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.