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How a robust agenda for healthcare restored trust and confidence in Flevoland



A bankruptcy that fueled panic and confusion

In 2018, two hospitals in The Netherlands declared bankruptcy, including the IJsselmeer hospital group which had several hospitals in the Flevoland province. This presented an urgent and sudden obstacle in the region, specifically in Lelystad, where one of the hospitals was located. Lelystad lies close to Almere, the largest municipality in the region with almost 200,000 inhabitants.

The Dutch Ministry of Health, Welfare and Sport decided to seek external help from experts who could explore the future and create a healthcare agenda for the province. The Ministry reached out to IG&H Partner Bas Leerink, who then formed a small team within IG&H made up of sector specialists, to answer the question:

What is needed in Lelystad going forward?

The IG&H team had quite a challenge ahead of them – because bankruptcy in the healthcare sector is largely unheard of, the discussion amongst the region’s patients and inhabitants became heated and emotionally charged. Some citizens even organized demonstrations, driven by the fear that they would lose access to high-quality, affordable healthcare.

IG&H’s mission: Collect the facts and engage with all stakeholders

Faced with an almost impossible situation and multiple stakeholders, IG&H conducted a rigorous investigation, which entailed extensive research, stakeholder interviews, and deep dives into the most pressing healthcare challenges in Lelystad and the Flevoland province.

We started by collecting the facts through stakeholder interviews, as well as public information from government agencies like the Central Bureau of Statistics (CBS). We gathered facts around information like healthcare usage and poverty statistics, then linked these to Flevoland’s context. For example, we found a strong connection between poverty and obesity, as well as overuse of care and the need for more preventative care.

All our research culminated in a factbook: over 100 slides of important information about the healthcare needs and demands in Flevoland. This factbook would help all stakeholders understand the realities of the situation, thereby encouraging fact-based discussions.

This factbook was discussed on many levels, from individual to organizational to provincial. This formed the basis of the rest of the project.

The stakeholders we engaged with include healthcare insurers, patient engagement groups, the region’s inhabitants, the municipality and the Ministry of Health. We placed a great deal of importance on making sure everyone was heard, from the locals of Flevoland to healthcare professionals.

After analyzing the interviews and factbook, IG&H defined the three most pressing themes for Flevoland to focus on:

  1. Acute care

  2. Care for vulnerable populations

  3. Obstetrics

We then formed expert groups for each topic, made up of healthcare professionals and other stakeholders, to further investigate and create an agenda for each theme. We all wanted to find out: What kind of hospital does Lelystad need, if any?

The outcome: A high-level vision for the future of healthcare in Flevoland

After six months, we created a robust agenda for healthcare in Flevoland, a hands-on approach for all stakeholders to improve the healthcare landscape in the region.

Our final analysis showed that Lelystad did not need a hospital as substantial as the one it had before. For example, we found that it was unnecessary for Lelystad to have a 24/7 emergency department, as well as in-hospital rehabilitation for the elderly. Instead, Flevoland should shift this type of care to external facilities or at-home care to reduce the burden on the hospital. In short, Lelystad needed a hospital that provided only the essential care we identified in our research. By streamlining its healthcare delivery, it would also be easier for the region to achieve Triple Aim: offering high-quality, affordable and accessible care to its inhabitants.

We presented the final report factbook to Bruno Bruins, then-Minister for Medical Care and the commissioner for this project, and to the Provincial Council of Flevoland. The Ministry also presented the factbook to the Dutch parliament, and we helped answer a variety of questions to help everyone understand the situation.

We are incredibly proud that, with all the different interests and possible approaches to tackle this challenge, IG&H was able to create a vision that addressed everyone’s concerns. We are also proud that we (re)ignited a new form of collaboration in the process, leading to a renewed sense of trust, confidence and faith between all stakeholders.


“IG&H succeeded in listening to stakeholders, picking up on all the sounds and opinions, taking everyone along in the process. They worked very diligently on the assignment, not only regarding the advice, but also the implementation. The collaboration was excellent, and the team was fantastic!”


- Bas van den Dungen, former Directorate-general Curative Care

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