Dutch Health Care Organizations Research Articles

Buurtzorg Nederland, a proposal for nurse-led home care.

Buurtzorg Nederland is a Dutch healthcare organization in which nursing teams provide home care in all the skills that affect their profession. This article raises some questions regarding more internal aspects of the organization based on 3dimensions. The first, the organizational dimension, in which the teams are structured based on 8 roles, without hierarchies and supported by the coaching system. The second, the nursing dimension, in which it is highlighted that nurses deal with all the competences that affect their profession, from basic care to more complex care, with the aim of defragmenting care. And the third, the economic dimension, in which it stands out that the sustainability of the organization is in being a system without managers, of small teams that work in small geographic areas, with a computer system that supports all organizational matters, healthcare and financial. The main characteristics of Buurtzorg Nederland are the self-management of the teams and the defragmented care that both the nurse and the patient satisfy. However, this defragmentation has been achieved in terms of patient care, with the same team attending to all basic and complex care needs at home, but at other levels of care it has not been achieved, and the patient must visit other providers, therefore, health care at other levels continues to be fragmented.

Power, legitimacy and urgency: Unravelling the relationship between Dutch healthcare organisations and their financial stakeholders

Healthcare organisations rely on their financial stakeholders for capital to invest in state-of-the-art buildings, equipment, innovation and the delivery of healthcare services. Nevertheless, relations between healthcare organisations and their financial stakeholders have not been well studied. Here, we studied the relations between Dutch healthcare organisations and two of their main financial stakeholders (banks and health insurers) against the backdrop of system reforms and the financial crisis. We conducted a survey of healthcare executives to evaluate their relations with banks and health insurers in terms of power, legitimacy and urgency. These three attributes are based on the salience model of Mitchel, Agle and Wood (1997). We further tested for differences in power, legitimacy and urgency across organisational sector and size. The results showed that healthcare organisations value banks as legitimate stakeholders with a well-demarcated influence and a clear-cut function. The relationship with health insurers is more complex. Healthcare organisations experience considerable influence from health insurers but question the legitimacy of their claims. Since health insurers play a crucial role in the Dutch healthcare system, these findings question the workability of the relationship between healthcare organisations and health insurers and the position of health insurers in the overall healthcare sector. Our results are relevant to countries with public-private health systems and contribute to the development of the salience model by showing the individual value of stakeholder attributes and the relevance of context.

Buurtzorg Nederland, a proposal for nurse-led home care

Buurtzorg Nederland is a Dutch healthcare organization in which nursing teams provide home care in all the skills that affect their profession. This article raises some questions regarding more internal aspects of the organization based on three dimensions. The first, the organizational dimension, in which the teams are structured based on 8 roles, without hierarchies and supported by the coaching system. The second, the nursing dimension, in which it is highlighted that nurses deal with all the competences that affect their profession, from basic care to more complex care, with the aim of defragmenting care. And the third, the economic dimension, in which it stands out that the sustainability of the organization is in being a system without managers, of small teams that work in small geographic areas, with a computer system that supports all organizational matters, healthcare and financial.The main characteristics of Buurtzorg Nederland are the self-management of the teams and the defragmented care that both the nurse and the patient satisfy. However, this defragmentation has been achieved in terms of patient care, with the same team attending to all basic and complex care needs at home, but at other levels of care it has not been achieved, and the patient must visit other providers, therefore, health care at other levels continues to be fragmented

Skills, Influence, and Effectiveness of Management Accountants

ABSTRACT The role of the management accountant (MA) has broadened to include acting as a strategic business partner. Our study examines whether MAs believe they need interpersonal skills (i.e., the ability to constructively challenge and question assumptions, numbers, and their meanings), conceptual skills (i.e., making and leading decisions consistent with the organization's business environment and strategy), and/or technical skills (i.e., computer, accounting, and data modeling) to be influential and effective in this expanded role. To examine our hypotheses, we use survey data from 215 controllers in Dutch healthcare organizations and develop a partial least squares path model. We conclude that interpersonal and conceptual skills are associated with MAs' perceptions that they influence management's decision making, while all three skills are associated with their effectiveness. We also find that technical and conceptual skills are jointly associated with the influence of MAs while conceptual and interpersonal skills are jointly associated with their effectiveness. Data Availability: The data are from a proprietary source and cannot be shared without the owner's consent. JEL Classifications: I19; C31.

Lessons learned from implementing a responsive quality assessment of clinical ethics support

BackgroundVarious forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other’s health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project.MethodsCES practitioners’ experiences with and perspectives on the RQA project were collected by means of ten semi-structured interviews. Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of the decisions.ResultsThe main findings illustrate the relevance of the RQA with regard to fostering the quality of CES by connecting to context specific issues, such as gaining support from upper management and to solidify CES services within health care organizations. Based on their participation in the RQA, CES practitioners perceived a number of changes regarding CES in Dutch health care organizations after the RQA: acknowledgement of the relevance of CES for the quality of care; CES practices being more formalized; inspiration for developing new CES-related activities and more self-reflection on existing CES practices.ConclusionsThe evaluation of the RQA shows that this method facilitates an open learning process by actively involving CES practitioners and their concrete practices. Lessons learned include that “servant leadership” and more intensive guidance of RQA participants may help to further enhance both the critical dimension and the learning process within RQA.

Innovation of the governance of integrated care

Aim: Interest in integrated care is growing. This is reflected in the rising numbers of scientific publications, IJIC’s increased impact factor and the increasing number of participants at IFIC’s international conferences. It is stimulating to see that organizations like the World Health Organisation are developing conceptual frameworks that embrace integrated care [1,2]. At the same time we know that integrated care does not become reality automatically; it takes a long timeframe. That can be conflicting with ambitions like ‘implementing good practices as fast as possible’ and with the pressure to deliver results in politically set tight time frames. Governance of integrated care: For future directions, the governance of integrated care and interorganisational collaboration on a local level needs more attention, more innovative thinking and more knowledge. We define governance as the total package of leadership, accountability and supervision in the local setting in an area or region [3]. In the Netherlands, a huge number of networks of collaborating organisations in a certain area, for instance for dementia care, stroke care, elderly care or palliative care, have been set up in the last decade. Too less is known about the governance of these networks. In the workshop we discuss how the governance of integrated care and these networks works and what doesn’t work and could be innovated. An inventory among 130 integrated care networks in the Netherlands will be presented. It showed that although in most cases the collaboration is signed up in a collaborative agreements commitment towards the network is not automatically present. Organizational interests predominate and often one of the partners is dominant in the network that may often result in reduced levels of cooperation [4]. Although the aim of these networks is to serve clients better, results showed that in one-third of the networks the interests of clients are not taken into account. If clients are involved this is often via the professionals. Overall, the inventory shows that these networks explore and also struggle with how to organise integrated care and on what scale population, target group, geographical area. Traditional governance within organisations often does not match the needed governance between organisations. Network governance is more horizontal, non-hierarchic, and focuses on trust as a basic value. The quality of the relationship between involved people, organizations and underlying values is a crucial factor to focus on in this type of governance [5, 6]. In the workshop also the results of a session with 30 CEO’s of Dutch health care organisations from all domains are shared that demonstrate the themes for the future regarding the needed innovation in governance that suits integrated care. Themes are for instance accountability, ownership, legal issues, collaborative models but also uniformity in language. Network session or workshop: In the session insights about local governance leadership, accountability and supervision of integrated care are discussed, the results of the inventory among 130 networks. Expertise from other domains like legislation is present, including a representative CEO from an integrated care network. Reference list: see remarks 7 references included.

Governance and performance measurement in integrated care. An Evidence Based Integrated Care Approach

Introduction: Healthcare institutions in The Netherlands are faced with the facts of increasing extent of internal and external accountability. This is related to the fact that healthcare institutions and their professionals are obliged to register a full set of indicators which are required input to effect this accountability. This is also known as governance. One of the definitions is: to control and to account for Minderman 2008 or controlling accountability Hoek 2007. On the one side in integrated care, care pathways are characterized by the delivery of care interventions proof of concept and on the other side pathways are characterized by the organization of the delivery of care interventions proof in context. Both concept and context of care are related to governance and performance measurement in healthcare. In general governance in healthcare in The Netherlands focuses on control, accountability and controlling the boards, mostly within one care organisation. However in integrated care governance and performance measurement should ideally be on cooperation and trust between the organizations. Governance therefore includes various forms of accountability, concerning several areas: from government national and local, to organizations and commissioners, to organizations and their supervisory boards, to organizations and their financiers and the patient. Healthcare organisations must be accountable to e.g.: The Dutch Healthcare Inspectorate, The care insurance companies and The National Healthcare Institute. Furthermore, healthcare institutions have to account for their efforts to deliver quality of healthcare. The way this is done is through a system administrating their internal performance indicators. In this respect, one can ask how indicators are administrated within healthcare organisations and how external accountability is designed. Different gaps of governance and accountability can thus be found e.g.: A gap between what accountancy data in care institutions is collected, their network and what is externally justified to the involved parties. The gap between governance and is the ones accountable to people and municipals are involved in decentralization. Gap of citizens and governance. Theory/Methods: A systematic review of literature on what is the current knowledge on governance in integrated care, and an extensive case study which will be conducted in Dutch healthcare organisations and healthcare network organisations. One of the characteristics of case study method is: a narrow domain with several research units, in depth rather than a broad view, the supposed concerns in many cases the entire research area instead of a few variables like in a survey study. Discussion: What should governance as an accountability tool look like within the context of evidence-based integrated care and what knowledge is gained and how can this knowledge be used to meet accountability issues?

Willingness to share knowledge in healthcare organisations: the role of relational perception

A growing number of studies have been conducted to study the antecedents of employees’ knowledge-sharing behaviours. However, the literature is limited regarding the influence of relational characteristics on knowledge sharing. We conducted a field study in two Dutch health care organisations, and examined employees’ willingness to share knowledge in 488 dyadic relationships. The results showed that an individual’s perceived reciprocity and positivity of a dyadic tie was positively related to that person’s willingness to share knowledge. Moreover, perceived competition was negatively related to willingness to share knowledge. Based on these findings, we discuss how to change organisational culture to encourage knowledge sharing. Suggestions for future research and practical implications are also offered.

Employee involvement in ideation and healthcare service innovation quality

ABSTRACTThis study hypothesizes and empirically tests the influence of involvement of (1) frontline employees and (2) top managers in ideation process on healthcare service innovation quality. Based on data from 168 service innovation projects in Dutch healthcare organizations, the empirical results indicate that frontline employee involvement and top management involvement in, respectively, idea generation and idea application both improve the quality of healthcare service innovation. We find that the positive effect of frontline employee involvement is stronger under the condition of higher service innovativeness. In the direct relationship of top management involvement and healthcare service innovation quality, our data do not show such a moderating effect. The key and general managerial implication of the findings is that healthcare organizations are inspired to involve frontline employees in the idea generation processes and involve top managers in the idea application processes of service innovation projects, in order to improve innovation quality.

Service innovation quality in healthcare: service innovativeness and organisational renewal as driving forces

Drawing on an integration of service-dominant (S-D) logic and the dynamic capabilities approach, this study focuses on the relatively under-researched issue of service innovation quality in healthcare services. We propose a conceptual framework for the relationships between user-induced and organisation-based renewal, and service innovation quality in the healthcare sector. By putting service innovativeness and organisational renewal at the input side of the healthcare organisations’ value creation process, and treating service innovation quality as an output, this study hypothesises direct relationships between these two ends. We conducted an empirical study in the Dutch healthcare sector. Based on data from 168 service innovation projects in Dutch healthcare organisations, the empirical study verifies these hypothesised relationships. The results reveal that both service innovativeness and organisational renewal are significant antecedents of quality improvement of the healthcare service innovations in these projects. This study provides theoretical and managerial implications for improving the quality of healthcare service innovations. The key managerial insight is that healthcare organisations are implicated to pay more attention to continuous renewal of value propositions to their users/patients, as well as to continuous renewal of their organisations’ functioning.

How 'healthy' are healthcare organizations? Exploring employee healthcare utilization rates among Dutch healthcare organizations.

Occupational health and safety research rarely makes use of data on employee healthcare utilization to gain insight into the physical and mental health of healthcare staff. This paper aims to fill this gap by examining the prevalence of two relevant types of healthcare utilization among staff working in healthcare organizations: physical therapy and mental healthcare utilization. The paper furthermore explores what role employee and organizational characteristics play in explaining differences in healthcare utilization between organizations. A Dutch healthcare insurance company provided healthcare utilization records for a sample of 417 organizations employing 136,804 healthcare workers in the Netherlands. The results showed that there are large differences between and within healthcare industries when it comes to employee healthcare utilization. Multivariate regression analyses revealed that employee characteristics such as age and gender distributions, and healthcare industry, explain some of the variance between healthcare organizations. Nevertheless, the results of the analyses showed that for all healthcare utilization indicators there is still a large amount of unexplained variance. Further research into the subject of organizational differences in employee healthcare utilization is needed, as finding possibilities to influence employee health and subsequent healthcare utilization is beneficial to employees, employers and society as a whole.

Onder de radar. Alledaagse omgang als kenbron voor zorgorganisaties in transitie

Onder de radar. Alledaagse omgang als kenbron voor zorgorganisaties in transitie

Adding value by health care real estate: parameters, priorities, and interventions

PurposeBecause of the transition of the Dutch health care sector from a governmentally steered domain towards regulated market forces, health care organisations have become fully responsible for their real estate. This paper aims to explore if/how Dutch health care organisations adopt the concept of adding value by corporate and public real estate, which values are prioritised and how these values are implemented in daily practice.Design/methodology/approachLiterature study and a meta-analysis of six student theses (1 × BSc, 1 × MSc, 3 × post-MSc and 1 × PhD) on adding value by health care facilities were conducted, using document analysis and semi-structured interviews with CEOs, project leaders, real estate managers and facility managers. All respondents work in Dutch hospitals, assisted living facilities for the elderly, or mental health care facilities. The interviews were jointly prepared by the students, and the author of this paper being their supervisor.FindingsEnd-user satisfaction, enhancing productivity and stimulating innovation are highly prioritised. Which values are prioritised depends on the organisational objectives, target group, available budget, position in the life cycle of design, construction and use and external context, in particular governmental policy and competition with other health care suppliers. The operationalisation into concrete design choices and strategic management of buildings-in-use is still underdeveloped.Research limitations/implicationsThe interviews lasted 1-1.5 hours, which is rather limited to get a complete picture. Although much work has been done to operationalise the added value of corporate real estate and building-related facilities, there is still a lack of a widely agreed taxonomy of added values and how to measure and manage these values. Ongoing international collaboration between researchers and practitioners aims to contribute to a common framework and to develop standardised measurement methods.Practical implicationsThe insights can support decision-makers in value-adding real estate and facilities management value by public and corporate real estate. The listings of prioritised values and related interventions can be used as a frame of reference to improve the current design and management of health care real estate.Social implicationsA clear insight in value-adding management of corporate real estate may result in a better fit among real estate, organisational objectives and end-user needs.Originality/valueThe findings link the added value theory to corporate real estate management in Dutch health care practice.

Getting cold feet?: Why health care mergers are abandoned.

Despite the frequent occurrence and sizeable consequences of merger abandonment in other sectors, there is no thorough understanding of merger abandonment in health care. The purpose of this study is to improve the understanding of determinants of health care merger abandonment. On the basis of the literature on merger abandonment, we formulated a framework on potential determinants of health care merger abandonment. We then constructed a survey that was sent to 70% of all executives of Dutch health care organizations (response rate = 35%, n = 291). We provide descriptive overviews of open, multiple-response, and multiple-choice questions on merger abandonment and use chi-square tests and Fisher's exact tests to test whether abandoned and completed merger processes differ. About 62% of the respondents were involved in at least one merger process during the period of 2005-2012. Thirty-eight percent of these respondents reported that their last merger case ended prematurely (n = 53). The most frequently mentioned determinants of merger abandonment are changing insights on the desirability and feasibility during merger processes, incompatibilities between executives, and insufficient support for the merger from internal stakeholders. We did not find significant relationships between merger abandonment and executives' previous merger experience, degree of organizational diversification, health care sector, size differences, or other organizational differences. Our findings partially confirm results from previous studies, especially with regard to the importance of changing insights and incompatibilities between the involved executives in merger abandonment. We also find that pressure from internal stakeholders, particularly nonexecutive directors, and distrust, fear, and animosity play an important role in merger abandonment. To minimize the organizational and societal costs of abandoned mergers, we advise executives who engage in mergers to construct backup plans with alternative strategies in case the merger is abandoned and to conduct a thorough analysis of pros and cons before the merger.

Managing different forms of distances in Dutch healthcare organizations: The relation between managers and professionals as a dynamic continuum of distance and proximity.

Dichotomous "gap" thinking about professionals and managers has important limits. The purpose of this paper is to study the specific ontology of "the gap" in which different forms of distances are defined. In order to deepen the knowledge of the actual day-to-day tasks of Dutch healthcare executives an ethnographic study of the daily work of Dutch healthcare executives and an ontological exploration of the concept "gap" was provided. The study empirically investigates the meaning given to the concept of "distance" in healthcare governance practices. The study reveals that healthcare executives have to fulfil a dual role of maintaining distance and creating proximity. Coping with different forms of distances seems to be an integral part of their work. They make use of four potential mechanisms to cope with distance in their healthcare organization practices. The relationship between managers and professionals is often defined as a dichotomous gap. The findings in this research suggest a more dynamic picture of the relationship between managers and professionals than is currently present in literature. This study moves "beyond" the gap and investigates processes of distancing in-depth.

Nursing under inconsistent organizational conditions

Purpose – Health care organizations often experience difficulty in aligning competing and changing demands, tasks and other organizational conditions in a consistent way, so that they uniformly influence employee outcomes in desired directions. The purpose of this paper is to theorize about the ways in which inconsistent organizational conditions affect employee outcomes, the authors introduce the concept of double bind situation, and assess its impact on negative employee outcomes among nurses in Dutch health care organizations. Design/methodology/approach – A survey was held among 4,018 Dutch nurses as a part of the European NEXT study. Various psychometric scales served as “proxy” operationalizations of the characteristics of the double bind situation and employee outcomes. Findings – Three of the seven distinguished characteristics of the double bind situation showed the expected direction and strength of impact. Together, they accounted for 20 percent explained variance in employee outcomes. The results suggest that a double bind situation does exist for the nurses surveyed and that three of its seven characteristics have an impact on negative employee outcomes. Originality/value – This study is among the first to empirically assess the impact of the double bind situation in health care organizations. In this way, it contributes valuable knowledge to the development and retention of staff in a relevant public sector, characterized by high personnel turnover and profound organizational change.

Adding Value by Hospital Real Estate: An Exploration of Dutch Practice.

To explore how hospital real estate can add value to the healthcare organization, which values are prioritized in practice, and why. Dutch healthcare organizations are self-responsible for the costs and benefits of their accommodation. Meanwhile, a lively debate is going on about possible added values of corporate and public real estate in the fields of corporate real estate management and facility management. This article connects both worlds and compares insights from literature with experiences from practice. Added values extracted from literature have been discussed with 15 chief executive officers and project leaders of recently newly built hospitals in the Netherlands. Interviewees were asked (1) which values are included in the design and management of their hospital and why, (2) to prioritize most important values from a list of nine predefined values, and (3) to explain how the chosen real estate decisions are supposed to support organizational objectives. Stimulating innovation, user satisfaction, and improving organizational culture are most highly valued, followed by improving productivity, reducing building costs, and creating building flexibility. Image, risk control, and financing possibilities got lower rankings. The findings have been used to develop a value-impact matrix that connects nine values to various stakeholders and possible interventions. The findings and the value-impact matrix can make different stakeholders aware of many possible added values of hospital real estate, potential synergy and conflicts between different values, and how to steer on value add in different phases of the life cycle.

Evaluation and perceived results of moral case deliberation: A mixed methods study.

Moral case deliberation is increasingly becoming part of various Dutch healthcare organizations. Although some evaluation studies of moral case deliberation have been carried out, research into the results of moral case deliberation within aged care is scarce. How did participants evaluate moral case deliberation? What has moral case deliberation brought to them? What has moral case deliberation contributed to care practice? Should moral case deliberation be further implemented and, if so, how? Quantitative analysis of a questionnaire study among participants of moral case deliberation, both caregivers and team leaders. Qualitative analysis of written answers to open questions, interview study and focus group meetings among caregivers and team leaders. Caregivers and team leaders in a large organization for aged care in the Netherlands. A total of 61 moral case deliberation sessions, carried out on 16 care locations belonging to the organization, were evaluated and perceived results were assessed. Participants gave informed consent and anonymity was guaranteed. In the Netherlands, the law does not prescribe independent ethical review by an Institutional Review Board for this kind of research among healthcare professionals. Moral case deliberation was evaluated positively by the participants. Content and atmosphere of moral case deliberation received high scores, while organizational issues regarding the moral case deliberation sessions scored lower and merit further attention. Respondents indicated that moral case deliberation has the potential to contribute to care practice as relationships among team members improve, more openness is experienced and more understanding for different perspectives is fostered. If moral case deliberation is to be successfully implemented, top-down approaches should go hand in hand with bottom-up approaches. The relevance of moral case deliberation for care practice received wide acknowledgement from the respondents. It can contribute to the team's cohesion as mutual understanding for one another's views is fostered. If implemented well, moral case deliberation has the potential to improve care, according to the respondents.

Implementation of the physician assistant in Dutch health care organizations: primary motives and outcomes.

Physician assistants (PAs) are trained to perform medical procedures that were traditionally performed by medical physicians. Physician assistants seem to be deployed not only to increase efficiency but also to ensure the quality of care. What is not known is the primary motive for employing PAs within Dutch health care and whether the employment of the PAs fulfills the perceived need for them. Supervising medical specialists who used PAs in their practices were interviewed about their primary motives and outcomes. The interviews were semistructured. Two scientists coded the findings with respect to motives and outcomes. In total, 55 specialists were interviewed about their motives for employing a PA, and 15 were interviewed about the outcomes of employing a PA. With respect to the primary motives for employing a PA, the most frequent motive was to increase continuity and quality of care, followed by relieving the specialist's workload, increasing efficiency of care, and substituting for medical residents. The outcomes were found to be consistent with the motives. In conclusion, the primary motive for employing a PA in Dutch health care is to increase continuity and quality of care.

Implementation of complementary interventions in the Netherlands: Experiences of pioneers

ObjectiveAlthough many Dutch patients desire integration of complementary interventions in conventional healthcare, implementation is in its infancy in the Netherlands. The objective of this study was to describe the implementation process of complementary interventions in Dutch healthcare organizations. MethodsData in this qualitative study were collected in two steps: by questionnaires and by interviews. In five organizations the project leader and a professional who provides the interventions participated in the study. ResultsMain facilitators for implementation are: enthusiasm and support of colleagues; appreciation of patients; effectiveness of the interventions; positive publications in media; possibility to link the project to objectives of the organization; and accessibility of the interventions. Main barriers for implementation are: ignorance and skepticism of professionals; lack of research; lack of budget; lack of integration of the interventions in daily practice. Participants developed strategies to overcome barriers and to exploit facilitators. ConclusionProfessionals play a leading role in the implementation of complementary interventions in Dutch healthcare organizations. They use several methods to deal with facilitators and barriers. Practice implicationsOrganizations and professionals that aim to implement complementary interventions in their service may learn from experiences of pioneer organizations.