Tour Diary: Best Gerontology Experience from the Netherlands

Gerontology is the study of human aging, its causes and ways to combat it. Experts in the Netherlands are currently leading the way in this field.

“What is gerontology?” you might ask. Gerontology is the study of human aging, its causes and ways to combat it (rejuvenation). A more than relevant topic, wouldn’t you say? Experts in the Netherlands are currently leading the way in this field. Come along as we discover the new horizons of future healthcare!

Day 1
Borrendamme Аllevo

On the first day of our tour, we visited Borrendamme Аllevo where a manager gave a presentation called Live with Care, after which we visited psychogeriatric patients in small groups and reviewed different care methods with a local ergotherapist.

At the Borrendamme Аllevo

Cornelia Allévo is a care home in Zierikzee that offers individual approach to each patient, a unique treatment and training program, assisted living, rehabilitation, expert assistance, nutrition consultation, etc. On-site facilities include shops, a restaurant, a hairdresser’s and other amenities that make a patient’s stay at Cornelia Allévo more comfortable. 

Allévo covers two islands and 2,000 home care clients, but there are only 400 employees who observe, support and assist patients with the aspects of living they find the most difficult, unlocking each person’s potential. Two times a year, the patients gather together with their relatives for family evenings.

Since many patients face aging-induced behavioural problems, depression or other disorders, the freedom dementia patients have is limited according to safety levels. Additional precautionary measures are taken such as badges and signs on ward doors. 

Interestingly, the healthcare system in the Netherlands has many degrees of medical qualification. Even the cleaning and technical staff are required to have medical knowledge to work at such facilities. Nurses have even more degrees that regulate their qualification and functions.

Day 2
Buurtzorg Nederland

On this day, the group left Zierikzee and travelled to the historic city of Amersfoort. Jos de Blok, the founder and CEO of Buurtzorg, told us of the history of his organisation and showed us how it operates in the Netherlands.

Here are some interesting facts about Jos de Blok and Buurtzorg: 

  • Buurtzorg Nederland is a Dutch home care organisation that has drawn the attention of the international community with its innovative way of using groups of independent nurses who provide relatively inexpensive care services.
  • Translated from Dutch, Buurtzorg means “neighbourhood care”. The company brings together self-organising teams of 10-12 healthcare workers (making them 950 in total) that provide care for the sick and elderly residents of small communities. 
  • Since Jos de Blok had worked as a nurse for ten years, he learned firsthand what kind of changes happened in his field. His main reasons for creating Buurtzorg in 2006 were the high cost and poor quality of home care combined with his disappointment in the established healthcare system. Jos de Blok left his previous job and founded a company that operates in a completely different way. 
  • What distinguishes it from other similar businesses is the absence of managers, its self-organising teams, low overhead costs, high quality of service and expense reduction

After our meeting with Jos, we visited patients in Amersfoort, spoke to a family doctor, stopped by at a day-care centre, learned everything there is to know about the IT sector (Buurtzorg has its own IT support system but lacks any strategic planning policy) as well as about corporate culture and a nurse’s role in self-managing companies. 

Incidentally, one of the most important skills nurses at Buurtzorg have is teaching a patient’s family special care-giving methods. Patient and nurse can be very close. Usually, they spend many years together, sometimes until the very end when a healthcare worker helps a patient to pass away peacefully. 

Jos de Blok, the founder and CEO of Buurtzorg

Internal organisation at Buurtzorg

  • Usually a nurse, working a full shift, provides care for 10-12 patients per day. In the morning, the employee takes care of 6-8 different patients (terminally ill, chronically ill, mentally ill patients, etc.).
  • Lunch time is spent meeting with colleagues among other things, while in the afternoon or in the evening the health worker, again, cares for 6-8 patients.
  • Employees take part in meetings/briefings one a week. 
  • Buurtzorg is so popular among patients and medical professionals that they leave conventional medical companies in droves. 
  • Every month, Buurtzorg receives hundreds of CVs from healthcare providers who want to join the company. Buurtzorg now has over 9,000 employees, or two-thirds of all district health workers in the Netherlands. All of them work in small groups of 10-12 people without a leader or manager in charge.
  • No one sets the time for patient care.
  • The company is managed by no more than 28 people.
  • Several years ago, an Ernst & Young study found that Buurtzorg spends less than 40% of the time assigned to doctors, and emergency calls are 30% less likely, which helps Buurtzorg to save hundreds of millions of euros annually for the Dutch social security system.

*(Some of the content was taken from the book Reinventing Organisations by Frederic Laloux)

Medical care at its best is a small miracle

What sets Buurtzorg apart from conventional medical facilities is its different view of healthcare.

In the relationship between the patient and the doctor, a miracle either happens or it does not. A mechanical approach to service leaves no room for miracles. To be able to help patients, a healthcare worker has to be respected as a professional. Give them freedom, and they will live up to your expectations. The first thing a Buurtzorg employee does when he or she comes to a new client’s house is sitting down for a cup of coffee. Healthcare workers help patients create a support network, to feel less lonely and dependent on others. For example, they often help elderly patients and their children to learn how to be around each other during illness. It is only natural that healthcare workers help patients to get to know their neighbours so that they could build their support network.  

Our group during the lecture
Day 3
This day was given to visiting patients at Amersfoort Care Home. The group learned all the ins and outs of working with people with dementia and had a Q&A session with an international coordinator at Buurtzorg.

As the saying goes, “growing old is no fun,” and one of the saddest things that await a person in their twilight years is dementia. But what kind of disease is it?

Dementia is a progressive decline in cognitive abilities, an ailment that is commonly believed to go hand in hand with old age. Dementia makes those afflicted lose their practical skills and ability to perform most common actions. The patients’ memory and cogitation are impaired. 

Visiting patients at Amersfoort Care Home

Here are a few insights of the day:

  • Amersfoort Care Home is a place where older people come for medical care, counselling and support during the day.  
  • Elderly people diagnosed with dementia (who are not dangerous to themselves or others) come to the care home as often as they see fit, one to four times a week. 
  • Patients with severe dementia stay at the care home permanently and are attended by trained medical staff 24/7.
  • They work with patients with various therapeutic techniques (music and game therapy, drawing, and much more.)
  • Every patient has two nurses assigned to them, while the entire medical cell consists of four nurses (who know the patient’s medical record and can be interchanged). 
  • A weekly treatment/follow-up plan for each patient involves two employees, which is automatically displayed in the system. 
  • The system is easy to use. Nurses can only access the medical records of patients within their cell, because stringent laws protect human rights and personal data in the Netherlands. Even if someone steals a health worker’s computer, the program cannot be hacked into, because every nurse uses a special key/keychain to enter the system, and a new code is generated every 3-4 hours a day. 
  • New data and patient monitoring results must be uploaded to the system every day. 
  • Each nurse has a specific schedule, but it can be changed to accommodate patients who always come first. 
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Here’s a bit of background:

  • Amersfoort is a historic city and community in the Netherlands, in the province of Utrecht. The name of the city is a two-part word, Amer (the old name of the river Eem) and foort (modern-day Dutch voorde, meaning “ford”). 
  • The city’s population is 155,089, which makes it the second largest in the province and the fifteenth largest in the country.
  • Since the 18th century at the latest, there have been one or two physicians in every region of the Netherlands providing care for the sick and the elderly. In the 20th century, the country’s social security system was already facing difficulties.
Amersfoort is a historic city and community in the Netherlands
  • In the 1980s, the Dutch government came up with the idea of ​​bringing all healthcare providers into large organisations. Soon enough, the organisations found ineffective the system where the same nurses always monitored the same clients. Now, care was provided by a new healthcare worker every day, depending on their schedule. A higher degree of flexibility meant less inactivity for health workers between patients.
  • Call centres were opened at head offices, and patients no longer had to call their designated healthcare workers directly. Later, it was decided to further narrow the specialisation of health workers. Those who had more experience got bigger salaries and visited patients only to perform complex procedures. Everything else, such as injections and dressings, was delegated to low-paid nurses, which helped save more money. 
  • Later, managers noticed that some healthcare providers worked faster than others, so they set time standards. Compression pad change was to take no more than 2.5 minutes and injection, no more than 10. Every minute was accounted for. 
  • Head offices now had planning departments. In the evening, healthcare workers received their detailed schedules for the next day, prepared by someone from the planning department. 
  • Such a system has several disadvantages. It is difficult for older, sometimes absent-minded clients to see a stranger invading their personal space every single day. They have to talk about their health with a person they don’t know, who is often in a hurry. In addition, healthcare providers did not like this, since the work style hurt their professional dignity.
Day 4
From Amersfoort to Hogewey

Hogewey is a specialized medical facility for the elderly with dementia. It is actually a village (or a small town) with a town square, a supermarket, a hairdresser’s, a theatre, a pub, a restaurant and twenty-three houses. The style of each house reflects the preferences of six to seven people who live there 

  • Number of employees: about 250
  • Compared to conventional nursing homes, the advantage of daytime memory therapy at Hogewey is that people with dementia are more active and need less medication, so the institution creates comfortable conditions for them.
  • Carers, doctors and nurses work around the clock to provide 152 residents with the daily care they require. 
  • People caring for patients wear normal day clothes, not medical wear, which makes dementia patients feel more comfortable. 
  • In working-class households, caregivers are considered neighbours or guardians, while in the aristocratic/upper class homes nurses behave like servants.

Here are some interesting facts about Hogewey and Eloy van Hal, senior managing consultant at De Hogeweyk

Eloy van Hal is Senior Managing Consultant at De Hogeweyk, a specialized medical facility for the elderly with dementia. He was born in Maastricht in 1967. Eloy van Hal has been working in the healthcare sector since 1997. Since 2002, he has been on the De Hogeweyk Management Board as project manager for De Hogeweyk.

Eloy van Hal - the Senior Managing Consultant at De Hogeweyk

Eloy also advises organisations and governments on various projects in the areas of housing, social welfare and care, construction and, of course, the Hogeweyk concept. He studied consumer science at Wageningen University and production management at Hogeschool Zuyd.

De Hogeweyk is an absolutely magical place that you can talk about for hours
  • People come first! The town has 169 residents, 37 houses for 6-7 each, and there are four kinds of houses: formal, traditional, urban and cosmopolitan.
  • De Hogeweyk is fully sponsored by the state.
  • According to Dutch law, a person with severe dementia cannot live alone, even if they have relatives and all the necessary devices. 
  • The long-term care facility has doctors, nurses and home assistants.
  • Neighbourhood simulation means the nursing home looks less like a facility and more like a community where patients are provided with care. 
  • The masterminds behind the village were an organisation manager and a private business manager, and their synergy gave birth to a brand new format. 
  • Caregivers try to refer to the people they look after not as patients but as residents. 
  • To become a resident, one has to meet all the criteria set by the government. 
  • De Hogeweyk tries to resemble a medical facility as little as possible (there are no restrictions, no medical hierarchy, etc.). 
  • Employees and caregivers work behind the scenes to create a homelike atmosphere for the residents.
  • The facility uses an integrated approach where caregivers are always on hand to ensure that the residents’ quality of life does not suffer.
  • Only 2% of residents use psychotropic medication and 7% use antidepressants

 

By FastForward tradition, our visit to the Netherlands ended with a guided tour of the country’s capital. 

The Amsterdam Tour

Beautiful Amsterdam fascinated us not only with its style, views and landscapes, but also with interesting content, as there are many museums here, including the Rijksmuseum, Van Gogh Museum, the Stedelijk Museum Amsterdam, Rembrandt House Museum, and Anne Frank House. Additionally, this city is famous for its world-class symphony orchestra. All aesthetic requests of the tour participants were satisfied.

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Participants’ impressions of previous management tours:
Having already taken part in educational tours, these people are happy to share their knowledge and impressions.
Anton Nesiforov
Anton NesiforovUnified Concept Manager for Izbenka and VkusVill

On our tour of Germany, we visited the most famous food exhibition, the Green Week, as well as numerous retail chains and enterprises operating in various interesting industries. We have a lot to learn. We must take the best and use it. Thank you, FastForward, for your careful approach to creating this tour.

Alena Nesiforova
Alena NesiforovaUnified Concept Manager for Izbenka and VkusVill

We visited several retail stores in Germany, as well as manufacturing facilities. What we liked the most about the stores we visited was the high quality standards of German retail. Retailers know how to sell high-quality goods at affordable prices, and this is probably the main secret of Germany's retail success. As for production, we were inspired by some of the small family businesses we saw.

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