Healthcare is in a value crisis, says hospital administrator Kjeld Aij. Costs are rising, but the quality is not growing along with it and is not perceived as better. According to Aij, this development carries a clear leadership challenge: "A good leader's goal is not efficiency, but adding value to healthcare."
"If your costs go up but quality doesn't, so value goes down," Aij explained in his key note during Care & Facility 2024. "Focusing on quality leads to higher costs." To do things differently, according to the Dijkzigt director, we need to think and work differently.
Difficulty learning
"We have great difficulty with learning in our healthcare organizations. We continue with an approach until it really doesn't work anymore and doesn't produce results. Then we start a new approach, with a new steering committee and new project. We don't go back and look at why something didn't work. While that gives much more peace of mind than introducing a new working method every two or three years. Especially in large bureaucratic organizations, you see that problems are not actually solved. The source cause of the problem is not looked at."
Lack of confidence
Aij attributes it to the lack of trust that prevails. "No trust leads to chaos, but that is self-inflicted chaos. So you can do something about that yourself. Don't keep feeding the current system, but fix the problem. If a flower is not blooming, you're not going to fix the flower, you're going to fix the environment of the flower, like the soil, so that the flower will bloom again."
In healthcare, however, we do, he argues. There is too little trust in people. "We have drifted too far away from trust in the professional. We're trying to fix that. For example, we're going to reduce a consultation from 10 minutes to eight minutes because that's more efficient. But does that add value for the patient or professional?"
"Our hospital has 1,400 reports of aggression and violence every year. This ranges from abusive acts to broken fingers and threats. What do we do? We train our people on how to better deal with aggression and violence. But the solution to the problem lies in the environment. So it requires different ways of thinking. Unchanged thinking leads to recycled experiences."
Lean value addition
Less steering and more trust requires different ways of thinking and working. Aij therefore advises managers to get out of the office more. "Go out on the shop floor, ask questions," he said.
That's why Aij advocates a Lean strategy. "Lean is precisely not about efficiency, but about adding value. It's about people, how do you make them grow again, how do you bring back their enthusiasm? How do you bring the beating heart back into your organization?"
Five questions for the organization
There are actually five questions to ask yourself as an organization, Aij points out.
- What are your basic assumptions?
- What exactly provides value to the patient?
- What is the real work and how do you improve it on a daily basis?
- Now what is the real problem to solve?
- How do you develop people and get the most out of them?
In short, we need to learn to understand problems more instead of imposing solutions; we need to ask more questions, he argues. "For example, look at the current shortage of medicines. Is that because of a shortage of raw materials? No, it is because we want to bring down the cost of care and insurers prescribe the cheapest possible drugs. However, that in turn leads to a lot of extra administration at pharmacies and a lot of errors in the chain."
Less is better
A different way of looking at things can also be seen when treating cancer patients. Sometimes de-escalation works; less is better. An article in De Volkskrant shows that for some cancer patients, treating less may be the best approach.
He gives an example of redundant processes from the practice of the Dijkzigt. The hospital worked with consent forms to request permission from insurers for certain treatments. "Actually, insurers never said no in the forms. So we just got rid of the whole circus of forms. Sometimes you just have to stop an efficient process. It's about effectiveness, whether you're adding value."
Innovation doesn't have to be fancy
As an example of adding value, he again points to his own practice. At the Dijkzigt, Koos van der Ree Doolaard, nurse and team manager of Intensive Care Adults, was greatly disturbed by the entanglement or entrapment of cables and lines on the fences of the hospital beds.
Employees spend an unnecessary amount of time on them every day, and if they break down, you have to replace the whole set. Then the costs quickly add up to 15,000 euros. "For a few cents, Koos came up with a plastic tube to attach to the bed rails to keep the cords safe," says Aij. We call it the KoosGuard. It can be used in all departments where monitoring is present and multiple infusion lines run, such as ICU, operating rooms and recovery rooms. It is the epitome of innovation. It doesn't always have to be fancy."
Role for patient
The patient in particular plays an important role in adding value. At the Dijkzigt, for example, patient Merel collaborated from her sickbed on a digital app for fellow patients and visitors. Aij: "The signposts bothered her enormously. As a graphic designer, she then designed an app with the help of other patients and friends to help others find their way through the jungle of the hospital. For that we are immensely grateful to her. Even though she has since passed away, we continue her legacy by actually looking at how we add value in our work in this way."
This is an article by Dutch Health Hub. Want to keep up with all the news from the healthcare industry? Then take a look at the hub and sign up for the weekly newsletter.
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