0:00:10.690,0:00:14.310
I had quite a normal life till I was 20.

0:00:14.770,0:00:16.879
I was a good student,

0:00:16.879,0:00:19.999
and I studied economics.

0:00:20.229,0:00:23.234
And then I made a radical choice.

0:00:24.504,0:00:26.486
I became a nurse.

0:00:27.666,0:00:30.045
I've got my wings,

0:00:31.255,0:00:33.828
but as a nurse, as a male nurse,

0:00:33.828,0:00:36.323
as I hope you can see,

0:00:38.093,0:00:40.994
I worked the rest of my life

0:00:40.994,0:00:42.274
with a lot of women,

0:00:42.274,0:00:46.491
and I saw it as something very positive.

0:00:46.491,0:00:48.621
I learned a lot from it.

0:00:49.651,0:00:52.115
I worked for many years in a hospital,

0:00:52.685,0:00:57.215
and after that I started to work[br]as a district nurse in a community.

0:00:57.551,0:01:00.541
And this was the most[br]beautiful part of my life

0:01:00.541,0:01:05.428
because I learned how to deal with[br]all kind of problems in the community.

0:01:05.780,0:01:09.874
And I had colleagues[br]in the same village I worked,

0:01:09.874,0:01:13.239
and together, we solved[br]all the problems we met.

0:01:13.649,0:01:15.285
There was not a big organization,

0:01:15.285,0:01:19.965
it was just a team of nurses[br]who organized the work themselves.

0:01:20.160,0:01:23.978
We took care for patients[br]who were terminally ill,

0:01:24.238,0:01:26.489
patients with dementia,

0:01:26.829,0:01:29.358
people who were discharged from hospital,

0:01:29.498,0:01:31.938
and there was a big variety of activities.

0:01:31.938,0:01:33.903
We also took care for little children.

0:01:34.403,0:01:39.202
So it was in that period,[br]the most healthy job you can get.

0:01:39.918,0:01:45.658
And we also built support systems[br]in the community.

0:01:46.141,0:01:49.271
It was a very inspiring job,

0:01:49.751,0:01:54.051
and I enjoyed it very much till 1993

0:01:54.051,0:01:56.497
in Holland we got a big disaster

0:01:56.497,0:01:59.286
because the politicians discussed

0:01:59.286,0:02:03.836
that community care[br]should become more professionalized.

0:02:04.108,0:02:06.132
And what I meant by that

0:02:06.132,0:02:11.462
was that it should become -[br]it should be part of a bigger organization

0:02:11.642,0:02:13.962
managed by managers

0:02:14.202,0:02:18.358
and organized not focusing[br]on solutions for people

0:02:18.358,0:02:20.758
but delivering products.

0:02:21.801,0:02:24.391
For the nurses, it looked like this:

0:02:25.241,0:02:27.884
Instead of thinking helping patients,

0:02:27.884,0:02:31.524
they had to think: What kind[br]of products should I deliver?

0:02:31.766,0:02:34.426
We had personal care, personal care extra,

0:02:34.426,0:02:36.412
personal care special.

0:02:36.412,0:02:40.572
We had nursing care, nursing care extra,[br]nursing care special.

0:02:40.955,0:02:45.125
And all theses nurses[br]got disturbed by thinking:

0:02:45.125,0:02:50.795
What kind of activities should I give,[br]and how should I code it?

0:02:50.795,0:02:52.965
Because there were a lot of codes.

0:02:53.913,0:02:58.433
For patients, it was also[br]even a bigger disaster

0:02:58.806,0:03:02.053
because for every task,[br]they got someone else,

0:03:02.053,0:03:05.292
and there were sometimes [br]people with dementia

0:03:05.292,0:03:11.212
who got 30 to 40 different people[br]coming into their house in one month.

0:03:11.212,0:03:12.310
And can you imagine

0:03:12.310,0:03:16.860
that every time you have to tell again [br]what the situation is

0:03:16.860,0:03:19.360
and how you want to live your life?

0:03:19.538,0:03:22.541
So both nurses and patients

0:03:22.541,0:03:26.891
were very, very dissatisfied[br]about how things were going.

0:03:27.117,0:03:32.357
The same time, it looked more and more[br]like factories, the care organizations,

0:03:32.357,0:03:35.252
and I see it in a lot[br]of countries happening.

0:03:35.252,0:03:37.245
So you saw that all the things

0:03:37.245,0:03:40.665
that were developed[br]in industries and companies,

0:03:40.665,0:03:42.379
they were also in the organizations,

0:03:42.379,0:03:47.703
and you saw that more and more managers[br]were taking over the profession.

0:03:48.178,0:03:50.451
So what you saw was that

0:03:50.451,0:03:54.881
there was more and more[br]management layers in the organizations:

0:03:54.881,0:03:58.588
a CEO, directors, managers,

0:03:58.588,0:04:03.488
and they almost forgot[br]that there were also employees.

0:04:03.488,0:04:05.692
And it can be done so much differently

0:04:05.692,0:04:09.114
as you can see[br]in the other side of the slide.

0:04:09.874,0:04:16.674
The consequences, they were very different[br]than the politicians expected.

0:04:17.044,0:04:20.819
Because the expected[br]that by organizing this way,

0:04:20.819,0:04:23.676
the costs would go down[br]and the quality would go up.

0:04:23.676,0:04:27.210
They also had market incentives.

0:04:27.348,0:04:30.920
But what you saw[br]is that the opposite happened.

0:04:30.920,0:04:33.221
The quality went down dramatically

0:04:33.221,0:04:37.013
because of the many people[br]who were involved with every patient,

0:04:37.013,0:04:40.811
and the costs doubled in 10 years.

0:04:40.971,0:04:45.741
So the assumption[br]of the politicians was quite wrong.

0:04:45.741,0:04:49.636
But what you saw was that[br]the people who paid us

0:04:49.636,0:04:52.830
were even more focusing on efficiency.

0:04:52.830,0:04:57.066
So for example, when a nurse[br]took 10 minutes longer

0:04:57.066,0:04:58.834
for travelling to a patient,

0:04:58.834,0:05:02.732
she had to explain that[br]to her manager, why she did that.

0:05:04.312,0:05:10.468
In 2006, some friends and myself,[br]we thought it's time for a change.

0:05:10.468,0:05:14.208
I had been director for a few years[br]in a few organizations,

0:05:14.208,0:05:17.123
and I saw that it could be done[br]very differently.

0:05:17.123,0:05:22.301
And our ideas was to change[br]the healthcare in Holland

0:05:22.301,0:05:23.874
and to start a movement to show

0:05:23.874,0:05:27.146
that elderly care[br]could be done much better,

0:05:27.146,0:05:28.265
based on trust

0:05:28.265,0:05:30.284
and based on self-organization.

0:05:30.504,0:05:35.376
So the principles[br]I worked myself with in the '80s,

0:05:35.376,0:05:39.917
we took them again as the basic principles[br]for our organization.

0:05:40.237,0:05:46.648
And for four nurses in 2007,[br]we grew to 9000 nurses in 2015.

0:05:47.458,0:05:50.057
And it just happened by itself.

0:05:50.337,0:05:53.727
The first year, 2007,[br]it was some kind of experiment.

0:05:53.727,0:05:56.529
So we started in 10 locations,

0:05:56.691,0:05:58.994
and every time happened the same:

0:05:58.994,0:06:03.464
we got nurses who just developed[br]their networks in the community;

0:06:03.464,0:06:08.168
they started to work again[br]on the same principles we did in the '80s,

0:06:08.168,0:06:10.321
and within a few months,

0:06:10.321,0:06:13.889
they had got their patients,[br]and they covered their costs.

0:06:13.889,0:06:16.444
So there was no financial problem.

0:06:16.924,0:06:18.694
So from 2008,

0:06:18.694,0:06:22.245
we got 10, 20 teams a month,

0:06:22.245,0:06:25.094
and every time it happened the same.

0:06:25.294,0:06:30.734
They called me to come[br]to one of the houses of the nurses,

0:06:30.734,0:06:33.795
and we sat all evening talking about[br]of our profession:

0:06:33.795,0:06:35.850
What does it mean to help people?

0:06:35.850,0:06:38.320
And how can we do it[br]just the way we want it

0:06:38.320,0:06:43.016
and not be bothered[br]by any kind of regulations?

0:06:43.596,0:06:44.708
So that's what we did,

0:06:44.708,0:06:47.268
and the evening of the day after,

0:06:47.268,0:06:49.908
I usually got a phone call[br]from one of the nurses,

0:06:49.908,0:06:52.628
and they said, "When can we start?"

0:06:53.238,0:06:56.263
And then we started just a new team[br]in a new neighborhood

0:06:56.263,0:07:00.583
focusing on patients as we are used to.[br]

0:07:01.244,0:07:07.104
So this went at a very high speed,

0:07:07.104,0:07:12.224
and we didn't have problems to manage this[br]because they were managing themselves.

0:07:12.228,0:07:13.576
We had a small back office,

0:07:13.576,0:07:17.278
and we still have a small[br]back office with 30 people.

0:07:17.768,0:07:21.419
My wife and me, we are some kind[br]of a management team,

0:07:21.419,0:07:26.827
but we don't have meetings,[br]and everything is going very well.

0:07:27.637,0:07:30.532
My wife is always awake[br]very early, around 6:00,

0:07:30.532,0:07:34.439
and then she tells me what to do[br]like any other wife, I think,

0:07:34.439,0:07:36.440
is telling her husband.

0:07:36.440,0:07:39.930
So that's the way we are managing.

0:07:39.930,0:07:45.130
And this way, we have a lot of time [br]just to solve problems.

0:07:45.800,0:07:50.422
In my job I had before, I had meetings[br]from morning till evening,

0:07:50.422,0:07:53.733
and I didn't had time[br]to solve the problems.

0:07:53.953,0:07:55.857
So that's quite different.

0:07:56.697,0:08:02.239
In 2015, we see that there's[br]still no management.

0:08:02.239,0:08:04.789
Because there was a lot[br]of criticism when we started.

0:08:04.789,0:08:09.231
They said, yes, you can do this easily[br]when you're with just a few persons.

0:08:09.590,0:08:10.749
And then, they said,

0:08:10.749,0:08:16.810
oh wait, perhaps next year[br]they will collapse

0:08:16.810,0:08:19.975
or they will have big financial problems.

0:08:20.285,0:08:21.560
But the opposite happened

0:08:21.560,0:08:27.184
because what you saw that the teams[br]were more and more in control

0:08:27.184,0:08:30.124
and taught a lot of solutions

0:08:30.124,0:08:32.380
they could find [br]for the problems they met.

0:08:32.710,0:08:36.127
So it was growing, the knowledge[br]was growing in the teams,

0:08:36.127,0:08:39.194
and it became more and more sustainable.

0:08:39.370,0:08:42.470
We still tried to avoid[br]any kind of bureaucracy.

0:08:42.475,0:08:44.560
We built an IT system

0:08:44.560,0:08:51.200
[which prevented] all the bureaucracy[br]to take over the work of the nurses.

0:08:51.500,0:08:53.921
So all the bureaucracy was kept outside.

0:08:53.921,0:08:58.271
We split the administrative process[br]with the professional process

0:08:58.557,0:09:02.767
so the nurses just can focus[br]on what they're there for,

0:09:02.767,0:09:04.915
and that's taking care for patients,

0:09:04.915,0:09:09.183
find solutions for patients[br]who have severe problems.

0:09:09.850,0:09:14.770
In 2015, we can look at it,[br]if you look back now,

0:09:14.770,0:09:16.581
we can say we have, since we started,

0:09:16.581,0:09:19.487
the highest client[br]satisfaction in Holland.

0:09:19.487,0:09:22.706
And what's very important[br]for the policy makers

0:09:22.706,0:09:28.201
is that instead it took[br]more costs, or more hours,

0:09:28.201,0:09:31.758
because we're working[br]with higher educated nurses,

0:09:32.048,0:09:35.238
the costs went down with 40 percent.

0:09:36.078,0:09:37.974
So last evening,

0:09:37.974,0:09:43.023
the Parliament in Holland [br]was debating about the district nurse.

0:09:43.023,0:09:46.630
And they were debating[br]about the position of the district nurse

0:09:46.630,0:09:49.570
in the future in Holland.

0:09:49.570,0:09:53.146
And they said, this movement[br]should be spread all over in Holland,

0:09:53.146,0:09:54.388
so we want to support it.

0:09:54.388,0:09:57.388
All the political parties agreed on that.

0:09:58.091,0:10:02.641
And at the same time,[br]we became the best employer of the year,

0:10:02.641,0:10:04.201
three times in a row.

0:10:04.201,0:10:05.546
Just by doing nothing.

0:10:05.546,0:10:07.796
We don't have an HR department,

0:10:07.796,0:10:08.848
so we don't -

0:10:08.848,0:10:13.866
so by doing nothing, and doing less,[br]you get far better results.

0:10:14.086,0:10:16.636
So all these management ideas

0:10:16.636,0:10:19.587
about controlling and command people,

0:10:19.587,0:10:22.657
are just, in my opinion,[br]quite destructive.

0:10:22.657,0:10:25.903
So if you just let people[br]organize the work themselves,

0:10:25.903,0:10:30.083
you get much better results[br]and people are much happier

0:10:30.083,0:10:32.648
because they can do what they want to do.

0:10:32.648,0:10:34.778
And it sounds very logic,

0:10:34.778,0:10:39.468
but we make it very difficult for people[br]to work this way in a lot of places,

0:10:39.468,0:10:42.493
also in schools and also with police.

0:10:44.373,0:10:47.299
It was not only in Holland[br]that this happens.

0:10:47.299,0:10:50.799
There are a lot of countries[br]who have the same problems,

0:10:50.799,0:10:53.419
and we got questions[br]from the United States,

0:10:53.419,0:10:57.585
from Japan, Sweden, China,[br]Czech Republic and so on.

0:10:57.875,0:10:59.462
I visited 30 countries,

0:10:59.462,0:11:03.052
and in every country[br]I meet nurses who had the same ideas.

0:11:03.752,0:11:05.407
And we start the same movement.

0:11:05.407,0:11:07.776
Just with a few nurses, that's enough.

0:11:07.776,0:11:10.454
And then you show that it can be done.

0:11:10.454,0:11:15.063
And then you see that[br]other people become curious.

0:11:15.063,0:11:19.463
And they say, oh, we never expected[br]that it was possible in our system

0:11:19.463,0:11:22.278
because we have such a complex system.

0:11:22.438,0:11:25.346
So we also developed a theory on that.

0:11:25.346,0:11:28.276
It's the integrating[br]simplification theory.

0:11:28.276,0:11:31.969
Try to make things simple, not complex.

0:11:33.049,0:11:35.569
And when you do that consequently,

0:11:36.139,0:11:39.470
it's more easy for people[br]to take their responsibility,

0:11:39.470,0:11:43.599
and to think about what can be done[br]to solve problems.

0:11:43.779,0:11:47.343
So, I think healthcare is about trust.

0:11:47.343,0:11:51.926
I never met a nurse who didn't want[br]to do her work as good as possible.

0:11:51.926,0:11:53.824
So you can trust nurses.

0:11:53.824,0:11:56.144
It's about meaningful relationships,

0:11:56.144,0:11:59.760
with each other but also between nurses[br]and patients, of course.

0:11:59.760,0:12:01.490
And it is about empathy.

0:12:01.490,0:12:04.838
Try to understand[br]what the concerns of people are,

0:12:04.838,0:12:07.387
and try to do something positive with it.

0:12:07.787,0:12:10.975
So, in my opinion, we should -

0:12:11.705,0:12:15.177
let's bring the soul[br]back into the organizations,

0:12:15.177,0:12:18.862
and let the complexity[br]get out of the organizations.

0:12:18.862,0:12:20.232
Thank you very much.

0:12:20.232,0:12:21.982
(Applause)