Bas Leerink new Health partner at IG&H

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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. “

Princess Máxima Centre: Providing a path for medical technology

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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.”

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

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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.