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!”

Bart ter Horst

Author Bart ter Horst

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