Healthcare in the Netherlands is in urgent need of change and improvement. Politicians, healthcare institutions themselves and advocacy organisations: they all warn of an ageing population, decreasing affordability, loss of quality and an acute shortage of professionals. Measures often consist of tightening legislation and regulations to mitigate risks, prevent mistakes and to tackle the undesirable effects of labour shortages etc. Each ++BlacklistOne example is the response to the Healthcare Inspectorate’s infamous ‘blacklist’, which was seen as ‘naming and shaming’: special supervision programmes were initiated. It is highly doubtful whether this has led to the quality and innovation required. Read more (in Dutch). in healthcare leads to a chain reaction of new measures and knee-jerk responses from managers and staff determined to ensure that everything is first and foremost “under control”. However, this tendency to draw hasty conclusions only exacerbates the problems, and the solutions often ignore the wishes of those who are most important: the people who require healthcare++ProtocolsJan Kremer, professor at Radboudumc and chair of the Quality Council of the Dutch Healthcare Institute: “Following strict protocols leaves insufficient space to do what is right for individual patients. Professionals nevertheless end up doing what the protocol says, otherwise they face hassle, or even worse – claims.” (source, in Dutch)
Dignified, inclusive, high-quality, sustainable healthcare: everyone wants it. This wish also drove the decentralisation of healthcare in 2015. The intention was that healthcare would be closer to the people, more efficient and more effective. Politicians have the best intentions, but are far removed from practice. Interests and responsibilities are fragmented among healthcare offices, advisory bodies and umbrella organisations, which results in suboptimal, one-sided solutions.
There is a need for structural change in the healthcare landscape. However, for the various playersThe tendency to draw hasty conclusions only exacerbates the problems, and the solutions often ignore the wishes of those who are most important: the people who require healthcare. in this landscape (hospitals, municipal health institutions, nursing homes etc.), each with their own logic and role, this is no easy task. They run up against the boundaries of society’s capacity to adapt, budgets and possibilities.
Good healthcare should involve everyone
True progress is only possible if we redefine and redesign the playing field. Because the drawing board on which this major transformation must be designed is still in the same old place: where social engineering is the dominant mindset, where blinkered compartmentalisation is rife, and where there is little space for experiment and innovation. Those in charge think and design in the same old way, and this leads to the same plans – lacking in innovation, and not future-proof.Those in charge think and design in the same old way, and this leads to the same plans – lacking in innovation, and not future-proof.
There is something fundamentally wrong with this: it is a top-down approach to deciding what healthcare should look like, and the conditions it must meet. This means that central bodies institutionalise something that, in principle, can and must come from people themselves. The combination of ever-increasing demand for good healthcare, shrinking budgets and out-of-date institutions means that our collective task is to involve many more people throughout society with issues related to the healthcare of the future. Kennisland wishes to play a leading role in this++Social labsWe organise social labs to bring together different perspectives on social challenges, and to design solutions together from this starting point. Read more.
For example by initiating a new, positive movement around growing old better: Living a Whole Life – a movement of pioneers who all have an innovative vision for nursing care, who have different ideas about how it should be organised, and who also want to put those ideas into practice. Innovators could be older people themselves, healthcare professionals, informal carers; everyone who wishes to contribute to one of the most important social challenges of our time.
Study the special
In 1961, Jane Jacobs wrote the book The Death and Life of Great American Cities, in which she argued that it was not urban planners who created good neighbourhoods, but residentsUtilise the capacity of people directly involved with the issue to solve problems and to innovate.++Directly involvedFollowing the work of Jane Jacobs, residents and their family members were the starting point for the ‘Nursing Homes of the Future Challenge’ (link in Dutch). In this project, we worked together to use technology to achieve a better night’s sleep, greater job satisfaction and better quality of care in the Prins Hendrik nursing home. In Jacobs’ opinion, we must reason from the special towards the general, and not the other way round. We must move away from generic “blueprint policy”, devised by institutions and implemented by organisations. Work the other way round: study the special, the lives of individuals, families and communities, and utilise the capacity of people directly involved with the issue to solve problems and to innovate.
As well as their stories and experiences, their imagination is the key to a hopeful future. Let us focus on their wishes and dreams, instead of the limits that currently define healthcare++Better, closer heathcareKennisland believes that you can discover people’s wishes by inviting them to join the discussion. We did so previously in three districts in Amsterdam, where we sought out ways of achieving better healthcare that was closer to people. We invited local residents, healthcare professionals and the municipality to work together. Read more (in Dutch). Everyone can imagine how they would wish to grow old comfortably, but few would gladly imagine themselves in a nursing home.Everyone can imagine how they would wish to grow old comfortably, but few would gladly imagine themselves in a nursing home. That imagination must be grasped by all levels of our society (living environment, practice, organisations, system environment), to take a radical approach to designing healthcare. After all, imagination without implementation and the right conditions won’t get you anywhere.
We believe that, based on stories and imagination, hopeful places in healthcare can be realised. Places where it is pleasant to live and to work. Where we continue to think and dream about good healthcare and quality of life, and where we experiment and learn how to put this into practice. Where it is accepted by all that we do this together, to create better, more pleasant and hopeful healthcare. Do you have a good idea, and would you like to work with us to create good, future-proof healthcare? Then please contact Suzanne van der Geest (firstname.lastname@example.org).