distribution of medical specialist capacity. By jointly exploring the strategic scenarios, a shared view of the urgency arises: the considerations and the opportunities that this offers.For example, in some regional hospitals together with the MSB we have experienced in practice what the different scenarios mean, also for the departments in the MSB: which healthcare do we no longer provide, which partnerships are important and which investments in technology and (ICT) infrastructure are needed? And which form of healthcare is being shifted internally to a specialist nurse?
  2. Maintaining a uniform working method: the right steering information.
    Medical and business manager form a crucial team in realizing the strategy and the clever organization of healthcare. In addition to formal authority for the medical manager, it is important that both maintain a uniform working method when it comes to steering. ‘Are we seeing the right patients? Do we provide healthcare in line with our chosen healthcare model (eg, do/do not perform surgery, e-consult versus screening, hospital stay)? Do we use our critical resources properly and how happy is our scarce staff actually?”In order to reach the right steering information, we are able to point out three success factors in practice: – Conducting the conversation about “when are you doing it right” and what do you want to know to get there, or even better; what do you want to know to stay there. – Developing together with the person in charge: making a semi-finished product better through good consultation. Only then does responsibility arise to also improve the quality of source information, after all ‘garbage in = garbage out’. – Transparency and the ability to down drill information to patient or employee level.
  3. From volume incentive to risk sharing and creating space to invest.
    It is not fair to jump to conclusions by saying that medical specialists at the MSB with the current incentives are only driven to make revenue and to monitor their own trade. However, in the current cooperation model, the MSB hardly bears any entrepreneurial risk. In the field of management accounting, sufficient research has been done to state that steering the performance is less effective without the right incentives.The path that has been taken to outcome steering offers opportunities. Let the medical and business manager themselves make a proposal for the results on which performance agreements can be made and which remuneration structure fits. Thus, with the space that has been created, a buffer for investments needed in technology and innovation can be supplied. So that the focus is no longer on distributing the proceeds, but on the transition to the right healthcare in the right place.

Bas Leerink new Health partner at IG&H

By | Health, News | No Comments

On January 1, Bas Leerink will join IG&H as a partner. Leerink has in-depth sector knowledge about healthcare and wants to use his knowledge for the benefit of the patient.

Leerink previously worked as a director at health insurer Menzis, and afterwards as chairman of the board at top clinical hospital Medisch Spectrum Twente. At the time of his appointment in 2013, the hospital was facing difficult times; it came under strict supervision, while at the same time a new hospital was being built. In the last six years, Leerink focused on more transparency and received a lot of praise for doing so. Presumably, the organization is currently doing very well financially. Leerink has also put Value-Based Health Care on the agenda, together with the other Santeon Hospitals.

He wants to apply this knowledge to healthcare institutions and insurers in a broad sense. On his move to IG&H, Leerink says: “There is a lot to do in healthcare. Society expects better services, continuous introduction of new medical techniques and medicines, more “joint decision”, and more possibilities for healthcare at home, at the same cost. For me, the continuous focus IG&H places on the end-user of healthcare or health insurance is an important reason to make this transition. Besides of course the team of people with whom I will be working. “

Share of independent insurance advisors increases further

By | Insurance, News

The share of independent advisers in the distribution is increasing, but the evaluation of insurers’ services is deteriorating, according to the Performance and Distribution Monitor of IG&H. Are insurers properly pre-sorted?

Last year we reported that the independent consultant was on a strong rise. The most recent data show that this growth continues. With the exception of the life market, the share of independent consultant remains at least equal. In the commercial insurance market, individual income market and mortgage market, the share of independent consultant even increased. Due to the strong positioning of the advisor for advice requirements regarding mortgages, occupational disability and (new) business risks, this growth is expected to continue.

Tension field of interest advisers and insurers
However, the evaluation of independent consultants’ insurance services is declining. Historically, insurers in private sub-markets were better assessed than those in business submarkets. In the last measurements, this difference was reduced because the performance in private submarkets deteriorated. This is partly due to the need to realize cost savings.

The market is clearly in motion. Insurers are rearranging their processes and improving solvency, agitated and under pressure from shareholders and regulators. In the search for a new balance, the emphasis is now on cost reduction and risk reduction. That is why they make strong choices in the areas of products, processes, pricing and remuneration. In some cases in the non-life insurance market, this even leads to uninsurability within certain branches.

Together with a declining performance, this all forms a breeding ground for a lower NPS. Given the prominent and often even increasing importance of advisers in distribution, this creates a tension field.

Jan Pieter van der Helm
Director Insurance at IG&H
j.vanderhelm@IGH.NL

Princess Máxima Centre: Providing a path for medical technology

By | Health, News

The run-up to the opening of the Princess Máxima Centre was a special time. Today, the third blog of a series in which we discuss the following question with the experts involved: how did the centre so quickly go from dream to reality in no more than 8 months?

“What do you need to put into what type of medical situation?”

“We only just began tackling the question of medical technology this past December 2017. Only a half year before the opening”, says Wilco Kleine, healthcare technology and innovation manager. At that time, there had not yet been a single thought about what the centre would need in this area. “What demands do we have to put into place regarding equipment? Which brands do we choose? How do we get the ultimately 3000 different types of medical devices delivered on time? Which healthcare professionals need what type of training to be able to work safely and efficiently with the equipment involved? And what if a device breaks down during use? These kinds of questions had not been answered until that moment. Which is why we had to go through the entire process quickly. “This was not easy, because it involves a lot of regulations and medical technology that directly affects patient care. For example, you can not just go out and buy a hospital device and install and use it.” Kleine: “You have to think carefully about what you need to do exactly for any medical situation that may arise. So we first determined which devices would fit in the new care processes, such as patient monitors. Afterwards, together with the healthcare professionals, we looked at the requirements that were set, which providers could supply the right equipment, and which configuration was best suited for our centre.”

“It was like shooting at moving targets”

The fact that everyone took care of a specific task during the transition period, especially within their own domain, did not always make it easier. “Everything had to be done quickly and therefore run simultaneously”, says Kleine. “In this context, it is very difficult to keep the various disciplines well-managed. IG & H participated in all program lines and monitored the coordination within the organisation, which was fully ensconced in the construction and set-up phase. There was a great added value in that.”

Arvid Glerum, consultant at IG&H, adds: “For us it was one of the biggest challenges to get everything done in time. At the organisational level, all sorts of things are so new and interesting that you want to share them, but we always had to weigh up: when is something just interesting to know and when is it critical?” Because everyone at the Prinses Máxima Centre was making choices at the same time in order to organise everything properly, there were a lot of mutual dependencies. For example, when something changed in the building, this had consequences for the technology needed, and vice versa. “It was like shooting at moving targets”, says Arvid. And Kleine agrees with this: “We have managed to keep a good grip on things by putting together a multidisciplinary group with which we have managed the whole process. This included representatives from all areas: from care to purchasing to technology. This made it easier to discuss developments with each other on a weekly basis. Arvid informed us about all the relevant developments in the other programs and provided us with progress reports with which we kept the entire transition organisation up-to-date.”

“Everything had to work out and everything had to be safe”

Because the subject of medical technology came relatively late on the agenda, the team encountered the necessary problems. That often required making swift decisions. “Once you have ordered a monitor, for example, there’s not much you can change”, says Kleine. “So there were times when we had to tell the organisation that it was really time for a final decision. In this way, we have also been able to set the framework.”

“Because some decisions were postponed, we often had to join forces with the suppliers”, says Arvid. “We once had a supplier show up at the door, having driven in his own car during the weekend, with equipment in the boot of his car.” Kleine thought it was nice to see that everyone came together in this success mode: “Everything had to work out and everything had to be safe. The equipment not only had to arrive on time, but also comply with all the regulations. The quality of care is indeed a precondition for the centre.”

The balance that was established provided a solid framework. We mapped the risks and determined how we would tackle them. “We opted for a more pragmatic approach for less risky systems, while we used very detailed procedures for high-risk systems”, Kleine explains. “We have done everything neatly and meticulously, but without the stagnating bureaucracy that you often encounter in existing hospitals.”

“Hands-on, a-typical, successful: the process was unique”

The Princess Máxima Centre attaches great importance to keeping patients mobile. This was the mentality throughout the entire process. Kleine: “The patient must go through the care process smoothly. For children, it is very important for them to be able to move around and get out of their room. The centre works with innovative care concepts, which we had to design technologically during the transition.” Because the opening date of 18 May was rapidly approaching and medical equipment normally had delivery periods of a few months, the team had to act quickly: “We have organised the medical technology in such a way that the centre is ready for innovative care concepts, now and in the future. For example, we have ensured that nurses can monitor all the vital parameters of patients remotely, via smartphones, and even watch them live on monitors. But perhaps the most important thing is that patients are actually mobile now!”

Another important and complex part of the project was the training of health care professionals. Starting up with a completely new organisation has had its share of challenges, but also unique opportunities. For example, through transition meetings we have been able to train all doctors’ assistants, nurses, and medical specialists on all the risky equipment and critical work processes. Even before they started working in patient care. Super-users have also been given extra training and brought into the position for providing support at the workplace, as well as training new colleagues in the future. In fully operational hospitals this is often difficult to manage.

Both Kleine and Arvid proudly look back on a fantastic process. Because of the hands-on mentality and solidarity within the collaboration, but also because it has been a very a-typical experience in hospital care. “Within a ‘pressure cooker setting’ we achieved a solid, final result in a very short time”, says Arvid. “The entire centre, from the doctors to the employees, really came together in the final weeks. Together we rolled up our sleeves. It was very special to see and experience that.”

“We have built a centre completely from scratch: a new organisation, in a new building, with new stuff”, adds Kleine. “We had a successful dynamic with each other, throughout the entire transition. And we achieved this through a combination of being able to shift gears quickly when necessary and maintaining an organisation-wide view when making decisions. It was a wonderful, unique, and inspiring experience.”

Princess Máxima Centre: from 11 workflows to 1 opening

By | Healthcare, News

On May 18th, 2018, the Princess Máxima Centre opened its doors. The run-up to this opening was a rather particular period of time that did not go without its struggles. Today, the second blog of a series, in which we discuss the following question with the experts involved: how did the centre move from dream to reality in just over 8 months?

“No concessions regarding the opening date and patient safety”

“The first thing I did was create urgency”, says Ben van Miltenburg, the all-round transition manager who was involved in the project at the end of the summer of 2017. “At the administrative level, the need was already felt, but this was not yet the case in every branch of the organisation. The message to everyone was therefore twofold: we have to open on May 18th, and then everything has to be assured for the patients.”

Then an alarm went off: with our plan of action at that time it was not going to be feasible. Two things were needed: overview and coordination. On basis of this, it would be possible to set priorities. The question was: where do we start? Van Miltenburg: “That was the moment IG & H came into the picture.”

“A border collie that kept the herd together”

“You have to consider that the building was still an empty concrete box at that time”, says Van Miltenburg. “Everything was needed at every business unit and there was nothing available.” Once the urgency of this had been felt, everyone started to roll up their sleeves: “One thing was clear: we would not postpone the opening date. I kept track each week of how many people said that it must be postponed. Eventually I ended up with 206 tick marks. And yet we have achieved our goal.”

The 11 workflows that have been drawn up – including ‘HR and recruitment’, ‘care processes’, ‘compliance’, ‘finance & BI’ and ‘ICT’ – played a major role in this. “These were perceived as sort of little factories that all had to deliver at the right time”, says Bart van Sambeek, consultant at IG & H. “In the beginning, we took a thorough inventory of what was needed for a sure opening. We then translated this information into milestones, which we packaged into the 11 workflows. This way, everyone knew who was going to pick up what and when.” A hospital business only works if all cogs fit well together, but naturally everyone is more concerned with themselves – with their own cogs – than with the interaction. What we have therefore in essence created is an exoskeleton that kept the organisation-in-the-making of the Princess Máxima Centre together.

“The model of the workflows also meant that we had 1 language and 1 central steering mechanism”, adds Van Miltenburg. “In the workflows, people did what they were responsible for.” The intention was deliberately chosen to designate MT members as leaders of the workflows: “After all, they also lead the regular organisation.”

“If the transition team wanted something, it happened”

“In the end, we had about thirty to forty external experts in various fields – such as personnel & organisation, ICT, construction & design and planning – delivering extra capacity and crucial knowledge”, says Van Miltenburg. “In addition to substantive knowledge and experience, IG & H also provided the people necessary to help coordinate and make everything happen.” According to Van Miltenburg, this helped enormously in achieving objectives: “When we called something together with the IG & H consultants, it happened. This was also because I was able to act with the mandate of the board of directors. Everyone within the organisation honoured this, because nobody wanted the centre to not open on time because of them.” Repeating the core message proved to be a key element to success: “we had to open on May 18th and at that time it also it had to be assured for the patients. That core message gave a focus amidst the multitude of things that screamed for attention and energy. We have always looked at and emphasised what was necessary to be able to open on May 18th. That is what we have done together.”

“No pressure or control, but support”

“I knew for sure that it would work”, says Van Miltenburg. “I never doubted that. It was, however, crucial that patient assurance was guaranteed. We have looked at the processes meticulously for that.”

Within the overall plan of action, there were 2 methods. On the one hand, IG & H took care of the milestones planning and reporting, so that people could see exactly when targets were achieved or not. On the other hand, the transition team explicitly chose not to place control or performance pressure at the centre. We did not ask people why objectives had not been achieved, but what they needed to achieve the goals. They saw this as having been given support. What you notice is that people are used to performing within set limitations. But we were dealing with a very special – and temporary – situation in which that was not enough. We therefore did not say what had to be done to do something faster or better. We provided the means to accomplish what had to happen, regardless of the limitations. That could be manpower, information, alternatives, or decisions. By doing this, we were able to set things right again.

“When you work with so much external knowledge and experience, there is always a solution”, says Van Miltenburg. “Within their own domain, people do not always see the whole picture. When we asked why something had not been delivered on time, for example, they often thought it was because it was too expensive, even though the board was prepared to make extra funds available if needed. In addition, the transition team also exerted pressure on the suppliers: “We flew in some of the apparatuses months earlier than usual. This requires a certain level of creativity that you do not need in normal business situations.”

“We would have never made it without the voting mechanism”

A final element that was essential in the coordination was the voter system. Van Sambeek explains this clearly: “The workflows and components of a hospital organisation are all interlocked. When a workflow wanted to pass on a decision or milestone that had an impact outside its own workflow, it had to be submitted to all of the other workflows for voting. So everyone could indicate whether they agreed or not, with which we could ensure that all cogs continued to connect. This meant that people had to think and co-decide on matters outside their own domain. In view of the short period, it was necessary to do this.”

“We would not have made it without that mechanism”, says Van Miltenburg. “Because everyone had to see and approve almost any final decision, we were able to avoid many unpleasant surprises and gaps. In addition, no one could ‘duck away’ at a later stage. When you make decisions together on everything, you also bear the responsibility of delivering in accordance with the agreements. The voting mechanism has therefore really been invaluable!”

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.

Digitalization: the right approach for lasting success

By | News, Technology

Digitalization is a complex undertaking. Unfortunately, this appears to be a well-kept secret, and as a result, digitalization is a laborious process for many companies. Often, they don’t achieve the set goals. The question is: What’s the right way to go about it and make your process succeed?

An interesting and topical research conducted by Gartnerreveals 6 points at which digitalization appears to go wrong: a conservative culture, sharing and collaborating too little, an organization that is not ready for digitalization, a talent gap, a way of working that hampers talent, and challenges involving change. All of these are recognizable obstacles that our IG&H consultants often come across at the companies which choose to work with us. All the more reason to have a close look at digitalization.

Doing ‘something’ with digitalization, but what?

“We need to do ‘something’ with digitalization.” It’s a frequently heard statement made by many company managements. This generic announcement has to do with the fact that many organizations have only just begun to discover that IT is a big part of their product. Some industries have even grown into true software factories – such as banks, which solely create software and algorithms. Virtually, this means IT is the only remaining product for them. In retail, growth continues steadily through e-commerce, and in healthcare, the digital component also keeps expanding. In short, automation is indispensable to everyone who wants to respond quickly to their customers’ demand. Of course, this is essential if you want to survive – or, even better, if you want to distinguish yourself!

It is good to realize this, but awareness alone will not get you far. For example, your current process design and way of working may be at odds with your digitalization plans. In that case, what are you supposed to do? Adjusting such matters is expensive and time consuming, and it often comes with risks. If you don’t handle digitalization the right way, your process will fall apart before you’ve had the chance to go through it from A to Z.

Knowing what’s going on

If, for example, your system isn’t properly documented, it will be difficult to digitalize it. Before you start with a transition towards digitalization, it is essential to be abreast of various aspects within your organization.

Many companies are dealing with legacy issues, which make it hard to quickly respond to user needs. Larger organizations that have gone through mergers and acquisitions, for instance, can easily work with 3 or more CRM systems. In such cases, you often don’t know exactly who your customers are. This makes it difficult to develop a good, central overview of your customers, which would allow you to utilize every opportunity and achieve true customer loyalty. Additionally, companies often lack insight into the productivity of and the value delivered by development teams.

If you want to develop towards a so-called Digital Factory, so ‘IT’ truly becomes the measurable factory of added value, you need to know such things exactly. Only then, you can correctly set up IT processes, select the right people (and provide teams with the right coaching to achieve objectives), and use proper tooling! The construction industry has embraced this approach years ago: those who design a bridge have a computer calculate the required strength of the construction. Manual labor is completely unacceptable, and in many countries – including the Netherlands – it is even forbidden. But when it comes to digitalization, many organizations go back to old-fashioned ‘manual labor.’ Remarkable, because as with a bridge, a lot is at stake here. Therefore, it seems more logical to use the right tooling. After all, this ensures that the construction rests on a solid foundation that won’t collapse after you’ve built the bridge.

What direction will you take?

After you’ve defined the desired goal, you need to determine what direction you and your company will take. The strategy is essential, as is the transition itself.

Before delving into this, it is important to realize that there is no 1 formula for success when it comes to digital transformation. Elements such as company culture and the need for change play a significant role. A retailer who still wants to exist in 3 years, for example, should really have their online branch in place. In some other sectors, the urgency is a little less high, which means there’s more time to handle digitalization.

Get to work enterprise-wide

Should IT be part of the business or vice versa? It is the central question of a discussion held within many companies. The answer is: it doesn’t matter. What matters is that you’ll only succeed if you truly work together. Eventually, there will no longer be a ‘business’ and ‘IT.’ They will converge.

Moreover, you should look at the data/analytics part: how will you measure and what data do you need for proper and timely control? Even better, how will you predict what may happen, and are you currently anticipating this? To this end, elements such as the right KPIs and dashboarding, which are often still highly spreadsheet centered, should be fully in order and automated…!

Briefly put, think carefully about how you measure. What you really need to track is the number of people who love to use your product! This is crucial. Unfortunately, not many companies judge themselves on this user adoption. A missed opportunity with far-reaching consequences, because ultimately, users determine your long-term success. If you provide a pleasant experience by optimizing processes using IT, you’ll secure your organization’s future. This is just as important as the quality of the product you deliver – the experience is part of your product or service!

How to go about it

A number of the issues discussed above can be tacked perfectly with the introduction of a Low-Code platform and an Agile way of working. As OutSystems is currently the best Low-Code platform, IG&H has decided to work with it.

With a Low-Code platform, you can build software faster and better. Like the name suggests, you need very little code. You largely model software the way you would model a bridge, car, or plane. The difference is that with this model, you subsequently generate the software with 1 press of the button. Moreover, there’s a level of flexibility: when you have specific software that you cannot yet model, you can add it manually later – hence, the word ‘Low.’

Furthermore, maintaining models requires less time than maintaining hand-written software. So with a Low-Code platform, you considerably lower your company’s maintenance costs, making more money available for innovations and improvements.

Organizations with legacy systems can keep using these sources through OutSystems, but get the opportunity to rationalize them in a phased and low-risk way. In the meantime, they already benefit from shorter lead times for new functionality andmodern, pixel-perfect user interfaces. Using these, they can support and improve the much-needed customer experience.

In addition, OutSystems offers the possibility of rapid prototyping. This is the quick development of prototypes without high costs, which often enables the delivery of a prototype within several weeks – very useful when you want to test new concepts in practice! If you combine rapid prototyping with a smart use of data analytics, you can quickly book results.

Using OutSystems, we help organizations make a successful transition to sustainable digitalization. All the points we’ve discussed in this blog are covered during the process.

Interested in what we can do for your organization? Don’t hesitate to contact me. You can also find us at the NextStep conference on October 8thand 9th, which IG&H will attend.