Never waste a good crisis: time for reflection and deliberations

Maarten van Rixtel
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What does the digital transformation of healthcare entail in my eyes, and what does this mean for geriatric care? What were my experiences at Sensire the past few years, and what are the expectations for the years to come? What does digitalisation mean for healthcare professionals and healthcare facilities? And how do we embrace and implement technological innovations as best we can in practice, heading into the future?’

These were only some of the initial questions I was asked for this column. Questions that were posed shortly before the outbreak of the Coronavirus Crisis. Now, whilst writing this column, the crisis still rages on just as intensely. As does the discussion on whether or not the ‘boost’ in the use of different technological applications, provided by the crisis, is temporary or permanent. ‘Never waste a good crisis’ is an oft-used saying during this time. Time for some reflection and deliberations.

New paradigms in a digital world

In 2014, healthcare organisation Sensire made the strategic decision to look for a new business model. We concluded that the current model, purely physical care with reimbursements per activity, wasn’t sustainable in the context of demographic developments and the job market. But we also concluded that improving the current business model is pointless. We started looking for new paradigms, in order to reinvent Sensire. We found them in three concepts: professional autonomy, digital, and added value.

The consequence of these new paradigms is that we are building a new organisation based on a fundamentally different foundation. A foundation in which the professional is appreciated for their mastery and in which the organisation should (digitally) support that professional as much as possible. With that, the Sensire’s mission shifts from ‘healthcare provider’ to ‘the best supporter of healthcare professionals’. A tall order for a transformation that is taking place in a world in which  several developments in (geriatric) care can be observed:

  1. People in the Netherlands are growing old at home. Since 1980, the amount of hospital beds has been cut in half, and 95% of those over 65 are still living at home;
  2. The government facilitates and connects. We are shifting from a welfare state to value creation, through market forces;
  3. Geriatric care is turning into a consumer market. We see a shift from client, to confident consumer, to choosing citizen. The customer is more and more in control and is the departure point for thinking and acting, together with their social network. The customer is an informed user and uses a personal healthcare environment as the cockpit of their (healthcare)life;
  4. The role of the healthcare professional is changing due to new concepts of health, organisation, and employment relations;
  5. Technology (= everything is IT) is increasingly more important in organisation, communication, and care;</span
  6. In collaboration, customised knowledge is being developed and shared in networks of patients, professionals, and organisations.

The developments are all taking place in a new world – the digital world. A world that has its own laws. Thus, organising is becoming more important than organisations. And people are looking in from the outside – from organisation-centred to user-centred. The professional is no longer in service of the organisation, the organisation is there to support the professional-customer relationship. The objective of healthcare is no longer production, but finding added value for the client and society as a whole.

This search is also taking place at Sensire, but can never take place isolated. For in a digital world there is no inside and outside the organisation. With that, close collaboration within the region becomes a crucial element in the development of Sensor as an organisation, but also of healthcare. Via the transmural council and the information council Achterhoek, we try to inform each other and tackle subjects that can be realised precisely because of collaboration. With a wide array of fellow healthcare organisations and Menzis as the dominant insurance provider in the region. With the metaphor of the ‘healthcare tower’ as perspective, we are working towards a digital healthcare region, using VIPP, OPEN, and the InZicht arrangement.

A sustainable digital movement requires a fundamental transformation

And there, suddenly, was the Coronavirus, even in the Achterhoek, and the entire healthcare system, in the region and nationwide, was turned upside down. The ‘intelligent lockdown’ causes mass use of video platforms, the use of ‘Corona apps’, and the use of a portal for the national transfer of data from patients with the Coronavirus. Supervisors temporarily halt obstructive rules – a first consult doesn’t have to take place in-person, et cetera. Disrupt healthcare in optima forma. And in a few weeks time, the transformation from ‘doing ditigal’ into ‘being digital’ appears to be a reality. But how sustainable is all this? For Sensire has been working on its transformation into professional mastery for years, in order to become a digital company and be the best supporter of healthcare professionals. But does this mean anything else besides ‘video calls’, ’using an app’, and a ‘new national portal’?

First of all, the foundation: professional mastery. We have been working towards this with Sensire for several years. By now, we have a Sensire guide, framework of norms, and Professional Statute. In the Professional Statute, the relationship between the professional and the board is outlined in terms of responsibilities. The director thus no longer deals with the professional deliberations in the individual relationship between the client and the professional. And the professional acknowledges that this individual relationship is formed in the context of many questions of care and social shifts. By now, we can tell by the results of care that the quality of clinical reasoning increases, and with that the effectiveness of the treatment process and actions. This requires a further development for the necessary digital transformation. ‘Digital first’ will (have to) become an intrinsic part of the entire professional repertoire of actions. This also means that, in the subject-specific domain, the healthcare-related informatics is secured as a knowledge worker for the support of nursing staff . Sensire does this on a tactical level with medical computer scientists , and on a strategic level with a chief nursing information office. Sensire also supports its healthcare professionals with ‘professional environments’ (digital dossiers) that offer the best support in the execution of professional mastery. For the director, this means they must oversee  a development from concepts like ‘letting go’. But at the same time, this ‘letting go’ must result in a different grounding. Insecurity is an important theme with which the director must confront themselves. It is essential for the innovation that the ownership of the innovation-development goes to the professionals.

Secondly: Sensire as a digital company. The business model of healthcare organisations, and therefore of Sensire, is no longer sustainable in light of the digital transformation and the rise of the platform economy. The ‘classic paradigm’ that IT in healthcare leads to the substitution of work (efficiency) and improvement of care (effectiveness) is insufficient. Digitalisation must lead to a fundamental reform of healthcare processes, and Sensire will have to transform into a facilitating digital infrastructure in which you are not just available from 9 to 5. With that, Sensire is on the path to a scalable, digital platform for triage, advice, matching, and data-driven learning. A platform which will be the best support of healthcare professionals and clients because of its maximised accessibility, freedom of choice, and, finally, relevance. To accomplish this, Sensire is transforming its entire digital landscape. From basic infrastructure (internet only, zero trusted, software-defined networking), via limitless collaboration (identity management, public cloud technology stack (Google), open standards and interoperability), to workstations and applications-as-a-service. All IT services are procured as managed services with an agreed outcome based on care and organisation goals. Sensire has also accommodated its other eHealth activities with another organisation, NAAST, this way.

In short: ‘Never waste a good crisis’, and in order to do so really observe, think, and act differently. If this doesn’t happen, the explosion of applications triggered by the ‘intelligent lockdown’ will only lead to NT + OO = VEOO. Also known as New Technology in an Old Organisation equals a Very Expensive Old Organisation. The durability of the digital movement, which cannot be observed during this Coronavirus Crisis, will only become sustainable when it is anchored in the fundamental realisation on the part of both director and professional that this is about re-institutionalisation and re-professionalisation. It requires a strategic embedding in the organisation and the region


Maarten van Rixtel

Maarten van Rixtel has been the director of healthcare organisation Sensire since 2009, and is convinced that technology will play a vital part in the development of healthcare, handing the patient back control over their life, and thus contributing to the happiness of Sensire’s customers. Sensire provides district nursing, care and living facilities, and provides (highly) complex care via a number of specialised services in the Achterhoek and the Liemers. Sensire has privatised the ‘remote care’ activities in the medical service centre NAAST, which operates in the entirety of the Netherlands, and provides support for care at home in particular, which not only makes care more efficient, but also more agreeable.