Other authors: Hannie Treffers, Saartje Sondeijker, Bellis van den Berg, Henk Nies Vilans centre of expertise for long-term care

Improving quality, cost-effectiveness and future sustainability of the long-term care sector in The Netherlands

Up to care! – A nationwide program

Suzanne van den Bosch, PhDEHMA conference, June 17, 2015

Context in the Netherlands

• Ageing population: 25% > 65 years in 2040 • Shrinking and ageing work force• Increasing people with chronical illness• Increasing costs for long-term care (27 billion euro)• Quality at risk

-> Since January 2015 major changes in healthcare funding, ensuring the sustainability of long-term care

Transition in Dutch healthcare

Shifting from…. ……towards:

Classical welfare state “Participation society”

Central funding Decentralised funding

Institutional care Care in the community

Hierarchy & top-down organisation

Self-organisation

Managers in power Empowerment of clients & care workers

‘Up to care!’ programme

• Initiated in 2009 by Dutch Ministry of Health, Welfare and Sport & Vilans centre of expertise for long-term care

• Nationwide program (> 100 million euro’s) • Supported > 450 organisations in long-term care: including elderly care, nursing and care, homecare, care for disabled people and long-term mental healthcare• Focusing on improving cost-effectiveness, while

maintaining quality of care (“more with less”)

Original objectives ‘Up to care!’

To improve future sustainability and transformation of long-term care:• Raise awareness and urgency in the field• Support transformations of long-term care organisations• Implement proven good practices

• Develop a learning sector:

-> with better connection between Dutch Ministry of Health, Welfare and Sport & the long-term care sector

-> ultimate goal: stimulating a nationwide movement in upscaling good initiatives into everyday practice

How organisations are supported

• Long-term care organisations receive in-kind support of a coach, for the duration of 1,5 years

• Building upon & accelerating existing processes • Input of expert expertise & best practices regarding

initiating and implementing “irreversible change”• Extracting new best practices, tools and methods and

share this with the sector -> value of narratives• Monitoring of results -> translating long-term visions in

measurable short-term effects

Results: improved cost-effectiveness & quality of care

• Decrease in overhead up to 50% • Efficiency gains up to 15% • An increase of informal care up to 20% • Cost reduction up to 26% • Higher client- and employee satisfaction• Lower absence through illness• More time for client care

General results of the program• Contributed to the scaling up of Self-Managed Teams:

self-organisation has become a common practice in long-term care

• Contributed to learning in the long-term care sector:

many learning activities, communities of practice were facilitated

• Wide spread dissemination of knowledge and examples: -> via website (300.000 unique yearly visitors), conferences, seminars &

other meetings (3000 participants)

• Contributed to raising awareness and urgency about the need for transformation, future sustainability/ affordability of long-term care

Irreversible changes

Requires integrated approach and fundamental changes at all levels in organisations: Changes in organisational structure Changes in vision, strategy and culture Changes in daily processes, behaviour / habits

(practices)

-> Empowered employees don’t want to go back!

Reflections

• The Netherlands has a history of pilot programmes (“pilotitis”); this programme focused on implementing proven good practices

-> Implementation projects as a policy instrument

• Good practices cannot be implemented as ‘blue prints’; basic principles need to be adapted to context of a specific organisation

• Actual contribution of Up to care-program to ongoing transition is difficult to measure: many developments are intertwined

• Dealing with the financial and societal consequences of the Dutch transition in long-term care will remain a challenge for the sector!

here? Tran

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ion

-> Future sustainability

Where are we in transition?

-> Quality of care

-> Cost effectiveness

Questions?