The future of nursing starts with better decisions

A fireside chat with Eva ten Voorde and Femke van der Voort

Every request for home care requires careful assessment. What support does someone truly need? What can they still do independently? What role can informal caregivers such as family, friends and neighbors play? When professionals answer those questions more consistently, they can ensure more consistent care decisions and contribute to more future-proof healthcare.

For Eva ten Voorde (Nursing Information Specialist at Sensire) and Femke van der Voort (CEO of Alii), achieving this starts with providing better support for everyday care decisions.

Eva, many AI initiatives focus on efficiency. You started from professional autonomy. Why?

Eva: Professional autonomy is essential for future-proof healthcare. Care situations are becoming more complex while workforce shortages put additional pressure on professionals. That makes nursing expertise increasingly valuable. Instead of limiting ourselves to an efficiency dialogue, we should be asking: How can technology help professionals make better decisions without taking those decisions away from them?

As a former wijkverpleegkundige, a Dutch community nurse who assesses care needs and coordinates care in people’s homes, I have seen how much clinical reasoning happens behind the scenes. Nurses make decisions every day that affect the care a client receives, yet the reasoning behind those decisions often remains invisible.

What currently prevents the healthcare system from learning from that expertise?

Eva: While the nursing process is performed at multiple points in time and across different systems, forms and reports, clinical decision-making is often insufficiently explicit. As a result, working practices vary and professionals may rely on different information when providing care. We know a lot, yet we do not always learn systematically from what we know.

Femke, is that lack of visibility of decision-making the problem Alii set out to solve?

Femke: It is certainly one of them. Healthcare has no shortage of knowledge. The difficulty is bringing it into a specific client conversation at the right moment. The relevant knowledge may already exist in many forms and sources. However, finding and applying it during a busy working day is much harder. Alii makes knowledge—from textual guidelines and protocols to knowledge embedded in the minds of individuals—available as decision support in the professional’s workflow.

Some people hear “AI-driven decision support” and worry about losing human control. How do you respond?

Femke: I understand that concern. That is why we are very explicit about Alii’s role of making expertise more accessible while keeping human judgment at the center. The professional continues to interpret the client’s situation and owns the decision. We are fully transparent about both the reasoning behind decisions and the outcomes.

Eva: Decision support can also encourage more reflection. Once the reasoning behind a decision becomes visible, colleagues can discuss why they made different choices and what they can learn from one another.

Does standardization risk turning nurses into box-tickers?

Femke: No. Structure should help professionals consider relevant information while leaving room to interpret the individual situation. Healthcare professionals are experts, not computers. Rather, the issue is the combined challenge of recalling the right piece of knowledge at the right moment while also assessing risks, thinking about next steps and of course building rapport with the client simultaneously.

Eva: Not all variation is undesirable. Good variation is caused by individual client needs and unwarranted variation is caused by differences in information, knowledge or process. A more systematic approach creates a shared foundation: Everyone considers the same information, follows the same process and has access to the same knowledge. That makes decisions easier to compare and discuss.

What does the decision support look like in practice?

Eva: One important addition we made was the nursing advisory conversation at the beginning of the process. We now first explore the client’s resilience. We do this by looking at the demands a client faces alongside their capabilities and the support available within their network. What can the person still do independently? What can their network contribute? Is professional care required, or could another strategy be more appropriate?

If a situation is urgent, care can still begin immediately. The nursing advisory conversation helps professionals look beyond the immediate request and consider what should happen next. The information gathered can then inform the assessment, diagnosis, care plan and evaluation.

What principles guide the way you assess what a client really needs?

Eva: Reablement and Positive Healthcare are two important pillars behind the decision support, shifting the focus towards both a client’s capabilities and what matters to them. The question becomes What can the client do, and what does the client want to be able to do? A client may still be physically capable of preparing a simple meal, but perhaps what matters most to them is being able to cook dinner for their grandchildren again. Care can then focus on supporting independence in an activity that has meaning for the client.

What difference does that make to the conversation?

Eva: The feedback we received from users was that the structured questions lead to different conversations with clients and colleagues. It can also encourage clients to think more actively about their own lives, what they can do and what matters to them.

Where does AI fit into that vision?

Femke: The immediate value of AI lies in structuring knowledge and decision-making. Guidelines and protocols can be enriched with organizational choices, professional expertise and client data, then presented as decision support within the primary care process.

When professionals document decisions, progress and outcomes more consistently, organizations gain a better foundation from which to learn. The platform itself does not autonomously learn from that data. However, organizing the information can help facilitate future analysis, knowledge development and improvement.

What is the most important lesson you have learned from the collaboration?

Femke: This collaboration reinforced just how much healthcare professionals already know and juggle daily. Decision support can carry part of that cognitive load, enabling professionals to give more attention to the person in front of them.

Eva: And that is exactly where it becomes powerful. Professionals remain responsible for the decision, but they no longer have to rely solely on what they know themselves. They can draw on the collective intelligence of the entire healthcare system.