Translator: Claire KEFALAS Reviewer: Rhonda Jacobs
I had quite a normal life till I was 20.
I was a good student,
and I studied economics.
And then I made a radical choice.
I became a nurse.
I've got my wings,
but as a nurse, as a male nurse,
as I hope you can see,
I worked the rest of my life
with a lot of women,
and I saw it as something very positive.
I learned a lot from it.
I worked for many years in a hospital,
and after that I started to work as a district nurse in a community.
And this was the most beautiful part of my life
because I learned how to deal with all kind of problems in the community.
And I had colleagues in the same village I worked,
and together, we solved all the problems we met.
There was not a big organization,
it was just a team of nurses who organized the work themselves.
We took care for patients who were terminally ill,
patients with dementia,
people who were discharged from hospital,
and there was a big variety of activities.
We also took care for little children.
So it was in that period, the most healthy job you can get.
And we also built support systems in the community.
It was a very inspiring job,
and I enjoyed it very much till 1993
in Holland we got a big disaster
because the politicians discussed
that community care should become more professionalized.
And what I meant by that
was that it should become - it should be part of a bigger organization
managed by managers
and organized not focusing on solutions for people
but delivering products.
For the nurses, it looked like this:
Instead of thinking helping patients,
they had to think: What kind of products should I deliver?
We had personal care, personal care extra,
personal care special.
We had nursing care, nursing care extra, nursing care special.
And all theses nurses got disturbed by thinking:
What kind of activities should I give, and how should I code it?
Because there were a lot of codes.
For patients, it was also even a bigger disaster
because for every task, they got someone else,
and there were sometimes people with dementia
who got 30 to 40 different people coming into their house in one month.
And can you imagine
that every time you have to tell again what the situation is
and how you want to live your life?
So both nurses and patients
were very, very dissatisfied about how things were going.
The same time, it looked more and more like factories, the care organizations,
and I see it in a lot of countries happening.
So you saw that all the things
that were developed in industries and companies,
they were also in the organizations,
and you saw that more and more managers were taking over the profession.
So what you saw was that
there was more and more management layers in the organizations:
a CEO, directors, managers,
and they almost forgot that there were also employees.
And it can be done so much differently
as you can see in the other side of the slide.
The consequences, they were very different than the politicians expected.
Because the expected that by organizing this way,
the costs would go down and the quality would go up.
They also had market incentives.
But what you saw is that the opposite happened.
The quality went down dramatically
because of the many people who were involved with every patient,
and the costs doubled in 10 years.
So the assumption of the politicians was quite wrong.
But what you saw was that the people who paid us
were even more focusing on efficiency.
So for example, when a nurse took 10 minutes longer
for travelling to a patient,
she had to explain that to her manager, why she did that.
In 2006, some friends and myself, we thought it's time for a change.
I had been director for a few years in a few organizations,
and I saw that it could be done very differently.
And our ideas was to change the healthcare in Holland
and to start a movement to show
that elderly care could be done much better,
based on trust
and based on self-organization.
So the principles I worked myself with in the '80s,
we took them again as the basic principles for our organization.
And for four nurses in 2007, we grew to 9000 nurses in 2015.
And it just happened by itself.
The first year, 2007, it was some kind of experiment.
So we started in 10 locations,
and every time happened the same:
we got nurses who just developed their networks in the community;
they started to work again on the same principles we did in the '80s,
and within a few months,
they had got their patients, and they covered their costs.
So there was no financial problem.
So from 2008,
we got 10, 20 teams a month,
and every time it happened the same.
They called me to come to one of the houses of the nurses,
and we sat all evening talking about of our profession:
What does it mean to help people?
And how can we do it just the way we want it
and not be bothered by any kind of regulations?
So that's what we did,
and the evening of the day after,
I usually got a phone call from one of the nurses,
and they said, "When can we start?"
And then we started just a new team in a new neighborhood
focusing on patients as we are used to.
So this went at a very high speed,
and we didn't have problems to manage this because they were managing themselves.
We had a small back office,
and we still have a small back office with 30 people.
My wife and me, we are some kind of a management team,
but we don't have meetings, and everything is going very well.
My wife is always awake very early, around 6:00,
and then she tells me what to do like any other wife, I think,
is telling her husband.
So that's the way we are managing.
And this way, we have a lot of time just to solve problems.
In my job I had before, I had meetings from morning till evening,
and I didn't had time to solve the problems.
So that's quite different.
In 2015, we see that there's still no management.
Because there was a lot of criticism when we started.
They said, yes, you can do this easily when you're with just a few persons.
And then, they said,
oh wait, perhaps next year they will collapse
or they will have big financial problems.
But the opposite happened
because what you saw that the teams were more and more in control
and taught a lot of solutions
they could find for the problems they met.
So it was growing, the knowledge was growing in the teams,
and it became more and more sustainable.
We still tried to avoid any kind of bureaucracy.
We built an IT system
[which prevented] all the bureaucracy to take over the work of the nurses.
So all the bureaucracy was kept outside.
We split the administrative process with the professional process
so the nurses just can focus on what they're there for,
and that's taking care for patients,
find solutions for patients who have severe problems.
In 2015, we can look at it, if you look back now,
we can say we have, since we started,
the highest client satisfaction in Holland.
And what's very important for the policy makers
is that instead it took more costs, or more hours,
because we're working with higher educated nurses,
the costs went down with 40 percent.
So last evening,
the Parliament in Holland was debating about the district nurse.
And they were debating about the position of the district nurse
in the future in Holland.
And they said, this movement should be spread all over in Holland,
so we want to support it.
All the political parties agreed on that.
And at the same time, we became the best employer of the year,
three times in a row.
Just by doing nothing.
We don't have an HR department,
so we don't -
so by doing nothing, and doing less, you get far better results.
So all these management ideas
about controlling and command people,
are just, in my opinion, quite destructive.
So if you just let people organize the work themselves,
you get much better results and people are much happier
because they can do what they want to do.
And it sounds very logic,
but we make it very difficult for people to work this way in a lot of places,
also in schools and also with police.
It was not only in Holland that this happens.
There are a lot of countries who have the same problems,
and we got questions from the United States,
from Japan, Sweden, China, Czech Republic and so on.
I visited 30 countries,
and in every country I meet nurses who had the same ideas.
And we start the same movement.
Just with a few nurses, that's enough.
And then you show that it can be done.
And then you see that other people become curious.
And they say, oh, we never expected that it was possible in our system
because we have such a complex system.
So we also developed a theory on that.
It's the integrating simplification theory.
Try to make things simple, not complex.
And when you do that consequently,
it's more easy for people to take their responsibility,
and to think about what can be done to solve problems.
So, I think healthcare is about trust.
I never met a nurse who didn't want to do her work as good as possible.
So you can trust nurses.
It's about meaningful relationships,
with each other but also between nurses and patients, of course.
And it is about empathy.
Try to understand what the concerns of people are,
and try to do something positive with it.
So, in my opinion, we should -
let's bring the soul back into the organizations,
and let the complexity get out of the organizations.
Thank you very much.
(Applause)