Monday, 14 May 2018

Self-management: Buurtzorg Identity








Frederic Laloux in "Reinventing organizations" describes the teal-evolutionary companies as those based on the personal growth of their employees and chooses Buurtzorg Netherland as an organization to which we should be paying attention to if we are among those who believe that the time to do things differently has arrived.

What is Buurtzorg Netherland?

Buurtzorg Netherland is a non-profit company, which was founded in 2007 in the Netherlands, when a group of community nurses rethought their work and came to believe that, instead of only going to homes and exercising the functions of their profession, they should advance to becoming the patients’ referee and take charge of attending to their global needs.

Ten years later, Buurtzog Netherland is a company that has already more than 70% of the market share. It has hired 10,000 nurses and 4,000 family employees, organized into 850 self-managed teams, each comprising of a maximum of 12 professionals who serve 40-50 home patients. In a study by Ernst & Young and collected in Lalouxs’ book, the results of Buurtzorg compared to the other companies are spectacularly good: 40% fewer hours are spent per patient, this despite the fact that the Buurtzorg nurses take time to chat and have coffees with the people they attend to, the health care plans last half the usual time and patients recover their autonomy earlier, a third of the hospitalizations are avoided, and when people do have to be admitted to hospital, the stays are shorter. The consultant estimated that if the Buurtzorg model were to be implemented in the US, the health system would save 49 billion dollars.

Inside Buurtzorg Netherland

The work teams don’t have a boss, and to make self-management viable, everyone, when joining the company, must attend a course: "Interaction methods oriented to find solutions", where they learn to listen, communicate, drive meetings and help each other (coaching). Team meetings should ensure that all voices are heard, but no one has the right to veto a proposal. They avoid, as much as possible, conceptual discussions and consensus and instead, there is a tendency to say: "if you have it clear, try it, and we will value the goodness of what you say with the facts". The test-error system is the preferred one. If a team gets stuck, it asks for the help of an external coach, usually a veteran nurse with prestige, who has no executive capacity and is only a facilitator for the resolution of conflicts. As there is never any decision made by an outside official, there is never a manager to blame. According to Laloux, learning to live with this degree of freedom and responsibility can generate confusion and frustration, but this is a journey of personal development from which mature professionals emerge.

Are there general rules?

There are very few, of which Frederic Laloux, in his analysis of the organization highlights the following:

- The teams must know how to distribute tasks in a way that is adjusted to the capacities of each of their members and they must be alert not to concentrate too much on one person, since this could be the seed of a traditional hierarchical form.

- The coaching should be used on a regular basis not only in the resolution of conflicts but in order to encourage the team's ongoing learning.

- Once a year team members should evaluate each other according to the competencies they had defined.

- The teams must prepare annual plans with the initiatives they want to implement, mainly in the areas of patient care, quality, training and organization.

- It’s a sign of maturity that the teams manage to allocate 60-65% of the time for direct care work which means that they have enough time for community work, internal teamwork, training, personal growth, etc.

- The hiring of new professionals, personnel management, task planning, administrative work and investments are the responsibility of each of the 850 work teams. There is no central staff for any of these issues. Laloux admits that with this decentralized model economies of scale are lost, but he says that this is compensated for in sufficient quantity by the enthusiasm that professionals feel for a job well done.

- BuurtzorgWeb, more than an intranet, is a Facebook where all professionals put questions, answers and feelings. This network has the utility of being a substitute for traditional planning. When someone has a proposal that affects the organization as a whole, the debate is generated on the internal website and, if there is sufficient support, a specific work group is created to study its opportunity and viability from a more technical perspective. 

- Each month, the compared productivity data of all the teams is openly posted on the intranet. 

The video includes a lecture by Jos de Blok at King's Fund in London, in which he asks if the Burtzoorg model would work in England.



The spectacular growth of Buurtzorg, the results it credits, and the fact that, right now, the Dutch government encourages competing companies to adopt its model, suggests that self-management, difficult as it may seem, should be the answer to the burnout of professionals. 

Frederic Laloux states that when people have the power to make decisions and the resources to work for a meaningful goal, they don’t need motivational speeches and challenging targets.


Jordi Varela
Editor

Monday, 7 May 2018

I don’t know ... but it seems to me that times are changing

Joan Escarrabill




Health care’s future is an issue that is debated multiple times. The most academic visions or those that start from the observation of reality have common elements. Increasing the number of professionals (more doctors and nurses are needed, is strongly agreed), to the extent that the weight of the hospital will be reduced and interventions in the community will gain prominence, health education of the population is very important or in what way are we going to create sustainability in a system that has contributed significant improvements during the last years, can be just a few examples of these common places of all the debates.

Monday, 30 April 2018

Could we organize ourselves in a different way?








Frederic Laloux, in "Reinventing Organizations", a revealing book, at least for me, invites us to rethink the way we manage companies. The age of the internet, he says, has precipitated a new vision of the world that contemplates the possibility of a distributed intelligence instead of a vertical hierarchy. According to Laloux we should be able to invent a more powerful and meaningful way of working together if we would change our belief system.

In the first part of the book, the author makes an evolutionary analysis of the way in which humans organize companies, which I found colourful and insightful, and that is why I have prepared a summary (for more details I recommend going to the tables that are at the end of chapters 1.1 and 2.3):

Wednesday, 25 April 2018

Weapons of mass distraction in the National Health System

Salvador Casado




When we go to a health professional's office there are recurring constants, white coats, stretchers, blood pressure monitors and a computer on the table. The medical record is no longer a folder full of paperwork, but an electronic form on which health professionals work. There is no doubt that it has many advantages over the previous format but it has not yet been able to correct its major flaw: its great power of distraction of the professional who uses it.

The limitations of design and usability mean that at each clinical meeting a considerable amount of time has to be devoted to registering, filling in numerous protocols and making requests for analyses, consultations to other professionals or issuing prescription, bureaucracy  or reports of any kind.  The perception of many patients is that health professionals look at their screens more than they do at themselves, and that's usually not cool.  Nor is it a dish  for nurses and doctors who see how their limited time is spent on tasks that prevent them from devoting dignified attention to the people they attend.

Monday, 23 April 2018

Debate with Vinay Prasad on the value of clinical practice and doctors’ training








Vinay Prasad (University of Oregon) and Adam Cifu (University of Chicago), authors of "Ending Medical Reversal: Improving Outcomes, Saving Lives" (Johns Hopkins University Press, 2015), point out 146 clinical practices that should be ditched because it has been proved that they do not deliver the promised results. The list of these practices affects the whole range of the health activity; however, making a detailed reading, it has been observed that these are mainly found in four specialties: cardiology, gynaecology, orthopaedics and family medicine. It’s because of this reason that the Section of Clinical Management of the Catalan Society of Health Management (SCGS), in its Annual Conference to be held on May 18, in agreement with the team of the project Essencial of AQuAS, has organized a debate between one of the authors of the book, Vinay Prasad, and representatives of the 4 mentioned specialties: Xavier Viñolas, president of the Sociedad Catalana de Cardiología (SCC), Juan José Espinós, gynecologist at the Hospital de Sant Pau, Joan Miquel, orthopaedist at the Hospital de Igualada and Marta Expósito of the Sociedad Catalana de Medicina Familiar y Comunitaria (CAMFIC). The debate, which will rely on the moderation of Sandra Garcia Armesto, director of the " Instituto Aragonés de Ciencias de la Salud ", aims to not only find out first-hand about the work of Vinay Prasad, but also to find out what the related specialists think of these practices and what is the impact on our situation, differentiated in many aspects from that of the United States.



On the other hand, Prasad and Cifu, in the book, propose to significantly modify the training programs in medical schools, in order to train new physicians that are more demanding with regards to scientific rigor, more critical of practices with poor value, more sensitive to the needs of patients and more oriented to the evaluation of results. The proposed formula is very simple: the clinical sciences should be the priority, while the basic ones (as we understand them today) should be complementary. It’s not about studying models and then checking them (current system), but about doing it the other way around: from the findings of the clinic, doctors should review (or accept) the theories. Given the importance of the proposal, we thought it appropriate to organize, in the same framework of the Conference, a second debate moderated by Xavier Bayona, with three academic authorities in the training of doctors: Francesc Cardellach (Universitat de Barcelona), Ramon Pujol (Universitat de Vic - UCC) and Milagros García Barbero, president of the Sociedad Española de Educación Médica and, logically, also inviting Vinay Prasad to join them.

The program of the Conference is attached, with the clear purpose of encouraging all readers to register, because nobody should miss out on the opportunity to listen to and pose questions to Vinay Prasad and all invited speakers.






















Organizes:
  • Clinical  Management  Section  –  Catalan  Healthcare  Management  Society 
In  collaboration  with:
  • IDIBAPS.  Institut  d’Investigacions  Biomèdiques  August  Pi  i  Sunyer  
  • Centre  de  Recerca  en  Economia  i  Salut  (CRES)  –  Universitat  Pompeu  Fabra  
  • Institute  for  Healthcare  Management  -  ESADE  
  • Agency  for  Health  Quality  and  Assessment  of  Catalonia  (AQuAS)  
  • Hospital  Clínic  de  Barcelona  
  • Aragonese  Institute  of  Health  Sciences 
  • Catalan  Society  of  Family  Medicine  (CAMFIC)  
  • Catalan  Society  of  Cardiology    
  • Catalan  Society  of  Gynecology  and  Obstetrics  
  • Catalan  Society  of  Traumatology  and  Orthopedic  Surgery  
  • Cochrane  Iberoamérica  
Sponsors:
  • Vifor  
  • Unió  Catalana  d’Hospitals  
  • Consorci  de  Salut  i  Social  de  Catalunya  
  • Novartis  

Monday, 16 April 2018

To optimise the expense, the cost must be reduced

Josep Mª Monguet




It’s well known that the budget allocated to health services has endured brutal cumulative reductions over recent years. This is a detrimental fact, but one can not deny the merit of having suffered and then having survived the cut, the professionals - in the first instance and the users alike. It’s sad but praiseworthy.

The health budget is unlikely to improve in the short to medium term because the situation is what it is and by definition the public deficit has a ceiling. Lamenting that resources were not well managed during the "good times" doesn’t change anything. Although it seems a contradiction, the financial management cannot be improved if the health system and its users, collaboratively, are incapable of reducing the avoidable costs that weigh us down. Only thus we can free up resources and allocate them to make the system more efficient.

Monday, 9 April 2018

Home sweet home and some other lessons

David Font




An article in the New England Journal of Medicine explains that the Department of Health in Victoria, Australia in 2010, announced the construction of a 500-bed hospital without using bricks. This virtual hospital currently receives 33,000 patients per year. And the introductory paragraph of the article ends by asking: What was the incredible technological progress that made it possible? Caring for the patient at home!

Let's continue without leaving the house. I remember post by Jordi Varela introducing the experience of Buurtzorg Netherlands, the Dutch home care company, described as a success story by King's Fund. During a Congress in Barcelona, I heard Jos de Blok, the leader of the project, explaining the experience as a paradigm of innovation success. Let's see why.