Changes in healthcare are happening faster than ever due to the Dutch Integral Care Agreement (IZA or het Integraal Zorgakkoord). Never before have so many healthcare providers been simultaneously engaged in planning to keep healthcare accessible, of good quality and affordable in the future. This initiative is urgently needed, as we all experience that healthcare is getting stuck. The willingness to change among healthcare staff and administrators is greater than ever. The big difference from years ago is that the ominous graphs of the past are now the new reality. There are healthcare providers who struggle every day to get the schedules right, and there are patients for whom the waiting lists are far too long.
This urgency of the staff shortage is also felt by the new cabinet. The coalition agreement literally states that “averting uncontrollable labor market shortages is a high priority.” The new cabinet is continuing the IZA and wants to further broaden, intensify and concretize it into a care and welfare agreement until 2028. How exactly this will look remains to be seen.
Meanwhile, healthcare providers can continue to draft quick assessments (Dutch snelle toetsen) and transformation plans, and insurers can continue to evaluate them on a large scale. This is fundamentally positive because these plans contain far-reaching ideas for healthcare. But with each approved plan, the question also arises of how we will bring the much-needed transformation into practice. How will so many healthcare providers simultaneously ensure a successful implementation? We provide seven tips, in no particular order.
Ambition is good, action is better
When developing transformation plans, overly optimistic effects are sometimes presented. This happens under pressure from insurers or due to the opportunism of suppliers. This is not only a significant risk for the willingness to change (as it gives negative energy) but also for financing (because milestones are not met). Therefore, stick to realistic goals and start on time.
The right people on the bus
Change is a profession, especially in healthcare. Ensure that there is a really good team of change makers in key positions. These can be temporarily filled by external experts —but only when they first demonstrate, then do it together, and finally, the healthcare provider does it independently. This way, the organization can continue independently without support. Ensure that new working methods, results and/or processes actually become ingrained in the organization.
From paper to practice
The downside of IZA is that it brings a huge classical project-based way of thinking. It’s in the plan, so we execute it as such. But if something doesn’t work in practice, stop it or change the approach. Discuss this with the insurer and move (“agile”) with the success. Also, take the time, as changing with so many different stakeholders demands time and doesn’t stop at the end of the IZA period.
Hard & heart
In the transformation plans, we mainly read hard elements such as KPIs, governance, organizational structures and business cases. However, successful change is mainly about stimulating desired behavior and discouraging undesired behavior. Not only among healthcare staff but certainly also among clients and patients. The heart elements concern the necessity, competence and willingness to change. Change does not happen with KPIs alone.
De-implementation
Let’s be careful not to stack applications and innovations on top of the existing ones. Introducing appropriate care also means saying goodbye to inappropriate care. Implementing digital care also means de-implementing non-digital care. In our experience, about 70% of the plans are substantively similar. There is now quite a bit of knowledge exchange between healthcare providers about the plans. Let’s also do this for de-implementation methods.
Change requires regional organization
Without good regional agreements and mutual trust, change is difficult. The extent to which regions and healthcare providers already collaborate varies greatly. There are still quite a few regions that are just starting with this and for whom, for example, addressing responsibilities is still new. Proper and timely establishment of a regional organization, including agreements, monitoring and finances, is crucial for the success of the implementation.
Don’t wait, start
What stands out is that healthcare organizations wait for the approval of the transformation plan before they start. This is quite remarkable because starting immediately is smart. It ensures a faster effect, gives an advantage in the labor market, and shows all stakeholders that you stand for change. Moreover, not all finances are covered by IZA, so there are activities that can continue without the insurer’s approval.
Talking about implementation is sometimes difficult. It is mainly something that needs to be done. Do you have any more tips on how it works in your practice? Let us know.
Walter Kien
Director Healthcare
T: +31 6 29 56 52 08
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