WEBVTT

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I had quite a normal life till I was 20.

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I was a good student,

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and I studied economics.

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And then I made a radical choice.

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I became a nurse.

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I've got my wings,

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but as a nurse, as a male nurse,

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as I hope you can see,

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I worked the rest of my life

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with a lot of women,

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and I saw it as something very positive.

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I learned a lot from it.

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I worked for many years in a hospital,

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

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And this was the most
beautiful part of my life

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

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And I had colleagues
in the same village I worked,

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and together, we solved
all the problems we met.

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There was not a big organization,

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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,

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people who were discharged from hospital,

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and there was a big variety of activities.

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We also took care for little children.

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

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And we also built support systems
in the community.

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It was a very inspiring job,

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and I enjoyed it very much till 1993

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in Holland we got a big disaster

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because the politicians discussed

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that community care
should become more professionalized.

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And what I meant by that

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

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managed by managers

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and organized not focusing
on solutions for people

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but delivering products.

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For the nurses, it looked like this:

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Instead of thinking helping patients,

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

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We had personal care, personal care extra,

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personal care special.

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

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And all theses nurses
got disturbed by thinking:

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

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Because there were a lot of codes.

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For patients, it was also
even a bigger disaster

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because for every task,
they got someone else,

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and there were sometimes 
people with dementia

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who got 30 to 40 different people
coming into their house in one month.

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And can you imagine

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

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and how you want to live your life?

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So both nurses and patients

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were very, very dissatisfied
about how things were going.

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

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and I see it in a lot
of countries happening.

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So you saw that all the things

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that were developed
in industries and companies,

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they were also in the organizations,

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

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So what you saw was that

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there was more and more
management layers in the organizations:

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a CEO, directors, managers,

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and they almost forgot
that there were also employees.

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And it can be done so much differently

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

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

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Because the expected
that by organizing this way,

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

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They also had market incentives.

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But what you saw
is that the opposite happened.

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The quality went down dramatically

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

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and the costs doubled in 10 years.

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So the assumption
of the politicians was quite wrong.

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But what you saw was that
the people who paid us

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were even more focusing on efficiency.

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So for example, when a nurse
took 10 minutes longer

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for travelling to a patient,

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

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In 2006, some friends and myself,
we thought it's time for a change.

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

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and I saw that it could be done
very differently.

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And our ideas was to change
the healthcare in Holland

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and to start a movement to show

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that elderly care
could be done much better,

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based on trust

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and based on self-organization.

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

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

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

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And it just happened by itself.

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

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So we started in 10 locations,

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and every time happened the same:

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

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they started to work again
on the same principles we did in the '80s,

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and within a few months,

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

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So there was no financial problem.

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So from 2008,

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we got 10, 20 teams a month,

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and every time it happened the same.

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

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and we sat all evening talking about
of our profession:

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What does it mean to help people?

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

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and not be bothered
by any kind of regulations?

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So that's what we did,

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and the evening of the day after,

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

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and they said, "When can we start?"

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

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focusing on patients as we are used to.


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So this went at a very high speed,

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

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We had a small back office,

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and we still have a small
back office with 30 people.

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

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

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

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

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is telling her husband.

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So that's the way we are managing.

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

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

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

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So that's quite different.

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

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Because there was a lot
of criticism when we started.

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

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And then, they said,

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oh wait, perhaps next year
they will collapse

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or they will have big financial problems.

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But the opposite happened

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

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and taught a lot of solutions

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they could find 
for the problems they met.

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

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and it became more and more sustainable.

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We still tried to avoid
any kind of bureaucracy.

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We built an IT system

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

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So all the bureaucracy was kept outside.

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We split the administrative process
with the professional process

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

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and that's taking care for patients,

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find solutions for patients
who have severe problems.

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

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we can say we have, since we started,

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the highest client
satisfaction in Holland.

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And what's very important
for the policy makers

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is that instead it took
more costs, or more hours,

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because we're working
with higher educated nurses,

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the costs went down with 40 percent.

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So last evening,

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the Parliament in Holland 
was debating about the district nurse.

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And they were debating
about the position of the district nurse

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in the future in Holland.

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

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so we want to support it.

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All the political parties agreed on that.

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

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three times in a row.

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Just by doing nothing.

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We don't have an HR department,

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so we don't -

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so by doing nothing, and doing less,
you get far better results.

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So all these management ideas

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about controlling and command people,

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are just, in my opinion,
quite destructive.

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So if you just let people
organize the work themselves,

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you get much better results
and people are much happier

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because they can do what they want to do.

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And it sounds very logic,

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but we make it very difficult for people
to work this way in a lot of places,

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also in schools and also with police.

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It was not only in Holland
that this happens.

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There are a lot of countries
who have the same problems,

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and we got questions
from the United States,

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

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I visited 30 countries,

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and in every country
I meet nurses who had the same ideas.

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And we start the same movement.

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Just with a few nurses, that's enough.

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And then you show that it can be done.

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And then you see that
other people become curious.

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And they say, oh, we never expected
that it was possible in our system

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because we have such a complex system.

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So we also developed a theory on that.

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It's the integrating
simplification theory.

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Try to make things simple, not complex.

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And when you do that consequently,

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it's more easy for people
to take their responsibility,

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and to think about what can be done
to solve problems.

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So, I think healthcare is about trust.

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I never met a nurse who didn't want
to do her work as good as possible.

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So you can trust nurses.

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It's about meaningful relationships,

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with each other but also between nurses
and patients, of course.

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And it is about empathy.

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Try to understand
what the concerns of people are,

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and try to do something positive with it.

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So, in my opinion, we should -

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let's bring the soul
back into the organizations,

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and let the complexity
get out of the organizations.

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Thank you very much.

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(Applause)