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I had quite a normal life till I was 20.

2
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I was a good student,

3
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and I studied economics.

4
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And then I made a radical choice.

5
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I became a nurse.

6
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I've got my wings,

7
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but as a nurse, as a male nurse,

8
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as I hope you can see,

9
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I worked the rest of my life

10
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with a lot of women,

11
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and I saw it as something very positive.

12
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I learned a lot from it.

13
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I worked for many years in a hospital,

14
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and after that I started to work
as a district nurse in a community.

15
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And this was the most
beautiful part of my life

16
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because I learned how to deal with
all kind of problems in the community.

17
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And I had colleagues
in the same village I worked,

18
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and together, we solved
all the problems we met.

19
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There was not a big organization,

20
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it was just a team of nurses
who organized the work themselves.

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We took care for patients
who were terminally ill,

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patients with dementia,

23
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people who were discharged from hospital,

24
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and there was a big variety of activities.

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We also took care for little children.

26
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So it was in that period,
the most healthy job you can get.

27
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And we also built support systems
in the community.

28
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It was a very inspiring job,

29
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and I enjoyed it very much till 1993

30
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in Holland we got a big disaster

31
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because the politicians discussed

32
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that community care
should become more professionalized.

33
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And what I meant by that

34
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was that it should become -
it should be part of a bigger organization

35
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managed by managers

36
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and organized not focusing
on solutions for people

37
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but delivering products.

38
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For the nurses, it looked like this:

39
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Instead of thinking helping patients,

40
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they had to think: What kind
of products should I deliver?

41
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We had personal care, personal care extra,

42
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personal care special.

43
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We had nursing care, nursing care extra,
nursing care special.

44
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And all theses nurses
got disturbed by thinking:

45
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What kind of activities should I give,
and how should I code it?

46
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Because there were a lot of codes.

47
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For patients, it was also
even a bigger disaster

48
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because for every task,
they got someone else,

49
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and there were sometimes 
people with dementia

50
00:03:05,292 --> 00:03:11,212
who got 30 to 40 different people
coming into their house in one month.

51
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And can you imagine

52
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that every time you have to tell again 
what the situation is

53
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and how you want to live your life?

54
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So both nurses and patients

55
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were very, very dissatisfied
about how things were going.

56
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The same time, it looked more and more
like factories, the care organizations,

57
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and I see it in a lot
of countries happening.

58
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So you saw that all the things

59
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that were developed
in industries and companies,

60
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they were also in the organizations,

61
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and you saw that more and more managers
were taking over the profession.

62
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So what you saw was that

63
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there was more and more
management layers in the organizations:

64
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a CEO, directors, managers,

65
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and they almost forgot
that there were also employees.

66
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And it can be done so much differently

67
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as you can see
in the other side of the slide.

68
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The consequences, they were very different
than the politicians expected.

69
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Because the expected
that by organizing this way,

70
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the costs would go down
and the quality would go up.

71
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They also had market incentives.

72
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But what you saw
is that the opposite happened.

73
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The quality went down dramatically

74
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because of the many people
who were involved with every patient,

75
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and the costs doubled in 10 years.

76
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So the assumption
of the politicians was quite wrong.

77
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But what you saw was that
the people who paid us

78
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were even more focusing on efficiency.

79
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So for example, when a nurse
took 10 minutes longer

80
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for travelling to a patient,

81
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she had to explain that
to her manager, why she did that.

82
00:05:04,312 --> 00:05:10,468
In 2006, some friends and myself,
we thought it's time for a change.

83
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I had been director for a few years
in a few organizations,

84
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and I saw that it could be done
very differently.

85
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And our ideas was to change
the healthcare in Holland

86
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and to start a movement to show

87
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that elderly care
could be done much better,

88
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based on trust

89
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and based on self-organization.

90
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So the principles
I worked myself with in the '80s,

91
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we took them again as the basic principles
for our organization.

92
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And for four nurses in 2007,
we grew to 9000 nurses in 2015.

93
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And it just happened by itself.

94
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The first year, 2007,
it was some kind of experiment.

95
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So we started in 10 locations,

96
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and every time happened the same:

97
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we got nurses who just developed
their networks in the community;

98
00:06:03,464 --> 00:06:08,168
they started to work again
on the same principles we did in the '80s,

99
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and within a few months,

100
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they had got their patients,
and they covered their costs.

101
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So there was no financial problem.

102
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So from 2008,

103
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we got 10, 20 teams a month,

104
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and every time it happened the same.

105
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They called me to come
to one of the houses of the nurses,

106
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and we sat all evening talking about
of our profession:

107
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What does it mean to help people?

108
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And how can we do it
just the way we want it

109
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and not be bothered
by any kind of regulations?

110
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So that's what we did,

111
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and the evening of the day after,

112
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I usually got a phone call
from one of the nurses,

113
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and they said, "When can we start?"

114
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And then we started just a new team
in a new neighborhood

115
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focusing on patients as we are used to.


116
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So this went at a very high speed,

117
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and we didn't have problems to manage this
because they were managing themselves.

118
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We had a small back office,

119
00:07:13,576 --> 00:07:17,278
and we still have a small
back office with 30 people.

120
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My wife and me, we are some kind
of a management team,

121
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but we don't have meetings,
and everything is going very well.

122
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My wife is always awake
very early, around 6:00,

123
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and then she tells me what to do
like any other wife, I think,

124
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is telling her husband.

125
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So that's the way we are managing.

126
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And this way, we have a lot of time 
just to solve problems.

127
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In my job I had before, I had meetings
from morning till evening,

128
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and I didn't had time
to solve the problems.

129
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So that's quite different.

130
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In 2015, we see that there's
still no management.

131
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Because there was a lot
of criticism when we started.

132
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They said, yes, you can do this easily
when you're with just a few persons.

133
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And then, they said,

134
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oh wait, perhaps next year
they will collapse

135
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or they will have big financial problems.

136
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But the opposite happened

137
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because what you saw that the teams
were more and more in control

138
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and taught a lot of solutions

139
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they could find 
for the problems they met.

140
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So it was growing, the knowledge
was growing in the teams,

141
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and it became more and more sustainable.

142
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We still tried to avoid
any kind of bureaucracy.

143
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We built an IT system

144
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[which prevented] all the bureaucracy
to take over the work of the nurses.

145
00:08:51,500 --> 00:08:53,921
So all the bureaucracy was kept outside.

146
00:08:53,921 --> 00:08:58,271
We split the administrative process
with the professional process

147
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so the nurses just can focus
on what they're there for,

148
00:09:02,767 --> 00:09:04,915
and that's taking care for patients,

149
00:09:04,915 --> 00:09:09,183
find solutions for patients
who have severe problems.

150
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In 2015, we can look at it,
if you look back now,

151
00:09:14,770 --> 00:09:16,581
we can say we have, since we started,

152
00:09:16,581 --> 00:09:19,487
the highest client
satisfaction in Holland.

153
00:09:19,487 --> 00:09:22,706
And what's very important
for the policy makers

154
00:09:22,706 --> 00:09:28,201
is that instead it took
more costs, or more hours,

155
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because we're working
with higher educated nurses,

156
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the costs went down with 40 percent.

157
00:09:36,078 --> 00:09:37,974
So last evening,

158
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the Parliament in Holland 
was debating about the district nurse.

159
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And they were debating
about the position of the district nurse

160
00:09:46,630 --> 00:09:49,570
in the future in Holland.

161
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And they said, this movement
should be spread all over in Holland,

162
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so we want to support it.

163
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All the political parties agreed on that.

164
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And at the same time,
we became the best employer of the year,

165
00:10:02,641 --> 00:10:04,201
three times in a row.

166
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Just by doing nothing.

167
00:10:05,546 --> 00:10:07,796
We don't have an HR department,

168
00:10:07,796 --> 00:10:08,848
so we don't -

169
00:10:08,848 --> 00:10:13,866
so by doing nothing, and doing less,
you get far better results.

170
00:10:14,086 --> 00:10:16,636
So all these management ideas

171
00:10:16,636 --> 00:10:19,587
about controlling and command people,

172
00:10:19,587 --> 00:10:22,657
are just, in my opinion,
quite destructive.

173
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So if you just let people
organize the work themselves,

174
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you get much better results
and people are much happier

175
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because they can do what they want to do.

176
00:10:32,648 --> 00:10:34,778
And it sounds very logic,

177
00:10:34,778 --> 00:10:39,468
but we make it very difficult for people
to work this way in a lot of places,

178
00:10:39,468 --> 00:10:42,493
also in schools and also with police.

179
00:10:44,373 --> 00:10:47,299
It was not only in Holland
that this happens.

180
00:10:47,299 --> 00:10:50,799
There are a lot of countries
who have the same problems,

181
00:10:50,799 --> 00:10:53,419
and we got questions
from the United States,

182
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from Japan, Sweden, China,
Czech Republic and so on.

183
00:10:57,875 --> 00:10:59,462
I visited 30 countries,

184
00:10:59,462 --> 00:11:03,052
and in every country
I meet nurses who had the same ideas.

185
00:11:03,752 --> 00:11:05,407
And we start the same movement.

186
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Just with a few nurses, that's enough.

187
00:11:07,776 --> 00:11:10,454
And then you show that it can be done.

188
00:11:10,454 --> 00:11:15,063
And then you see that
other people become curious.

189
00:11:15,063 --> 00:11:19,463
And they say, oh, we never expected
that it was possible in our system

190
00:11:19,463 --> 00:11:22,278
because we have such a complex system.

191
00:11:22,438 --> 00:11:25,346
So we also developed a theory on that.

192
00:11:25,346 --> 00:11:28,276
It's the integrating
simplification theory.

193
00:11:28,276 --> 00:11:31,969
Try to make things simple, not complex.

194
00:11:33,049 --> 00:11:35,569
And when you do that consequently,

195
00:11:36,139 --> 00:11:39,470
it's more easy for people
to take their responsibility,

196
00:11:39,470 --> 00:11:43,599
and to think about what can be done
to solve problems.

197
00:11:43,779 --> 00:11:47,343
So, I think healthcare is about trust.

198
00:11:47,343 --> 00:11:51,926
I never met a nurse who didn't want
to do her work as good as possible.

199
00:11:51,926 --> 00:11:53,824
So you can trust nurses.

200
00:11:53,824 --> 00:11:56,144
It's about meaningful relationships,

201
00:11:56,144 --> 00:11:59,760
with each other but also between nurses
and patients, of course.

202
00:11:59,760 --> 00:12:01,490
And it is about empathy.

203
00:12:01,490 --> 00:12:04,838
Try to understand
what the concerns of people are,

204
00:12:04,838 --> 00:12:07,387
and try to do something positive with it.

205
00:12:07,787 --> 00:12:10,975
So, in my opinion, we should -

206
00:12:11,705 --> 00:12:15,177
let's bring the soul
back into the organizations,

207
00:12:15,177 --> 00:12:18,862
and let the complexity
get out of the organizations.

208
00:12:18,862 --> 00:12:20,232
Thank you very much.

209
00:12:20,232 --> 00:12:21,982
(Applause)