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.”

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!”

Princess Máxima Center: IG&H’s motivator

By News

On June 5th, the Princess Máxima Center for Pediatric Oncology officially opened its doors. It was a small miracle, as the past 10 years were marked by a heated debate on its realization. Every person involved in healthcare had and has an opinion about this initiative. IG&H will remain closely involved in this project for the rest of 2018, because it is close to our hearts. In this blog, we would like to explain why.

Lasting improvement of the healthcare system: where to start?

Generally speaking, hospital care in the Netherlands is properly organized. But while performing our daily work, we have also observed that this organization is very ‘dense.’ Different specialisms and facilities as well as public, medical, and business interests are interlinked. Within this context, we constantly need to focus on the question: What will be a lasting improvement of the healthcare system?

Healthcare: more than the best medical treatment

Maneuvering within the interconnectedness of things that are all tied together is very difficult. The Princess Máxima Center has broken through it by demonstrating that concentrated healthcare also becomes better – even when it concerns a complex field such as pediatric oncology. It shows that healthcare goes beyond offering the best medical treatment. Everything and everyone in the center help parents and children to better get through the disease process.

This doesn’t mean that we believe all specialisms should be accommodated in such concentrated centers. Providing good healthcare is extremely complicated, and multidisciplinary general hospitals will always be indispensable. But an initiative such as the Princess Máxima Center really makes a difference. If we don’t continue such projects, we won’t learn anything, and healthcare will reach an irrevocable deadlock at some point. Therefore, we are incredibly happy and proud that the center is now officially open.

Unanimous decision: our personal motives

When our health team came into contact with the Princess Máxima Center, the decision to help realize it was quickly made. We were unanimous that we wanted to use our knowledge and expertise to help young patients receive better care.

This also stems from the fact that each of us understands very well that everyone is a patient, even though many pretend this isn’t true. At some point in life, you will have to deal with illness and healthcare. Being a heart patient and survivor of meningitis myself, for example, I have been a regular at hospitals from a very young age. In these cases, you assume that there’s an expert team which can help you in the best possible way. But you can expect much more at the Princess Máxima Center. Attention is paid to development, exercise, making sense of life, sports, and games. The center offers room for such matters, as well as for a child’s all-important own space and mobility. Children can go outside. Often, you see children and parents talk on a balcony or circling the sports square together in a duo kart. You want every family to have that in such a difficult situation: the opportunity to cope with being a patient, to stay together, to continue to grow and play. Children should be able to be children – anytime, anywhere. The seriousness of the disease requires a special team, pioneering research, and exceptional facilities.

Realizing something like that in a complex field such as hospital care is a major challenge. And at IG&H, we gladly accept challenges with a social interest – especially when we can do so while joining forces with professionals who share our passion. Based on this underlying thought, a child suffering from cancer is, of course, the most powerful motivator. Someone who doesn’twant to run for them must have a heart made of stone.

And when such a challenge comes in the shape of a pioneering patient-oriented center, we believe that the puzzle is complete.

Committed on all layers

From macro to micro level: IG&H is committed to the realization of the Princess Máxima Center on all layers. We consider it an honor that we are allowed to contribute significantly to one of the most topical themes in healthcare. Together with the exceptional people of the Princess Máxima Center, we will do everything to continue to help the center improve care for children with cancer for the rest of the year. That is what makes us tick.

Official opening Princess Máxima Center and IG&H’s role

By News

It’s been a long run, but the Princess Máxima Center for Pediatric Oncology is here. A unique project that resulted in the setup of Europe’s largest specialized children’s hospital. On May 18th, the first children were transferred, and on June 5th, Dutch queen Máxima will officially open the center. IG&H has contributed significantly to the realization of the Princess Máxima Center, a project that is close to our hearts.

Success has many fathers, which also goes for this success. Therefore, we are starting a blog series to discuss all the aspects involved in realizing a dream – together with the special men and women whom we collaborated with.  Today, we look back on the past few months: what had to be done to set up an entirely new hospital and get it running within an eight-month time frame?

From dream to debate

There had been a long-running debate on concentrating special care in the Netherlands. Pediatricians and parents had a dream to combine care and research in one place. This would allow them to take the necessary next step in the fight against childhood cancer. But this dream was met with a range of objections. It ended in a heated debate whose outcome was, to say the least, uncertain for a very long time. This alone is reason enough to call the center’s opening on May 18th a small miracle. Of course, the debate was about the position and distribution of people and resources. At this phase, the pediatric oncologists, who go to all lengths for their patients with undiminished energy and motivation to realize the best in care and research, have been decisive.

From ‘just doing it’ to ‘getting it done’

When the Princess Máxima Center finally got the green light and the business case appeared to be complete, the center entered the realization phase. At the time, there were only a handful of project staff, several drawings, a start budget, and a board. Needless to say, going from a green polder in Utrecht to a top-notch children’s hospital required a lot of work.

At this phase, IG&H was involved in the project. By then, the center was already well underway, as was its construction. As a hospital is always a complex puzzle, everyone in the steadily growing organization had started fleshing out their own piece pragmatically. Together with the center, we initially assessed whether it was on the right track via a transition readiness audit. While performing this audit, we ultimately defined hundreds of requirements: conditions that were critical to guarantee a safe opening. Then, we organized their completion in the form of 11 separate workflows that jointly made up the organization. We needed to assist in turning from pragmatism (‘just doing it’) to a focus on results (‘getting the safe opening done’). Organizing collaboration and setting priorities were essential in this regard. The main question remained unaltered: Is this absolutely crucial to a safe opening on May 18th – and if so, who do we need for this purpose?

The fact that the Princess Máxima Center had already grown into a multi-project organization at the time proved to be a challenge. When several projects are running alongside each other, it is no longer self-evident that you ‘quickly’ align things with each other. Subprojects may diverge in terms of content and timing. Therefore, it was very important to fill the gaps and promote collaboration. IG&H worked to achieve this goal as well as joint coordination and decision-making. Focus was also placed on following up milestones. In addition, we paid great attention to partial deliveries of the 11 workflows.

Coordination without a location

The combination of organizing, coordinating, and supporting the organization took place without a physical meeting point. After all, the building was still in scaffolding, which meant that those involved were divided over locations in Zeist and Utrecht. Additionally, the Princess Máxima Center is the central hub in a national network of general and academic hospitals. It was not possible to drop by and consult with each other face to face, so much was done through digital channels and by phone. We acted as a connecting factor between all these internal and external players.

This took quite some getting used to, as the center had started out with a small group of people who knew each other very well. The growth of the project involved more and more people, which increased pressure. We worked to continue to understand, follow, and help each other. In an energy-laden process that bears such importance, you need to stay close to each other despite the lack of a single location.

Doing what you need to do

Moving shoulder to shoulder in the workflows means that everyone goes to all lengths to get things done. Not only does this require genuine commitment, it also demands that you take responsibility and take on all tasks that need to be completed. In other words, we had to go to the limit. Over the past eight months, IG&H’s people have regularly put their shoulders to the wheel in the most literal sense of the word: we put on gloves, carried boxes, and drove across the country to organize training courses as well as information transfers. Our motto, ‘Hands-on where required,’ has allowed us to contribute to the Princess Máxima Center’s major milestones: transferring the first children from the Wilhelmina children’s hospital on May 18th, transferring the patients and child oncologists from the University Medical Care Centers Utrecht on June 1st, and the official opening on June 5th.

What specific challenges did we encounter? What approach did we adopt to meet the seemingly impossible timelines? We will discuss these and other topics in our next blogs, allowing the special people with whom we proudly collaborate to share their views and experiences. Will you go on this journey with us?