Why start a change programme when both employee and client satisfaction score well and there is no financial need? Stichting Zorgspectrum Het Zand in the Zwolle region did exactly that and rose to the challenge. For Wybren Bakker, chairman of the board of directors, an improvement programme with Accezz would help the company retain its position as a good healthcare provider and employer. Maintaining high standards involves a great deal of hard work every single day. Even if you aim to continue operating at your highest level, change is required because standing still is not an option.

Demolishing care homes and building quality
As a healthcare provider, Het Zand has traditionally focused on care and nursing homes. However, the nature of care has changed considerably over the years and some care homes have even been demolished. Wybren Bakker: “Although the old, conventional type of nursing or care home no longer existed, we had not adequately adapted our procedures. In the past, we had 30 clients on a corridor. Each client required help with getting up in the morning and three employees were scheduled in by default. Whether it was peak time or quieter periods, three employees were always present during the day. The system determined what should happen and the type of care the client received. I thought it would be useful to investigate how we could turn this around and let the system be shaped by the needs of the client.” The decision to implement an improvement programme surprised staff because there was no apparent need for it. Bakker continues: “We had worked the same way for years and everyone was quite satis ed. But we underestimated one thing. When you bring in an improvement programme, people are quick to draw the conclusion that there must be a nancial necessity behind the decision. After all, it does involve an intensive change process.”

Although there was a good deal of optimism at the start, Wybren Bakker now feels the works council could have been more involved in the decision. He says: “It took a while before we had convinced everyone that there really was no underlying nancial cause. And, of course, Accezz did reveal after the analysis phase that we could achieve considerable savings by working more efficiently. However, we were first and foremost committed to maintaining a high level of care quality and to being a good employer. It was therefore made clear that we wanted to spend at least half of the savings to bene t clients directly. As we did not have to economise on staff, we could plan more ef ciently and kill two birds with one stone: employees would be able to spend longer with clients while feeling less rushed all the time.”

If you adjust work processes, workplace relations improve
He continues: “The most shocking discovery at the end of the analysis phase involved realising how much time was being wasted on the work oor; much more than we had thought. Employees were pushed to extremes, either dashing from one chore to the next or just at a complete standstill. The morning was such a hectic time as clients all got up at 8:00 am.” During the implementation phase, staff consulted with clients so that peak times could be managed more effectively. Bakker explains: “We looked at solutions put forward by our clients and the staff themselves: perhaps not all clients required the same approach, processes could be completed faster or maybe care could be provided at slightly different times for certain clients. We also critically reviewed the needs of each client. Care workers are inclined to do more from their ‘care heart’ than is indicated or required. This ‘over care’ is unpaid and might even entail staff inadvertently adopting a patronising approach whereby control is taken away from the client, which is not in line with our view of care.” Working together, Accezz and staff devised worklists based on the background, education and authority level of each employee. “When a client needed wound care or an injection, employees used to have to wait for a colleague who was authorised to perform these tasks. That held up other areas of work and was also quite frustrating for the employee in question. When you realise this is happening and then structure work processes smarter, the quality of workplace relations improves,” says Bakker.

What determines excellent care and how do you measure that you truly are the best?
Only clients can decide what good care is and providing quality time with the client is vital. “In our organisation, it is important to spend time with clients and this is scheduled in on the worklist. It sometimes took a while for staff to get used to the fact they could legitimately drink coffee, go for a walk or play a game with a client. When a client asks, ‘Isn’t there something else you should be doing now?’, it is very nice that you can respond by saying, ‘Don’t worry, I can still chat for another 15 minutes’,” explains Bakker.
He continues: “This affects how we are regarded, which is reflected in our clients’ assessments of us on the patient experience and satisfaction website Zorgkaart Nederland, for instance. We are the third-best care provider in the whole of the Netherlands and have been awarded the gold standard for quality of care. In addition, we rank seventh as the best employer in the country and are in the top three when it comes to the lowest rates of absenteeism. These types of rating initiatives make our sector increasingly transparent. Thanks to Accezz, we can now be even more open about what truly excellent care entails.”

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Wybren Bakker

Chairman of the board of directos, at Zorgspectrum Het Zand

"Even if you aim to continue operations at your highest level, change is required because standing still is not an option."

Change to improve

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