‘How can we steer this transition in the right direction?’ For Wink de Boer, gastrointestinal specialist and the medical director of Bernhoven general regional hospital, this was one of the first questions that sprang to mind. A few years ago, the hospital was about to embark on its transition programme, ‘Dream’, based on the principle of ‘Less healthcare is better healthcare’. ‘One thing is certain: the individual customer experience must take precedence. We make it a priority by involving patients in decision-making right from the start and by taking the time we need to do so,’ says De Boer.
Designing appropriate care inevitably means implementing a long-range transition agenda. A transformation that affects the entire organisation involves many different stakeholders, including the management board and supervisory bodies, physicians, support staff, insurers and partners in the care chain. It’s not something that can be wrapped up from one day to the next. It requires governance and a programme structure to guide the overall process, ensure coordination at the right levels, and monitor and manage progress. Thanks to the experience that Strategy& has acquired handling transition processes, we know that most care institutions are far too busy dealing with day-to-day practical concerns to take on the extra work of a transition process. How can they get off to a flying start if they have to do it on top of their ‘regular’ work?
The first step is to work on developing an appealing strategic vision supported by all the stakeholders. There should also be a sense of urgency that drives the organisation into action. Our experience has taught us that without a strong ‘case for change’, the transformation is much more difficult to achieve. ‘The sector is used to growth, but the third Rutte Government’s coalition agreement states that volume growth must be reduced gradually to nil in 2022,’ says De Boer. ‘That will create a sense of urgency in every hospital; they will realise that they can no longer go on as they have been.’ This critical new strategic vision must inform everyday practice; that way, everyone can do their bit and the vision will truly come alive.
Once a goal been set, it’s important to reinforce the new strategic vision as often as possible. ‘To ensure that our organisation truly takes the new vision on board, our management team has found that we need to repeat it on a regular basis. We raise the topic again and again and again. Because we discuss it at every single meeting, the entire organisation – project teams, doctors, nurses, support staff, even the supervisory board – gets swept up in the new vision. We’re not out to merely inform them about the transition, but also to create excitement about the new strategic vision and appeal to each person’s intrinsic motivation to deliver excellent care. We do this by involving them and asking them what they think. We’ve found that the transition has really come alive in our organisation.’ At Strategy&, we know that the new vision must become a fundamental part of the work and not something extra that is just ‘tacked on’. That too must be communicated. All ongoing and new initiatives must be geared towards putting the new strategic vision into practice.
‘The sector is used to growth, but the third Rutte Government’s coalition agreement states that volume growth must be reduced gradually to nil in 2022. That will create a sense of urgency in every hospital; they will realise that they can no longer go on as they have been.’
The transition must have an obvious ‘medical complexion’ if it is to win over medical specialists and make plain that the changes are content-driven and not management-driven. To generate support, the organisation needs high-profile physicians who will inspire their colleagues and get them on board. It is important to have a good blend of prominent, highly regarded doctors and up-and-coming, ambitious ones. The transition needs standard bearers who can craft the change narrative and promote it as care professionals.
The many stakeholders involved in the transition, including the management board, physicians, support staff, insurers and partners in the care chain, may not always trust one another completely at the start of the process. Interests may appear to clash. We know from experience that it is possible to foster trust and understanding and resolve ostensibly conflicting interests. That will not happen on its own, however. Rigorous governance is required to manage the programme and the alliance between the care institution and health insurers, including a steering committee, a programme office and working groups. The usual programme structure typically includes a steering committee to oversee the transition at management level, whose members represent the boards of the cooperating partners (care institution, health insurers and GPs). Overseeing the day-to-day change process is a programme manager, who sets up a programme office with a number of relevant staff members (project coordinator, financial team, and so on). In addition, various working groups can be established to tackle specific topics and push the content-specific agenda forward (e.g. financial or care topics for which initiatives can be developed). Programme governance must be compatible with existing structures and not lead a separate existence.
The programme office ensures that the structure and processes are transparent – a crucial factor in a transition phase. It must see that answers are provided to such questions as ‘What programme structure can facilitate progress towards meeting our objectives?’, ‘How are tasks divided between the regular structure and the programme structure?’ and ‘Which stakeholders should we involve, when should we involve them, and how?’. Having a programme office undoubtedly improves the hospital’s capacity to implement the transition, but ownership of the process is vested in the care professionals themselves. The programme office can challenge physicians on content but gives them the lead in shaping it. It offers them maximum support in this regard by using templates, drafting documentation, providing necessary information, and so on. The programme management administers a multi-year plan and breaks it down into annual plans and goals for individual departments and working groups.
It is important to involve regional GPs in the transition process right from the start, since the aim of appropriate care has implications for them as well. Their efforts are also needed to implement the content-driven plans. The challenge lies in organising effective representation for GPs in the programme structure. It is sometimes a challenge to find GPs who have been given a mandate to make firm agreements on behalf of their peers. GPs often work alone or in small practices with their own methods and interests. That means that it takes time to get them involved. Timing is another important factor in that context: the hospital should certainly not wait too long to involve GPs, but neither should do so before it has fully developed its strategic vision and action plan.
Patients and the public should naturally also be involved in the transition to appropriate care. After all, the change process is all about giving patients the effective and appropriate care that they expect and require.
In the following blog, we will look a bit further ahead. We will imagine that the transition has already been under way for a few years and that volumes are shrinking. How do we turn this into actual cost reductions?