University of Twente Student Theses


Future of Dutch hospital care: royal patients in regional networks - The future vision and strategy of Dutch hospitals mapped, using the TAIDA model.

Honcoop, M.M. (2011) Future of Dutch hospital care: royal patients in regional networks - The future vision and strategy of Dutch hospitals mapped, using the TAIDA model.

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Abstract:The health care sector is a dynamic field and subject to many changes. In the Netherlands major changes in policy have been made by the government over the past few decades to anticipate on the health care of the future. This affects the whole sector. A common complaint is: ‘We have to do more, with less’. This complaint often finds its origin in the cost cutting done by the government and the growing demand for care, while the labour force is decreasing. Examples of drivers for these trends are: the development of medical technology and the empowered patient, with its high expectations. The purpose of this study has been to investigate the future of the hospital care in the Netherlands. The pressure on the Dutch health care system is increasing, through policy changes, but also through requirements of health insurers and patients. This requires change. The main questions are: How do members of the board of directors of Dutch hospitals see the future (2016) of their organization? And how do they manage to reach their vision? This research was commissioned by the multinational consultancy agency Capgemini Consulting, department Public & Health. The results of the research may help them to broaden their knowledge about the hospital care market and to inspire and advise hospital board members on their change process. Another aim of the research was to gather data to use them in international research, to compare change processes in health care in European countries. A qualitative study was conducted, consisting of a literature study and semi-structured in-depth interviews with 20 hospital board members throughout the Netherlands. The Tracking, Analyzing, Imaging, Deciding, Acting (TAIDA) model of Lindgren & Bandhold (2003) was used to link future visions to strategies. For the first two steps literature was studied; trends relevant to hospital care were defined and on the basis of these trends four possible future scenarios were developed. The developed scenarios are; super specialization, royal patient, squeezing costs, patient awareness. Thereafter the hospital board members were interviewed to find out what their vision on the future is and what their strategy is to reach the outlined future situation. Based on the answers of the board members, the interviewed hospitals were plotted in the scenario matrix. Furthermore, the theory of Kotter (2007) was linked to the key success and failure factors that, according to the board members, will contribute to reaching their vision. It was discovered that a lot of board members fit in the scenario ‘royal patient’. They described that they aim to work according to the principles of Michael Porter’s ‘value-creation’. Value creation means that the provided care is patient-centric and quality is of major importance. Innovation and specialization will contribute to the quality and efficiency of care. Following these principles will automatically lead to cost reduction and an improved market position. A lot of different strategies were named by the board members, depending on the type and size of hospital and on the region they are located. For example, top clinical hospitals are distinguishing themselves based on the quality of the content of their work, but the basic hospitals are focusing more on the quality of their service. An overarching conclusion is, that working in regional networks will lead to more quality and efficiency for the patient. This development has been speeded up by the recent agreement between the Ministry of Public Health, Welfare and Sports, health insurers and hospitals about specialization of hospital care. This means that conglomerates will be formed, among which hospital care is distributed and concentrated based on volumes and complexity of care. Though, the current funding system forms a barrier towards making portfolio choices. The patient (and also the professional) will have to travel further for the best quality of care. The professional will have to be more committed to the hospital, instead of to his own discipline. According to some board members, the role of the health insurers is redundant. Others, however, hope that the insurer will take a more directing role. Currently this is hard, because health insurers do not have instruments to measure the quality of care. The Supervisory Board will be more committed and responsible; its role will be more complex because organizations become larger. At the same time they have to stay in the background. According to the board members, success factors contributing to leading change are: finding a balance between the internal and external environment, communicating constantly with the work floor, sharing the vision and setting clear goals, setting an example and addressing issues. Few hospital board members mentioned errors. One type of error is, for example, looking constantly over the shoulder of the professional. Some variety between the interviews is perceptible, which was due to putting multiple persons on the interviews. This thesis reflects the opinions of one board member per hospital. Yet, he/she is not on his/her own responsible for the strategy of the hospital. This means that these observations are not to be generalized to all the hospitals in the Netherlands. For further research it would be advisable to also interview change managers in hospitals and to appoint one single interviewer.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:88 social and public administration
Programme:Health Sciences MSc (66851)
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