As in other countries, the healthcare sector in the Netherlands is going through major turbulence. Changes in rules and regulations and in the way government covers healthcare costs have created great uncertainty and complexity.
To deal with these challenges, one 100-year-old mental healthcare institution in the Netherlands realized that it could no longer simply adjust its systems and structures—it needed to completely overhaul them. With the guidance of Reos Partners, it embarked on a learning journey, changing from a hierarchical organization to a network of flexible, self-steering teams. Even though this entrepreneurial bent is not a natural orientation for healthcare workers, people throughout the organization have come to embrace it as necessary for improving patient outcomes and the organization’s overall viability.
The healthcare sector in the Netherlands is a regulated market in which care institutions, professionals, government, and insurance companies negotiate terms for patient care. Before 2007, mental health was mainly financed by the national government. With the introduction of the regulated marked, this funding structure changed, and the health insurance companies began financing a large part of mental healthcare. The next big change in the system took place in 2015, when responsibility for mental healthcare was transferred from the national government to local governments. In 2015, local governments began to contract with care institutions to provide services within pre-established budgets. This shift represented a major change in the country’s welfare state.
The new policy had numerous consequences for mental healthcare providers. To stay on budget, mental health institutions have had to reduce the number of beds they maintain by 30 percent. Many in-patient treatment programs have shifted to home- and community-based services. New technologies, including apps for communicating with patients, have been developed to support out-patient treatment. With less need for office and treatment space, healthcare providers have reduced their facilities costs.
At the same time, government and insurance companies now require providers to use evidence-based treatment programs. These programs lower the costs of services by specifying treatment steps. Mental healthcare institutions are also referring patients with less serious mental health conditions to first-line healthcare providers, focusing their resources on high-level treatment programs for patients with complex and/or multiple problems. This tactic has meant a roughly 20% reduction in patient admissions.
This changing playing field has required healthcare organizations to make many internal shifts. Reos Partners worked with our client organization to identify several fundamental levels of change: strategy, structure, and culture. We designed the journey together rather than following a blueprint.
At the strategy level, the organization is setting its sights on better patient care, greater involvement of patients’ families, more entrepreneurial behavior by staff members, and a higher emphasis on learning and values.
At the structural level, leaders have defined nine care programs to address mental health challenges. These programs result from three different needs:
- For specific kinds of care by the market/clients
- For an ideal combination of ambulant and clinical care
- For the optimization of business processes
These programs were created for mental health challenges such as anxiety, addictive and personality disorders, and disorders experienced by the elderly. The client organization has shifted to a new structure around these care programs in which medical professionals, paraprofessionals, and functional staff members work together in teams. In these care-oriented units, team leader roles have been eliminated, and self-managing teams execute the processes. Some of these teams are already mature in taking on the new challenge, while others still have a long way to go.
At the cultural level, all of the members of the organization participated in dialogue sessions. These team-based sessions were designed to facilitate necessary shifts in the way teams and individuals operate. For example, in the new approach, nurses and paraprofessionals have to see their work as part of a process flow instead of considering cases and prescribing treatment on an individual basis. Now, after a patient goes through an intake session, a committee decides on a sequence of evidence-based treatment programs that professionals then execute.
Many professionals regard this protocol as limiting their latitude in treating patients. Part of the challenge has been helping them see this change not as a constraint but rather as a stepping stone towards becoming a learning organization. The benefit from this new approach is that value comes from the collective intelligence and not from the intelligence of an aggregate of individual professionals.
Support for the Change Process
Our client has worked with Reos Partners and Nyenrode University to develop a year-long leadership program for mental health professionals. Programs on leadership for team leaders and medical professionals and on lean principles and continuous improvement have also been launched.
In 2013, our client conducted a values survey. Since then, all teams have discussed their values and worked to translate them into their day-to-day practice. The organization will repeat this survey in 2016 to review the progress in the change in culture.
For two years, the organization has also held an internal competition in which employees launch new initiatives. Members of the management board serve as coaches. At regular intervals, the project teams present their progress and any hurdles they have encountered. Participants attend workshops on project management, change management, and leadership. After six months, eight teams are selected to continue in the competition. At the end of the cycle, the top five teams receive money to celebrate their success. Members of the winning team get to attend a personal development course. The organizational benefits of this creative approach include the introduction of new work methods, products, and revived cooperation among departments.
The Role of Reos Partners
Reos Partners’ role in this change process has been multi-fold:
- We worked with organizational leaders to design the route towards this transitional phase, and we supported individuals and teams in the journey.
- We brought in other views on ways to reorganize work and supported the implementation of new systems.
- We facilitated team sessions and conducted value assessments.
- We led project teams in areas ranging from assessing real estate to getting a pool of flex workers in place.
- In general, we contributed capacity, experience, skills, and knowledge about leadership and change.
The outcome of the process is still uncertain, but leaders are confident that the new route will lead to lasting success. The learning and inspiration has flowed in irections. We are building the bridge towards the future as we’re walking on it together.