The 9 lessons from South Korea, Taiwan and Singapore for combating the corona crisis (COVID-19)

Based on recent figures, the coronavirus appears to be present mainly in South Korea and to a lesser extent in

Taiwan and Singapore. None of these countries have instituted a total lock-down, but they have been very successful in controlling the number of infections and deaths due to the coronavirus. Given this remarkable success, it is important to understand what these Asian countries are doing differently from the rest of the world. In this blog, we describe the essence of Asian corona measures. These insights are essential to contain the current COVID-19 outbreak or a possible second outbreak in the Netherlands.

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The right care in the right place: To measure is to know!

Correct care in the right place (JZOJP) is the latest buzzword of administrators and policy makers. NNot surprisingly, because it sounds like a logical and therefore attractive solution to all complex problems in healthcare. The growing group of frail elderly people with dementia, who are living at home for ever longer? No problem, JZOJP will solve this. But those who look beyond the horizon know that it is not that simple. In fact, what if JZOJP is part of the problem? In this blog, we explain the problem with the current JZOJP approach and what it will take to break it.

it sounds like a logical and therefore attractive solution to all the complex problems in health care. The growing group of frail elderly people with dementia, who are living at home for ever longer? No problem, JZOJP will solve this. But those who look beyond the horizon know that it is not that simple. In fact, what if JZOJP is part of the problem? In this blog, we explain the problem with the current JZOJP approach and what it will take to break it.

Bullshit bingo

The Right Care in the Right Place (JZOJP) sounds promising, but turns out not to be easy to apply in practice. The first results of research by the NZA show that approximately 70% of the initiatives fail. The underlying cause of this problem is the so-called Bullshit Bingo that has the Dutch healthcare system in its grip. Just cross it off on the map: Right Care in the Right Place, Care Network, sensible care, care paths, 1.5-line care, substitution, positive health, network medicine, lifestyle medicine, etc. These are all wonderful, simple terms that obscure or ignore the complex connections in the care of the growing group of people with complex problems such as dementia. As a result, none of them provide a concrete solution. The fact that everyone has different definitions of and images of the JZOP concept does not help. At its core, of course, it’s about collaboration and people being able to do that in their own teams and outside their organization, in a context of innovation and trust. It is unclear how well we are really doing.

Knowing is measuring

Therefore, DementieNet and the Essenburgh have started a scientific study into the JZOJP for frail elderly and people with dementia. This cooperation is often far from optimal in the Netherlands. Nevertheless, there are good international examples that show that improving cooperation has many positive effects: vulnerable older people and their informal carers experience better quality of care, it is more pleasant to work for the care providers and ultimately it is cost-efficient. The research of DementieNetaims to identify the building blocks for successful collaboration in the complex care of people with dementia based on the Rainbow Model. To prove this, 50 local networks are examined and compared with international best practices. The results of the research help to determine concrete input for improvement targets for a successful JZOJP approach in the Netherlands.

Are you with me?

Would you like to know how your care network is doing? Then take part in the DementieNet survey. When you participate in the survey, you get direct insight into the performance of your network and tips on how to optimize collaboration. We ask of your network:

• Participation in an online audit care network, possibly supplemented by qualitative interviews.

Your network gets from us:

• Report with the results and comparison with benchmark data.
• Action plan and tips to improve cooperation step by step.

Want to know more about the research? Click here.

Alternate care: what if the solution is the problem!

Complex care in hospitals and simple care in the first line, that is the ideal picture. GPs and medical specialists are trying to refine this ideal by offering simple specialist care in GP practices through numerous projects. In short, the cardiologist, dermatologist, geriatrician or other specialist who sees patients a few hours a week in the GP practice. Alternate care is the trendy term given to this phenomenon. At first glance, one-way care doesn’t seem so bad. It brings care closer to the patient and that’s what we want. But we also want better care for less money, and unfortunately, in most cases, single-level care does not lead to that. This is not so strange, because what can you achieve with half a shot when you need to de-fragment the healthcare system to bring about real improvements? In this blog, we’ll be filleting the term other-worldly care. We show the pitfalls and give tips on how to achieve better health outcomes, better patient experiences and lower healthcare costs – or triple aim outcomes.

What is other-worldly care?

Divergent care is the transfer of hospital care to general practices. This is care that does not require sophisticated, expensive equipment. The idea is that the specialist might as well come to the patient for this kind of care. One-stop-shop care can be seen as a first cautious step towards abandoning the traditional echolalia approach – first line versus second line. The proponents of other forms of care say that this way of working is not only cheaper but also more pleasant for patients. They can often get their care faster and do not have to pay a contribution based on the excess. But that is the theory and practice, unfortunately, shows otherwise. Why is that?

Alternative care: what goes wrong?

When shaping other forms of care, we make mistakes in our thinking and our form on a number of fronts:

1. Unclear terminology.

Divergent care is in line with population management, network care, Proper Care in the Proper Place, substitution of care and transmural care. It is not a synonym for these terms, but part of them. You could say that one-way care is a part of substitution of care which, in turn, is a part of a care network (also referred to as ‘the right care in the right place’ or transmural care). One-way care is a small piece of the large puzzle that network care could be. Because all these terms are used interchangeably, a lot of confusion arises.

2. One-stop-shop care is pigeonholing.

The reasoning behind the establishment of other forms of care is as follows: the care system around the primary and secondary care is too fragmented to provide good care for vulnerable patient groups, so we are creating other forms of care as a solution. Then we will discuss whether this one and a half line should be generalist or specialist. So basically, that’s just adding a layer without changing anything. In other words, one more box on top of all the boxes that are already there….

3. Law of inhibitory chain care.

Too much is still done on the basis of the chain-based care model, while a crucial mistake was made when it was introduced in the Netherlands. We have forgotten to include the second line in the financing of the chain, so that the desired results in the field of quality improvement and cost savings are not achieved. But it can also be done differently! In countries where integrated care is successful, health insurers enter into integrated care contracts with both primary and secondary care providers working together in one organisational network. As long as the Netherlands lacks such integral financing and management, we will continue to suffer from the law of inhibiting chain care. As a result, new hypes are constantly being introduced, such as other forms of care, in an attempt to find a model that does work.

4. Who is ‘in the lead’?

Is it the general practitioner or the medical specialist (the hospital) who pulls the strings? There is often a lack of clear agreements on this, which leads to a lack of cooperation. In addition, the various stakeholders often have different interests, which hinders fruitful cooperation. Moreover, the cooperation is often motivated by external parties and lacks a real transmural incentive.

5. Lack of data exchange.

Effective collaboration requires the exchange of data between healthcare providers. In the Netherlands, however, data collection is incomplete and fragmented. This makes it virtually impossible to gain an insight into the current and future demand for care, and new care initiatives regularly miss the mark.

6. Process rather than outcome control.

The design of care is too often based on illness rather than on the needs, wishes and outcomes for the patient. Scores are awarded on process indicators rather than outcome indicators, while the latter should form the basis for healthcare improvement and innovation.

What to do then: four tips for practice

Multiple care is a Dutch concept, partly in response to the failed introduction of integrated care. It was conceived from a policy paradigm and not from the patient’s perspective. This ultimately makes it doomed to failure. If we want to find a serious solution to the problems currently facing our healthcare system – an increasing and more complex demand for healthcare and soaring healthcare costs – we must opt for an integral approach: networked care. But how do you approach network care? We give four tips:

Tip 1: Are you willing to take risks?

In a care network, all those involved have their own role and share responsibility for outcomes and costs. But as a healthcare provider, are you willing to run this risk? Second-line care is more advanced than first-line care, but first-line care is also necessary for successful network care. Ultimately, it is a matter of all care and assistance providers involved in a care network making agreements about the coordination of care, the division of responsibilities and the measurement of results. A number of best practices abroad show that it works for complex patient groups if you organise care across the whole network of prevention, care and welfare and make people jointly responsible for the outcomes. Daring to take joint risks therefore pays for itself!

Tip 2: Focus on results: Triple Aim outcomes

Put your achieved and desired outcomes at the center of how you design your care. Let the ideas of Triple Aim serve as a guideline. The Triple Aim approach is all about improving your outcomes in terms of quality, health and cost. To achieve the desired outcomes for a specific (sub) population, you work with a group of care providers in a coordinated way and share the risks. Together you are responsible for whether or not the quality and costs of care are achieved.

Tip 3: Winning is starting with the soft side

Working together and sharing responsibility is not always easy. It requires trust, openness and transparency. To make care networks a success, it is important that the individual interests are clear and that clear agreements have been made between them. Define a shared ambition together, link your objectives to it and make sure there is support for it among all the partners in the collaboration. This support can be created by building on trust. Make clear how the shared ambition contributes to achieving the objectives within a network. Create a safe culture in which people are willing to meet mutual agreements and dare to call each other to account if things are not going well. In short: make sure the soft side within your care network is in order.

Tip 4: Agree on the top 3 pitfalls

Clear agreements are needed in the areas of financing, data exchange and interests in order to increase the chances of successful cooperation. In terms of data exchange, make mutual agreements about which data you register and how and for what purpose you analyse them. And be aware of the differences in interests between medical specialists and general practitioners. For medical specialists, turning over volume is of great importance, while general practitioners have a much greater interest in creating space in their practice. How can you come closer together in this respect; how can you help and strengthen each other? This is context dependent. Starting from the care needs in your region increases the chance of a successful collaboration in your care network.

Getting started with care networks

Want to know more? Download the ebook Care networks that work and read more about the theoretical and practical side.

Sustainable business? Create employee engagement

Does your organisation want to operate in a sustainable way? Then you should definitely get involved with your employees. Because a lot of ideas come from the shop floor. Moreover, you increase the employee share. Your employees will feel that they are being taken seriously and will feel more connected to the organisation. And that in turn increases the chances of them staying. Together you will get further, is the cliché. But how do you anchor sustainability within your organization together?

Studies have shown that sustainability procedures contribute to employee retention and have a positive impact on productivity and overall employee engagement. Yet for many companies it is difficult to actually implement sustainability goals in the organization. These companies have not yet discovered how to successfully engage employees to achieve these goals.

Bright idea saves tens of thousands of euros

Inspired by Unilever’s sustainability slogan (‘Small actions can make a big difference’), employees at the PG-tips factory in Trafford Park, England, had a good idea. In Britain, most tea comes in paper bags. All in all, that takes a lot of paper. Employees had calculated the following: by reducing the end seals of each tea bag by 3 millimetres, 15 huge rolls of paper could be saved per shift. Since its introduction in 2015, this idea, as simple as it is bright, has resulted in savings of 47,500 euros and 9.3 tons of paper. A wonderful example of employee involvement in the field of sustainable business!

The knife cuts both ways in India

Another example of great employee engagement: 6 employees at the Unilever factory in Khamgaon, India, approached the factory manager with the idea of starting a beauty and hair care course in their own village. This is to help local women find a job or start a business. At the same time, they promoted Unilever’s personal care products. So the knife cuts both ways. In March 2015, the management gave the green light and the training center was opened. So far, 825 women have been trained. 610 women work in beauty salons or start their own business.

6 tips for embedding sustainability

Invite employees to come up with ideas

The examples from Unilever show conclusively that the best ideas often come from the shop floor. So if you want to work on sustainability, invite your employees to come up with their own ideas. Very important: failure is allowed. Because if it doesn’t work out, at least it’s been tried. By the way: most good ideas and innovations come from a mistake.

For inspiration, you can refer to the 17 World Goals that the United Nations established in 2015 to ensure that the world is a better place to live in 2030. You see, sustainability is much, much more than just good environment. It’s about making the world a little better.

Make sustainability visible (inside and outside the organisation)

Show what you are doing as an organisation. This keeps your employees involved in the process. This is an extra stimulus for them to come up with their own ideas. But of course also make the results visible and value employees in this. Do the same externally, because that is of course pure advertising for your company. And that in turn contributes to employee pride.

Show the benefits for your organization

Why is the organisation working on sustainability? What does it bring to the organization? And what are the benefits for employees? And how does it contribute to product development? The latter requires a great deal of creativity from Research & Development. And it takes patience. Because it might not get you anything right away.

Formulate a long-term goal

Formulate the purpose of the organization. And lay down that you want to achieve these goals in a sustainable way. It must be an aspirational goal with which everyone can identify. For example: ‘We make coffee and buy the coffee beans from farmers at a fair price. By doing so, we contribute to fair and social economic growth’. You can’t achieve such a goal tomorrow. You have to work towards that slowly. That’s why a long-term goal is so important.

Give employees knowledge and skills

Give employees the knowledge and tools so that they will actively think about sustainability. Tell them what sustainability is all about, which direction the organisation wants to go in and what they can do to help. Make every employee a sustainability expert. After all, employees often know best what could be improved or changed. For example, have them think about process improvement by taking steps out of it. In such a way that this benefits the quality of the product.

Encourage employees to implement sustainability

People find it difficult to change (Strebel, 1996). Because change takes energy and doesn’t always lead to the desired result. Therefore, show employees what the change means and involve them in it. And invite employees to just do it. By doing, they find out what the change brings and they become enthusiastic little by little. It’s just a matter of hanging on.

Sustainable organisations benefit from value-creating leadership

Organizations that want to work on sustainability benefit from modern leadership. With leaders who can make quick decisions that are economically, socially and environmentally justifiable. And thus create value on multiple levels. Such a leader gives employees their own responsibilities and ensures that they can do their job well. Supportive, inspiring and connecting. We call this: value-creating leadership.

Do you want to know more about value creating leadership? Then download the ebook Leadership in the Economy of Value below. Or click herefor our leadership training courses.

To a sustainable organization with these 6 actions

We all have a responsibility to make the world a little better. As a person and as an organisation. Making the world more beautiful, that is sustainability. Does your organisation want to get started with this? Then that can be quite a challenge. Because as soon as the pressure of work increases, people fall back into their old patterns. How can an organisation succeed in becoming more sustainable? Six actions to take now:

1. Identify goals and commit to them

Why are you on earth as an organization? What sustainable goals do you want to achieve? And how do you want to achieve this? Make this clear. Identify yourself as management with these goals. And commit to it all: management and employees. It is important to approach this strategically, aligning business priorities with relevant sustainable development goals. And by involving customers, employees and others in creating a positive impact.

2. Develop goals and KPIs

How do you set your goals? A good guideline are the 17 sustainable goals set by the UN. Such as: ‘Prevent food from being thrown away’, ‘Affordable and clean energy’, Fair and social economic growth’, ‘Sustainable production and consumption’, ‘Equal opportunities for all’ and ‘Healthy oceans, seas and rivers’. In doing so, also establish the Key Performance Indicators (KPIs). This is crucial for monitoring progress. To measure is to know for sure.

3. Make sustainability part of your business strategy

It is important that sustainability is not just a side issue, but an integral part of your business strategy. Otherwise, it’s not going to work. Analyze whether business strategies are sustainable and adjust business models as needed. See if the products and services the organization develops are sustainable. Do they contribute anything to the world? And what about the supply chain? Is it lean and mean? Can you outsource certain activities so that you can devote more time and attention to your own contribution to the world? Or can you do more yourself, making the chain more (cost) efficient and saving environmentally damaging transport movements?

4. Create new opportunities for your organization

It is still too often thought that sustainability measures only cost money. But sustainability also offers opportunities: for the company itself and for the environment. A good example is a manufacturing company in Brazil that is located in a large city and was having trouble finding good staff. This company decided to start a training program for unskilled people in rural areas. They gave the people education and thus opportunities. The company got the labor they needed. And because the training sessions took place in the village itself, there was even more solidarity between fellow villagers. All benefits, then.

So, invest. In education and staff. In innovative products and services developed in a sustainable way. And see how you can grow with that.

5. Cooperation is key

We all have a role to play in this world. Give each other that role. And work together. Good cooperation is the magic word in sustainable business. Between colleagues. With customers, suppliers and academics. Between profit and non-profit organizations. And between industries. The goal: mutually beneficial solutions. Leveraging networks. Scale up. And share responsibility. At least as important are collaborations with governments, cities and civil society. With the aim of harnessing the financial, technological and human resources of the business community to promote development, stability and trade.

6. Measure, assess, report and communicate

What do all these efforts yield? Measure the results of your sustainable projects and deployments. And communicate about this within and outside the organisation. The best way is to involve employees in this. This is done by developing systems for employees to report on sustainability targets and their results. Preferably as part of their daily operations.

Start small

Implementing sustainability in your organization is not always easy. Because change is hard. And all kinds of circumstances make it usually easier to continue on the old foot. Nevertheless, it is important to work towards a sustainable organisation. Why? Because that means you’re ready for the future. And because then you know for sure that you are really contributing something. This will only succeed if you formulate clear sustainability objectives and actually integrate them into the organisation’s goals.

Rest assured: you can start small and already make a sustainable contribution to your organisation’s immediate environment. You can build from there. Step by step and purposefully. Good for the environment, good for the organization.

Multiple value creation

Sustainable business requires companies to look beyond financial gain and also consider people and the environment. This calls for multiple value creation, in which economic, ecological and social values are in balance. It requires a different way of working for organisations and a new form of leadership: value-creating leadership.

Do you want to know more about value creating leadership? Then download the ebook Leadership in the Economy of Value below. Or
click here
for our leadership training courses.

The Right Care in the Right Place: Roadmap for a successful implementation

The Right Care in the Right Place is the new hype in healthcare. We see the term popping up everywhere and the memorandum ‘Proper Care in the Right Place’ forms the basis of all the mainline administrative agreements that have been concluded.

This is understandable, because in essence the Right Care in the Right Place is a fantastic way to realise the principles of Value-based Healthcare or Triple Aim in a region. However, a recent report by the NZA shows that the implementation has not got off the ground. We also know that implementation of such complex grant programs fails 70% of the time. As a result, stated goals are not achieved, time and money are wasted, and frustrated professionals and disappointed patients are left behind. The bottom line is that the Right Care in the Right Place – as it is currently designed – is doomed to failure. A different approach is needed. The key to success is a good implementation model and the great thing is: it exists! In this blog we will show you how to successfully implement the Right Care in the Right Place.

Why the right care in the right place?

The composition of our population is changing and with it the demand for and intensity of care. Compared to the year 2000, the number of people in the Netherlands aged 65 and over will double to approximately 4.25 million by 2030. As a result, not only is more care required, but other care as well. A large proportion of these elderly people have to contend with multi-morbidity and therefore a complex demand for care. But also in the population as a whole, multimorbidity will increase as a result of an unhealthier lifestyle. On top of that, there are more and more treatment options. All this will lead to an enormous increase in costs. It is expected that the average healthcare costs per person per year will rise from over 5,000 euros now to 9,600 euros in 2040, unless we intervene in time. This can be done by implementing the right care in the right place in the right way.

What is Proper Care in the Right Place?

Before we explain how to successfully implement Just Right Care in the Just Right Place, it’s a good idea to give it a definition, as this is often lacking. The national government formulates it as follows: ‘De Juiste Zorg op de Juiste Plek is an initiative of care providers. In this philosophy, the daily functioning of people is central. From there, they look for ways to relocate care (closer to people’s homes), prevent more expensive care and replace it with eHealth, for example. This helps people to live better with their illness or disability. The Ministry of Health, Welfare and Sport supports this movement where possible and facilitates parties to learn from each other and to get in touch with each other. Juist Zorg op de Juist plek is therefore care close to the patient, with various care and assistance providers working together and with increasing use of digital channels. Now you may be thinking, “Isn’t that network care? That’s right, Proper Care in the Right Place is a synonym for network care. And also for care network, sensible care, care pathway, 1.5-line care and substitution of care. We do not say this to make things even more complicated, but because these terms are also used all the time without us being able to see the whole picture – the entire elephant (figure 1).

Figure 1: The land of the blind

Right Care in the Right Place: a recipe for failure!

Why is the Right Care in the Right Place, as we are now approaching it in the Netherlands, doomed to fail? Apart from the fact that everyone has different definitions and images of the concept Proper Care in the Right Place, we do not meet the necessary preconditions. There is a lack of structural, integral funding and a coherent, evidence-based policy agenda. We do not regulate the care in an integrated way, but choose to start up separate projects and subsidy programs (like Juiste Zorg op de Juist Plek) as a countermeasure for our fragmented financing. They are all just a bunch of excuses with no coherence. As a result, the desired effects of quality improvement and cost reduction will not be achieved. The care providers do want to, but are not really stimulated by the current financial incentives to work integrally. As a result, the Right Care in the Right Place initiatives are struggling to get off the ground, let alone becoming embedded in practice. The problem is higher up in the tree. At the government level, policy is fragmented and not based on an evidence-based policy agenda. This makes the Dutch healthcare system inefficient. And who will suffer as a result?

The Subsidy Frustration Carousel (SFC)

1. Patient:

The patient who keeps getting stuck in the system because the Proper Care in the Right Place project he is using is due to expire after three years.

2. Healthcare professional:

The healthcare professional who becomes frustrated because his efforts are not continued in practice after those three years by means of a contract with the healthcare insurer.

3. Driver:

The director who cannot bring about structural changes due to a lack of a structural, integrated purchasing policy and a long-term contract with the health insurer.

4. Policy maker:

The policy maker who, time after time, has the difficult/impossible task of successfully implementing a new ‘hype’ because the field suffers from SFC syndrome.

In fact, the only ‘winner’ is the consultant who has his hands full trying to find the possibilities within the depths of the system. Incidentally, in most cases without long-term success. By now, it’s probably obvious why….

How can the Right Care in the Right Place be successful?

For about 15 years we have been muddling along in the Netherlands, while in other countries, such as America, England and Germany, successful initiatives have been launched. The reason is that they have arranged their financing properly (see figure 2).

Figure 2: International examples

However, there is also a solution within reach for the Dutch situation in the form of a scientifically substantiated implementation model: the Rainbow Model.

Figure 3: The Rainbow Model

In the Rainbow Model, the needs of the patient are the starting point for various forms of clinical, professional and organizational collaboration. Such cooperation can take place at: 1) micro level: between client/patient and care provider, 2) meso level: between professionals and organisations, and 3) macro level: laws and regulations affecting all forms of cooperation.

Collaboration, that’s what it’s all about. The right care in the right place depends on people – patients, healthcare professionals and administrators – who are willing and able to work together, even beyond the walls of their organisations. And you can achieve this in four ‘simple’ steps:

Step 1: Map out your patients’ needs.

Do this at a regional level, so share practice data. Also, try to predict the future needs of your patient population. You can do this using clinical and cost data. This way you know what interventions are needed for your patient population now and in the future.

Step 2: Determine what outcomes you want to achieve.

Both clinically and in terms of patient experience and cost. Use the principles of Triple Aim for this. PROMs (patient reported outcome measures) and PREMs (patient reported experience measures) can be useful here.

Step 3: Determine what forms of collaboration you need to achieve those outcomes.

The Rainbow Model serves as a guideline for this. Look at the micro-, meso- and macro-level to see which forms of cooperation you could use.

Step 4: Identify and organise structural and cultural preconditions.

List what you need to make the Right Care in the Right Place a success in the long term. For example, look at funding and whether there is a culture within your organisation where people are prepared to make changes.

Towards evidence-based policy

The fact that most Proper Care in the Right Place projects fail has nothing to do with the potential of the concept, but with the way it is put into practice in the Netherlands. Instead of an integrated policy approach, we choose to finance separate projects. Subsidy money as a stopgap measure, that’s what it comes down to. We really need to stop doing that and make sure that we create the right preconditions to make the Right Care in the Right Place the success it deserves. This means that we make agreements at macro level about integrated financing, that we shape our policy on the basis of evidence and that we create conditions for information exchange. Use the needs of your patient population and the desired outcomes of your care as the starting point for care improvement. And very important: work together! With patients, with other care providers and with other care organisations. If so, the success rate of ‘Juiste Zorg op de Juiste Plek’ will increase by leaps and bounds.

Would you like to know more about successfully implementing Just Right Care in the Just Right Place? Read more in our eBook Care networks that work: The key to better outcomes.

Patient experience or patient satisfaction: what does it get your organisation?

Measuring patient experiences and patient satisfaction is becoming increasingly important in healthcare in order to assess the quality of care. But the concept of patient experience is surprisingly complex and is often equated with patient satisfaction.

These terms are also regularly used interchangeably in the literature. Confusing and unjustified, because patient experience and patient satisfaction are two different things. In this blog we will discuss these differences. We show you what to measure to gather useful data to improve the quality and efficiency of your organization. And how to make sure you have happy patients.

Patient experience and patient satisfaction: the differences

Although the terms patient experience and patient satisfaction are often used interchangeably, there is a subtle distinction between the two (see also Table 1).

1. Patient experience

Patient experience includes all interactions a patient has with care and how they experience it. You can think of the reception by the receptionist and the care by doctors, nurses and other care providers. When measuring patient experience, we look at whether something that should have happened actually did happen.

2. Patient satisfaction

Patient satisfaction is based on the patient’s expectations of care and whether those expectations were met. As a result, two people receiving identical care may score totally different on patient satisfaction.

Table 1. Patient experience versus patient satisfaction

In short: patient satisfaction is often very personal, while patient experience is about testing a defined standard of care. Subjectivity versus objectivity, in other words. The subjectivity of patient satisfaction surveys is also endorsed in several studies(Evans et al 2018; Dunsh et al 2018). These show that:

• Patients tend to make positive judgments immediately after treatment.
• The chance of a positive judgement is higher if the questions are formulated in a positive way.
• Satisfaction is not a reliable measure of quality.

So, all indications are that measuring the patient experience is more meaningful. Hence, in this blog we will focus further on this.

Why is a positive patient experience so important?

Of course we want to provide care that our patients experience as ‘good’. Satisfied customers are nice to have, but positive patient experiences can also bring important clinical and financial benefits, research shows. We will mention a few examples:

1. 1. Mortality

    

   Research among patients with heart disease shows that a positive patient experience has an effect on mortality (Meterko et al., 2010).

2. Costs

There is evidence that positive patient experience leads to lower average costs for healthcare organizations(DiGioa et al., 2007; Charmel et al., 2008).

3. 3. Quality of life

Research shows that positive patient experiences have a positive impact on self-management skills and quality of life in diabetic patients (Greenfield et al., 1988).

4. 4. Adherence to therapy

A correlation has been demonstrated between positive patient experience and adherence in patients with chronic conditions(Doyle et al., 2013; Beach et al., 2006).

5. 5. Satisfied caregivers

Positive patient experiences lead to reduced staff turnover and increased job satisfaction among healthcare professionals(NHS, 2010; Agency of healthcare Research & Quality, 2016).

6. 6. Patients

Moreover, research shows that patients want to be more involved in decisions about their treatment(Picker Institute, 2006).

So, good patient experiences have an impact on various Triple Aim outcomes. By focusing on this as a healthcare institution and improving patient experience, you create a win-win situation.

Improving the patient experience: how to do it

But how do you improve the patient experience as a healthcare organisation or healthcare provider? This can be done in many different ways that may vary for each organization, because no organization and no patient population are the same. But while there is no one-size-fits-all approach, there are several proven methods to improve the patient experience. We mention a few of them:

1. 1. Waiting times and queues

Communicate waiting times and ensure that queues do not become too long, for example, by online and offline solutions that allow patients to make their own appointments.

2. 2. Signage

Make sure patients can easily find their way around your organization. In that respect, digital navigation is the future.

3. 3. Information in your own language

Use communication tools with translation functions. A patient who does not speak the language is more likely to be dissatisfied with the care provided.

4. Waiting room
Create a calm, relaxed, comfortable atmosphere in the waiting room. The logic is simple: if patients feel positive about the environment in which they wait for treatment, they are more likely to be positive about the experience as a whole.

5. 5. Staff

Make sure your employees are positive about their jobs. One way of achieving this is by designing work processes as efficiently as possible to prevent unnecessary work stress. But also by providing insight into which behaviour produces positive patient experiences. Staff treatment has perhaps the greatest impact on patient experience.

6. 6. Involve patients in the delivery of care:

Try to choose appropriate care together with the patient and divide the tasks. Display messages in the waiting room about developments in healthcare and offer patients the opportunity to provide feedback through a survey.

Measuring patient experience: PROMs and PREMs

Patient experience is one of the most important parameters to determine the quality of care. You could even say that the survival of healthcare organisations increasingly depends on their ability to provide good patient experience, and therefore quality. Like no other, the patient makes bottlenecks in your care clear. But patient experiences are only useful if they are measured with valid and reliable measuring instruments. For this we have PROMs (Patient Related Outcome Measures) and PREMs (Patient Related Experience Measures). With a PROM the patient gives an opinion about the perceived health in the areas of, for example, pain, fatigue and depression. A PREM measures how the patient experiences the entire care process, such as the collaboration between care providers, treatment and efficiency of care. PREMs are particularly interesting for value-driven care,which can be seen as the way to restore health to our fragmented, costly healthcare system. The problem is that few PREMs have been validated. Based on scientific research Essenburgh has developed a PREM for integrated care and validated it internationally. This makes it a reliable tool to gain insight into how care is experienced in your organization. The short questionnaire is based on the patient’s perception of the situation and indicates whether and where they experience fragmentation in the care process. Strengths and weaknesses of the care process become visible at a glance. And because it is possible to compare scores at the level of practice, district and/or (sub) population, you will discover best practices and therefore concrete points of departure for improvement.

Figure 2: PROMs versus PREMS

Want to know more?

Download the free E-Book Care networks that work: the key to better outcomes. And learn what your organization needs to do to improve patient experience and satisfaction. Would you like to use our scientifically validated measuring instruments to map out the patient experience? We are happy to help you. Please contact us for more information.

Social entrepreneurship: the answer to the circular economy

The circular economy is hip. This is not just about short-term profits, but also about ecologically responsible and socially just results. To what extent should organizations align their goals with corporate social responsibility? Is it worth it for organizations? And how do you promote the circular economy through social entrepreneurship?

Social entrepreneurship is becoming increasingly important

Social entrepreneurship is the answer to the circular economy. But what exactly do we mean by social entrepreneurship? According to Caroll (1999), social entrepreneurship is ‘the expectation that businesses can contribute financial and human resources that improve the quality of people and/or regions‘. Social entrepreneurship is therefore essentially about the company also realising value for its environment.

Social entrepreneurship emerged in the 1950s. It has changed the way many organizations do business. And now social entrepreneurship is hotter than ever. Consumers are increasingly opting for products and services from companies that practice corporate social responsibility. The government, business partners and other stakeholders are also finding this increasingly important and are focusing on it. This is only logical, as social entrepreneurship can help organisations create multiple value in every action and decision. Provided you approach social entrepreneurship strategically. How do you do that?

The Rainbow Model shows which steps are needed to arrive at multiple value creation, and thus at social entrepreneurship. The Regenmodel has been developed by Pim P. Valentijn, deputy director of Essenburgh Training & Advice.

Figure 1: Rainbow model

Caroll’s CSR pyramid

The pyramid of corporate social responsibility (Caroll, 1999)is a valuable tool for developing social entrepreneurship. This pyramid shows the organization’s priorities and four responsibilities to society: economic, legal, ethical and philanthropic.

The return of social entrepreneurship

In the ideal situation, economic, ecological and social values are in balance. The pyramid model can help organisations with this. Social entrepreneurship has several advantages, according to an increasing body of literature. Such as: less employee turnover, better reputation and higher customer satisfaction (Galbreath, 2010). According to Nurn and Tang (2010)social entrepreneurship provides better financial performance. It also helps to attract better employees, work more efficiently and reduce operating costs. According to Siddique (2015) , it can also improve employee motivation and confidence. In addition, there is also the competitive advantage for firms in the commercial sector(see also Klará (2011).

How do you anchor social entrepreneurship?

Do you want to get started with social entrepreneurship? It is wise to do this step by step. Because that is the only way to embed it properly in the organisational culture and in the minds of employees. After all, awareness creates support. And from support comes enthusiasm and determination. This is necessary for successful social entrepreneurship. A good instrument for this is the Rainbow Model. This model shows that value-creating leadership consists of several leadership domains. Namely the micro level (person level), the meso level (team and organisation) and the macro level (the ecosystem of different organisations). According to Tharp and Chadhury (2008)social entrepreneurship can be integrated into any organization and contribute to its goals. If you do this well, social entrepreneurship becomes part of the organisation’s capital. With activities, monitoring, goals and incentives (Lev and Radhakrishnan, 2005).

Have an eye for the hard and soft organizational capital

Multiple value creation depends on people who can work together in a context of innovation and trust. To realize this, according to the Rainbow Model, the right balance is needed between functional ‘hard’ (such as money, data and rules) and ‘soft’ change interventions (such as culture, mission, norm and values). This is a complex process that requires thorough knowledge of the context.

Develop social leadership

Good management and leadership skills are very important for good social entrepreneurship. For example, Jones & Kramer (2010)argue thatthere is sufficient evidence that management and leadership development are important. And that fostering leadership capabilities improves sustainability outcomes. Cornelius, Wallace & Tassabehji (2007)argue that ethical training is a catalyst for developing corporate social responsibility. Essenburgh Training & Advice therefore offers various evicence based leadership trainings.

Be transparent

Organizations that use corporate social responsibility as a sustainable strategy need to communicate well. And they need to be transparent about their processes and their revenues.

This is best done in the Annual Responsibility and Sustainability Report, also known as the CSR report. Such a report states what has become of the plans in terms of planet, profit and people. You also mention the plans for next year. Naturally, you can also communicate about CSR efforts in other ways. This will strengthen the reputation of your organisation.

Do something about social entrepreneurship too

Do you want to work on social entrepreneurship? A good first step is to realize that social entrepreneurship is about creating shared value (Porter and Kramer, 2011). This means that you not only create economic value for your own organisation (profit maximisation), but that you also have an eye for ecological and social values. Of course, your organization doesn’t have to become a charity.

Next, it is good to know that the organisational structure does not need to be completely overhauled. Small steps in particular can yield great results. Step by step you grow into social entrepreneurship.

What is important is that social entrepreneurship should not be seen as an isolated practice. Or as a means to an end. This requires a different way of working for organisations and a new form of leadership: value-creating leadership.

Do you want to know more about value creating leadership? Then download the ebook Leadership in the Economy of Value below.

Tip: checklist for social entrepreneurship

Want to know what commitment your organization has for social entrepreneurship? There are several tools for this. Like the assessment tool of CSR Europe: download the social entrepreneurship checklist. Or click herefor our leadership training courses.

Risk stratification: Drive value-based healthcare and the Triple Aim with smart algorithms

Consultation hours are overly busy, and a lot of time goes into checking off the required boxes. It drives healthcare providers crazy! Understandable, but unnecessary. With a different focus and approach, there is a lot to be gained in terms of the Triple Aim. The secret is to look at risks instead of diseases and making smart use of your own data through algorithms, also known as risk stratification. In this blog we will explain how you can organize your care based on patient groups with high, increased or low risk profiles. We will show you that it leads to: 1) better outcomes for patients, 2) lower workload and more job satisfaction for healthcare providers, and 3) more efficient business operations and lowering of costs for managers in the healthcare sector. And the best thing is: it’s all within reach.

Focus on risks instead of diseases

The biggest pitfall of our current healthcare system is the disease instead of person-focus view. Nowadays we are dealing with an increasing group of people who have two or more diseases simultaneously, who risk falling between the cracks because of this focus when it comes to healthcare. It is much smarter to adapt healthcare and organize it on the basis of risks and the patient’s corresponding health needs. By identifying unique subgroups of patients, healthcare organizations can offer person-centered care instead of a single disease one-size-fits-all approach. That way, they have more influence on a better outcome for these patient groups. They can also organize their care more (cost) efficiently. This means that the traditional chronic disease divide of groups (e.g. diabetes type 2, COPD, heart failure, oncology etc.) will become less important in the near future. This is a new way of thinking, at least for the Netherlands. In other countries, like the US, Australia, New Zealand and Colombia, it’s already proven effective. Their best practices show us that realizing the right kind of care in the right place starts with dividing patients based on risk stratification models.

How does risk stratification work?

All healthcare providers need to register data in a database. Releasing risk stratification algorithms on the data in such a database is a relatively simple way to categorize patients on the basis of risk profiles. Some people struggle with the idea of using algorithms because of negative associations. This is a shame and unjustified, because algorithms are much better at tracking down patterns than the average healthcare providerwhichis incredibly beneficial to your organization. We will try to explain what it benefits exactly based on three risk profiles that can be detected by means of risk stratification. We start with a short description of the profiles and explain step by step how, as a healthcare provider/organization, you can use it to adapt your healthcare services to these profiles.

Image 1: How risk stratification works

High risk patients

This group, which accounts for approximately 5% of the population, consists of people that visit their GP or another healthcare provider more than twenty times a year for different reasons. The so-called superusers.Not unsurprisingly, we find a lot of vulnerable elderly people in this group. But also people who have mental health issues. The group is more heterogeneous than you would think. For example, risk analyses can show us that a lot of superusers are middle-aged women with families. A group you wouldn’t necessarily think of right away, but that can clog up your consultation hour in your daily practices just as much as other high-risk patients.

Step by step plan:

1. Link every high-risk patient to a case manager. This can be a nurse practitioner, a district nurse, a GP or a specialist in geriatrics. The case manager coordinates the care of a patient along the entire spectrum of prevention, care and wellbeing.

1. 2. It’s important for the case manager to get off on the right foot with a patient. For example by making an appointment to get to know each other and explaining his/her role.
3. 3. The case manager and the patient then create a custom healthcare plan. The standardized approach with set templates and documentation options within the electronic health record (EHR) can be used for this. The healthcare plan can include clinical and non-clinical problems. Self-care and shared decision making are always part of a healthcare plan.
5. 4. Since a high-risk patient almost always deals with health and social related issues, it’s important that this case manager has a wide range of social tools at his or her disposal and is good at cooperating.

Increased risk patients

This group consists of people with one or more chronic diseases who switch between stable and unstable periods. It’s good to take into account factors such as obesity, depression, high blood pressure, high cholesterol, high blood sugar (pre-diabetic) and tobacco consumption in risk stratification algorithms. The goal here should be that these people don’t move into the high-risk category.

Step by step plan:

1. 1. Have a care group or health center coordinate the healthcare and make sure all relevant disciplines are represented. Models like Accountable Care Organization, and Patient Centered Medical Home (PCMH) are examples that already use this method.
3. 2. Try to involve the patients in their care as much as possible. This can be done through self-help support, shared decision-making, written healthcare plans and patient surveys. Family and friends can also be involved as ‘influencers’. They can encourage the patient in their self-care and act as an extension of the healthcare team, for example by informing the healthcare team of any significant changes.
5. 3. Plan yearly preventative screenings for chronic conditions. This will make it easy to detect gaps in care and risks. These can be done by a health coach.
7. 4. Invite increased risk patients to try new types of care. Like eHealth applications, online forums, group sessions and health coaches. Research has shown it’s also smart to involve family and friends at this stage.

Low risk patients

This is the remaining group: people that are healthy or whose health is stable. The goal of this type of care is to keep these people healthy. This can be done cheaper, more efficiently and more goal-oriented than it is now.

Step by step plan:

1. 1. Develop an online patient portal for the initial communications and encourage low risk patients to use it (image 1). You can put information about for example the most common conditions and what to do if you have those. This stimulates self-management. Research has shown that this approach increases the patient’s engagement with the organization. This is interesting because it can encourage efficiency in use of care. The number of unnecessary consultation visits can be brought down this way.
3. 2. Focus on low risk interventions. As described above, it is important to manage the low risk patient population in an efficient way. Explore other strategies to engage with these groups even better and prevent them from becoming increased risk patients.
5. 3. Reserve time and capacity for (online) prevention and preventing unexpected healthcare needs. This doesn’t necessarily need to be done by a doctor, often times a nurse practitioner or doctor’s assistant can suffice.

Image 2: Online e-Health interventions

How is this beneficial?

Research has shown that risk stratification is the way to put value-based healthcare (VBHC and/or Triple Aim)into practice and actually generate better outcomes. It forms the basis of offering custom proactive care. Coordinated, patient-centered care saves the patient unnecessary treatments and time. The focus on prevention can also avoid a lot of unwanted outcomes. This all leads to higher patient satisfaction and better healthcare outcomes. This is also beneficial for healthcare providers. By organizing care based on risk groups, valuable time can be used in a more efficient way. Instead of scheduling ten minutes for every consultation, you distinguish between these risk groups. You give low risk groups less time and high-risk patients more, which means you have more time to properly help the latter and they will visit less during consultation hours. It also means a better division of labor. Not every patient needs to see a doctor for every problem. Some cases can actually be easily solved online. This decreases the workload and costs and increases job satisfaction. Risk stratification also means managers can make more specific contractual agreements with health insurers or governments. Right now, those agreements are based on volume and price, mostly based on nation-wide statistics. But it’s hard to determine a nationwide average. The need for care in a metropolitan area is completely different from the one in rural areas. If you can map how they differ, you can make agreements based on the regional situation. This increases the quality of care and saves costs.

So what’s stopping us?

That’s the main question, because it doesn’t seem to be taking off. There is still too much talking and too little action. Risk stratification is only possible if healthcare providers manage their data right and report the relevant data. That means no process indicators, but outcome indicators, like quality, health and cost (Triple Aim). It’s also important to link data systems. And don’t say it can’t be done because of privacy. That’s a fallacy. It’s undoubtedly possible to link data sets and adhere to privacy regulations. It’s not technique and regulations that are stopping us, but the prevailing culture. It’s almost like we’re afraid of the unknown. We need to be brave enough to move past that. Because we can influence that full waiting room as healthcare providers. We can negotiate better contracts. Let’s try to do that proactively. Instead of waiting until the government or health insurers take action when the situation becomes unsustainable, let’s take matters into our own hands and work on risk stratification. That way we stand up for ourselves and for our patients.

Learn more

Want to know more about risk stratification? Download our whitepaper.