 Good morning. I Wanted to start with a question. We had a at the speakers dinner. We had a discussion And someone said I think that people want to be led Can you put your hands up if you say I like to have a boss? Who who likes to have a boss? I Don't see too many hands. Who who is the boss? Oh a lot of yeah, yeah, okay Um Makes it's clear So I want to tell you about my story. I'm I had the problems since my primary primary school with my teachers I had some authority problems. So I think that's one of the main reasons that I started this organization And I think you can develop yourself the best possible way when you are freed from all kind of Structures bits and people who are telling you what to do. So you should Find out yourself what you think it's important and that should be leading in your life like in your private life This presentation I called it in humanity above bureaucracy By integrating simplification in the teal organization Some of you have read the book of Frederick Lalu and the teal organization I didn't know I didn't hear from it before but we are a teal organization as I know now and We are integrating simplification So we try to make things simple where a lot of people want to make the world very complex Let me say if we make it simple then it's very easy to for people to take responsibility I started in a new organization in 2006 at the end of 2006 together with some friends so I've been a district nurse for 15 years worked as a nurse and after that I became manager director in two big home care organizations in Holland and It was amazing to see that The idea of the organization was it became more and more professional But the quality of the service went down and down every year now And that was one of the 16 directors and I said we are bit too many of us And we are just bothering the nurses to do their work But they didn't agree so then I had to leave and start something for myself We started with four nurses And we started we called it but sort of because it means neighborhood nursing And my idea was we should focus on the networks in the neighborhood And that's the way I worked myself in the 80s as a district nurse We just started delivering community health care again as we thought it would be the best possible way And we started to work together with GPs with volunteers with Occupational therapists social workers and so on at the moment. We have 9700 nurses working all over the country in 850 independent teams So these these teams are self-organized. I will tell more about it later We have 45 staff at the back of we don't have a management structure So we don't have managers and it's all self-organized. We only have 15 coaches They can be Supportive to the teams when the teams need it. So and when you have a manager, they're always there also when you don't need it And then it can be a big burden At the moment we are taking care for 70,000 patients a year all kind of patients Based swap terminal patients with chronicle diseases and so on One of the results of the Dutch policy and home care and I also see it within the NHS in England For four years. I've been in England a lot and I talked with a lot of people within the NHS and I'm Curious, but one of the coming speakers will tell me about what's happening within the NHS but what we saw in Holland is that based on the ideas of making health care a business led to a lot of Fragmentation so we were delivering activities instead of creating solutions and that's a very big difference And it led to a lot of fragmentation lists with showers and list was taking care for wounds and so on But and every nurse had to register it by the minute So the quality went down and the coast went up because we were doing a lot of things which was not really necessary and We created sometimes more problems and we solved so that was what I saw And what you saw also that the education level was going down throughout the years because Giving many hours spending many hours against low cost was very profitable for the organization And by working this way the prognosis were that we would have big capacity problems We all have an aging society So for the coming 10 20 30 years we have to think about how can we have enough workforce to do all the work? The clients are very important I had to face with a lot of different caregivers sometimes 40 50 per month different people and imagine that one of your relatives is Has diamond dementia and every time again you have to explain how it works What it's important for you you can't build trustful relationships with so many people when you have more than seven people Dealing with your big your family then you lose control on your life So then you are controlled by the others who are coming at your house And I think you shouldn't want this and then At the way we are we're monitoring the results led to not any information about the outcomes So we had we knew we know how many hours care we are spending all over the country But we don't know if it's helping anybody So we spent billions of euros Bounce euros, and we don't know if people are helped in the best possible way So we started this organization 2007 The idea was just create small teams in the neighborhood Nurses who are choosing their own colleagues and organizing everything themselves And from the start from the first moment we had this first team We got nurses all over the country who were phoning mailing Contacting with us and said would you come and tell us what what you're doing there in the east of Holland? So I was evening at by evening. I was at living rooms of people nurses talking about our profession. What's important for nursing and and at the end of the evening And they said when can we start because I think this is what we also want so every time Every evening again. There was in one part of the country The start of just small revolution and these nurses were just organizing themselves and within two months Usually they were running and they were cost effective So the risk was very low They have their the builder networks and what they were doing was much better than what they did before in the organization They've worked before so they're doing everything themselves. They talk about how to divide the roles in the team and they built their networks based on informal relationships This is what what our vision is that we should support independence We should focus on the community and we should create healthy communities by working with volunteers with the families with formal caregivers from an perspective of empowering the people and That's much more inspiring to do so if if you do that every day as a nurse then your day is like Every day it's like an an adventure so every day you meet people who you learn from You can decide yourself on how to deal with everything you meet and a lot of patients feel empowered By the way, we are working and you use the resources of the community So there are a lot of resources in the community which are not used so the pressure on the formal care Gets bigger and bigger and we should share it the former cavity informal caregivers That's and this is for most nurses. This is very logic So we're now working in 35 countries and when I explained this to doctors and nurses. They say yes That's what we should want to do It's all based on self-organization The idea is just let's just trust the nurses. You don't need to control them I don't know any nurse who started a day and say okay today. I'm going to Trouble my patients or tease them or hit them or whatever So when you trust the people they will take a responsible Responsibility they will feel accountable for what they're doing So that's what we try to show that it would work very Preventive if you work this way But we did to avoid all the complexity of the system because like in England and a lot of countries we built very bureaucratic Systems with a lot of regulations and administration. We build our own IT company. So We at the moment, I think we built around 10 companies And yeah, it's very easy just to build a company's not so I didn't do it before but when you started like Something like a disease It's yeah Yesterday I was on this television. We started to an health insurer. So to threaten the other health insurers to behave otherwise Yes, it's working already It's it's but we try to reduce the complexity So it's all dealt with in the IT system. So the nurse can just do what they think they should do They spent 10 minutes a day for the administration and that's it As I said, there's a maximum of 12 nurses because you don't have bigger tables So they have their own office and they in the office They talk about their patients and they can care for all the things what's needed 70% are registered nurses and in the average home care organization in Holland. It's just 10% on bachelor registered nurses They are responsible for their own education budget that they decide themselves on what they want to be educated in and what's needed And we say informal networks are much more important than former structures. So we don't Make any contracts with anybody. So we say just do what you think it's needed and create your networks Which is needed to create good solutions that the teams are supported by Training it's called the solution into interaction method solution driven interaction method We say focus on the solutions Don't spend too much time on the on the problems and analyzing the problems and who's guilty of the problems and so on Because that's not solving it. So try to focus on how can we in a simple way solve the problems? And then you get these kind of teams very happy Then you get these kind of patients. She's she's already 105 now. Yes. Yes, she won't like to die Yeah, and a lot of Rotterdam's is living So yes, we have a very active discussion in Holland about euthanasia, but it's not part of the discussion in Rotterdam We have different types of patients So the idea was when you are dealing with problems in the community It would be nice that you can deal with every kind of problem. So that's the reason that we say then you need high skilled nurses and These nurses have a very big variety on in their daily practice. So They as I said, they learn every day by the things they're doing and a lot of things we are learning in In in healthcare is based on tessit knowledge So it's you can't write it down in protocols and regulations and you shouldn't do it But you have to talk about it. You have to talk about it with each other and then you can share your knowledge and experience And when it's about quality, we had a lot of questions when we started how do you monitor quality? When I said at the moment, we are also not monitoring quality We're just saying that if you have a quality system, then it's something like an assurance that you deliver quality But we said is we are going to monitor the outcome. We want to show what the result is of what we are doing So that's so that's we doing that with the Omaha system it's too takes too long to explain that but It's a system which monitors problems intervention and outcome and At the moment the Dutch Ministry decided to make it a national standard. So it took us six years talking and discussing but at the end we Succeeded we focus on roles and activities in the teams So we said if you want to work together think think about how you deal with the burdens in the system The teams have a team compass so can they can see how they are doing compared also with other teams As I already said they have a higher education level and we measure the satisfaction of the clients regularly and every year We do a national research on that Then about the back office we my wife and me we started together as he's responsible for the back office And but she's she hates to be called manager or director So she's just said I'm just one of the others and when they need me this they just can ask my advice There are we have an hour turnover of three hundred fifteen million euro and we don't have a CFO So I don't if there are financial people here, but You don't need no sorry Now I would say before I became a nurse I studied economics for yes I was promised to be a very good economist, but it didn't work out They had to stay care of the bureaucracy So the nurses can just do that daily work and enjoy it But of course the care need to be charged We are paid by the health insurance most of the money comes from the health insurance And of course they want to have their salaries, but we have now almost ten thousand people ten thousand salaries per month And it's dealt a bit by three women So these three women taking care and the efforts organization has 25 to 30 people when you talk about these amounts of Employees and we're making some financial statements. It's all on the one page So it's very easy to have a very simple cost structure And when you keep it simple then you can avoid a lot of coordination and a lot of management This is about the IT system friend of mine was a quite a visionary in 2005 he Designed our IT strategy for the coming years and now a lot of other organizations are using it and What I've what I've seen of what I noticed is that Communication knowledge exchange Information can be dealt with in a quite a different way when you use IT in a proper way So all the nurses are working with iPads, so they're working They're making the care plans together with the patients and everything you need is in the system at the point of care so and I'm doing my my Blocks on on on the community so it's we we started Sharing information sharing knowledge and it was 2007 so Facebook was Growing very fast. So we said let's make our own Facebook and this way we are sharing ideas So some every two weeks I write my blog and then I got a lot of comments on it and then I say okay If these comments are going with certain direction, then we say, okay, let's make it our new policy So that's how policy I don't write strategy notes I don't write policy notes and I should advise everyone to stop with doing that because it's not No, it takes a lot of time and you think you're doing very serious things, but No, nobody nobody you don't do it. You see that nobody's waiting for it. So that's Really So and and that's what I noticed because I was in my former job. I was director of innovations and I was really I was the The champion in making plans And then I didn't do it anymore. Nobody was asking me. Why are you not making plans anymore? But all the the things and yet where the IT system is dealing with creates a Common feeling where shared values all the nurses that have focused on the neighborhood But they feel like they are connected with the other teams by the internet. So it's it's a network organization and But what makes it very special for me is that it doesn't lead to problems and the problem-solving The the way the teams are solving their own problems is growing throughout the years So and a lot of things are going horizontally. So then I can't just go to England and talk at conferences What we don't do is we don't have management meetings right policy. That's the easy documents We don't have HR department. So if there are it's hard people try to find another no Year plans and other useless things so Oh, sorry, sorry, sorry, I don't want to offend anybody and it's just a starting of the day. Yeah, we're growing very fast so Every every month we have 150 to 200 nurses coming to work for us and we don't know how to stop it So it's yes It's now we have real problem because we have more and more 65 plus nurses who don't want to quit their work They can retire but I don't want to retire. So we have more than 200 now who say cannot go on for a year or a year So I said, of course We are in the whole country now. We are doing new innovations youth care domestic social care mental care pensions for rehabilitation hospice is physiotherapy Occupation that's all these things are Just Starting by itself. So we're not organizing it But someone says, oh, it's a good idea to have also a youth care part Then we say, okay, let's try it and then it's going very well and then say, okay, let's let it let grow what What's can grow? We started international start in Sweden. It was I'm just came back from China and Taiwan I didn't know did you see that the president of China and Taiwan met? It was just after my visit Yeah No, I met I met with the first lady of Taiwan. So she even give me a present a present So it's it's influencing everything. We see It's it's be as I now understand we created a new theoretical model Frederick Lalu wrote a lot of nice things about it And I recognize the first time I talked with him I had an idea that he was the first one who really understood what we were doing because Tomman was a lot of people saying oh, it's just about the self-organizing teams or self-stealing teams But it's how how do you deal built a bit? Meaningful things in your daily practice then Shadda Nandram. She's wrote a book organizational innovation by integrating simplification and Said there are three main principles. She discovered in boots. Oh, she said the needing principle So though what needed don't do what's not needed the rethinking principle try to find out what works And then the common sense principle just use your common sense like you do at home. So that's a very important one Then you get these kind of teams We measure the satisfaction of the employees Because the idea was that the pressure on the nurses would be too big when they have to make all the decisions themselves So that were our competitors were there saying and and then we start 2011 to Join the price of the best employee then from the first moment we became the best employer of Holland Another happy team in the north hardling in And of course we measured the satisfaction of clients and what was funny that it's also from the start we had the highest client satisfaction and the assumption that people want much hours of care was not True because what we but we shown is that we deliver less hours of care and we created the highest satisfaction. So We also have some nice innovations. This is a radio program. It started by one of our nurses She said we should communicate in a different way with our environment. So every week. It's a radio program radio stockings And this is I will show you a few check seconds of What one of the other nurses? Started it's called the Walker race and I don't know if it's coming, but No Then I just tell you there was this one One lady she was 85 and she said there are competitions for everybody, but not for us ladies behind the Walker People behind the Walker. So this nurse said, oh, let's start just this competition and she did it 2010 for the first time in Amsterdam and Last September there was a national competition in the Olympic stadium It was it was called the Rolimpi8 So there were hundreds of people coming all over the country with the walkers and had to cut a medal for 400 meters Or 800 meters. Yes, it was amazing to see and it's just by focusing on what people can do Now we go back to this Slides I'm almost done. So I have four seconds for the last But I had one minute later because of the okay Now as I said We measured the outcome that the results of it gave there was a KPMG report and two Ernst and young reports and At the moment the governing is our government is supporting everything what we are doing So they say this would be a role model for the rest of the country I was with the Minister of Health in China and he was telling the Chinese mayors of Shanghai That it was became one of his most important pillars of his current policy So I was quite proud and now China wants to also And it's quite a big country So and it's more and more we see that other industries also want to use the principles And I'm traveling all over the world one side on health care and the other side on how to organize So this is it and this is what I want to achieve My youngest son is becoming a nurse he's 22 and I think we should leave the world in a much more friendly way than we Started it 10 or 20 years ago, and we need to attract young people in health care so they can have an attractive Job so this was what I wanted to share with you today, and I hope you have a wonderful day