Patients with a severe form of the pulmonary disease COPD have been using home monitoring since February. By completing a questionnaire twice a week via the Luscii app, they are monitored remotely and are immediately assisted in the event of deterioration. Pulmonary nurse Iris Huisman explains the benefits.
Fewer trips to the hospital
More and more people are suffering from Chronic Obstructive Pulmonary Disease (COPD), a chronic lung disease, in which the damaged lungs lead to shortness of breath, coughing and fatigue. In patients with a severe form of COPD, the symptoms are often so bad that they become less mobile or may need extra oxygen. For them, a mild cold can lead to a dramatic increase in symptoms. We call this a lung attack, resulting in hospitalisation and further damage to the lungs. Iris: “Now that we are monitoring this group of patients remotely, we are able to guide them more effectively and hope to prevent such attacks and hospital admissions. In addition, patients no longer need to come to the hospital for standard checks, which they often find tiring because of their limited mobility”.
Contact at the right time
For the home monitoring of patients, Tergooi is working together with the medical service centre, NAAST. The nurses at NAAST already have experience with this method of monitoring at Slingeland Hospital and know the procedure at Tergooi. They keep an eye on everything 24/7 and if they see a deterioration, they immediately contact the patient via a video consultation, calling through the Luscii video connection. “If NAAST are unable to respond, we become involved. Coincidentally, this afternoon I had a video consultation with a patient whose symptoms we had noticed had suddenly worsened. He admitted that he did not realise that things were going so badly and would not have called himself, but he was very pleased that there was direct contact and that action had been taken”.
Telemonitoring can also be a solution for COPD patients who need more intensive support. Iris: “Because NAAST is available 24 hours a day, a patient who is very anxious and scared at night can make contact very easily. A video consultation at such a moment is exceptionally reassuring and supportive. Patients’ voices are therefore heard if necessary and they can ask for care at any time. At the same time, they also gain more insight into their illness by completing the questionnaires twice a week”.
Since the introduction of telemonitoring for patients with chronic heart problems (in 2016), more than 500 Zilveren Kruis policyholders have been using HartWacht (translated HeartGuard, a remote monitoring service powered by Luscii, red.). 128 patients (25% of the participants) have been using HartWacht for more than a year. Comparisons have been made between their healthcare usage for the 12 months prior to telemonitoring and the 12 months following use. The results are impressive.
The first research results show a large decrease in the use of care. Olivier Gerrits, Director of Zilveren Kruis Healthcare Purchasing: “We were already convinced that telemonitoring contributes to more control and better quality of life. Now it appears that for our policyholders, there are also fewer admissions, emergency visits and ambulance trips”.
Major decrease in emergency first aid visits on A&E
Patients guided by HartWacht for a year have experienced a decrease in the number of nursing days, the number of emergency trips and the number of emergency room visits. This reduction has been compared to the year prior to the supervision of HartWacht. The number of nursing days has dropped by more than 40% and the number of emergency trips with the ambulance has been reduced by 30% in one year. The largest decrease occurred in the number of emergency room visits: In the group of patients that began with HartWacht, the number of emergency room visits (A&E) fell by 70%, compared to the year before.
VBHC Prize 2019
HartWacht is a joint initiative of Zilveren Kruis, the Netherlands’ Cardiology Centre (CCN) and the Dutch healthcare innovation company Luscii. The number of participants is growing steadily. This breakthrough in eHealth was an international first for the Netherlands in 2016. Last month, HartWacht received the VBHC Prize for its collaboration. Igor Tulevski, cardiologist and co-founder of CCN: “A wonderful reward for increasing the quality of life for patients and reducing healthcare costs on a daily basis”.
HartWacht, the innovative healthcare concept that was set up through a collaboration of Cardiology Centers the Netherlands, Luscii and insurer Zilveren Kruis, was awarded by the Professor Porter Value Based Healthcare Collaboration Award 2019. For Luscii, this means that one of its projects wins this prestigious award the second year in a row. Last year the COPDInSight-service of NAAST, insurer Menzis and Luscii was the winner of the Professor Porter Value Based Primary Care Award 2018.
HartWacht telecardiology service
HartWacht is a revolutionary telecardiology service offered by the Cardiology Centers The Netherlands to their patients in 15 centers across the Netherlands. Patients with heart failure, hypertension and atrial fibrillation don’t need to go to the clinic anymore, unless it is needed. The eHealth service was announced in 2016 and is currently available all across the Netherlands with full reimbursement from five of the biggest Dutch insurers.
HartWacht telecardiology service
Globally, the demand for cardiovascular care is rising due to the ageing populations, increased cardiovascular risk and the quest for personalized care. However, resources are limited.
The “classic” healthcare system cannot meet these requirements. Therefore, an affordable and scalable solution is needed. The aim of HartWacht is to increase population health, improve the quality of care and lower the per capita costs by making use of new health technologies such as Luscii vitals.
Heart failure, hypertension and atrial fibrillation
Patients are selected for HartWacht by their cardiologist based on their diagnosis and protocolized inclusion and exclusion criteria. Patients can then share their data with their healthcare provider using the app and the results will be integrated in their electronic patient file. By making both the home measurements and the other relevant medical data online available to the patients, they are encouraged to participate actively in their healthcare processes. In addition, therapy and policy are focused around patient data and adapted continuously if needed. Interventions include lifestyle advice if appropriate, change in medication, education about disease and/or additional diagnostics, thereby forming an IPU.
Patients with severe hypertension and heart failure are guided by the Luscii app to do home measurements with connected measurement devices for blood pressure, heart rate and weight. Also patients with atrial fibrillation are enrolled using Kardia with EKG-monitor. All the data of patients is analyzed and securely transmitted to the the electronic patient file and is interpreted by a dedicated team supported by smart algorithms and a nationwide network of outpatient clinics which can be visited by the patients if needed. The concept is financed through bundled payment schemes. Patient value is measured through standardized questionnaires.
To continuously monitor quality and safety and patient outcome, research projects have been initiated. First results are published in scientific peer reviewed journals and demonstrate a positive effect on safety of the program and patient experience and outcome. Research shows that HartWacht results in less visits to outpatient clinics and emergency departments, thereby adding value to our healthcare system by improved health outcome with less costs. Also patients and treating physicians are satisfied: with less effort they experience faster results of success of their therapy.
Tergooi Hospital (Gooi and Vechtstreek), in partnership with health insurer Zilveren Kruis, are set to bring 20 percent of their current hospital care closer to home. Both organisations have signed a declaration of intent for the new proposal. In doing so, they hope to respond to patients’ needs to receive the right care in the right place.
Subsequently, optimal use must be made of innovative technological options, such as telemonitoring for COPD and heart patients. The Zorg Dichterbij program aims to realise this possibility. In addition, Tergooi and Zilveren Kruis are starting projects focused on prevention. The goal is to avoid repeat trips to the hospital for treatment and/or admittance for patients with a specific condition.
Accelerated relocation of care to the home, an appropriate IT infrastructure and the prevention of care are central to the transition plan that Tergooi and Zilveren Kruis have agreed upon. As is now common knowledge, this is desperately needed to combat challenges such as cost increases, an aging society and the associated growth in the number of chronic disorders, but it is also necessary to help alleviate increasing pressures on the shrinking number of healthcare professionals.
Tergooi has a main location in Hilversum and two regional medical centres. By offering safe care at home, the hospital will organise its healthcare in a different way. Acute, intensive and complex care will remain within the hospital. Good cooperation between healthcare institutions and caregivers within the region is also essential to achieve the desired care in the right place.
Compact New Build
The new construction of Tergooi, which will begin at the end of this year, will be smaller. With the use of online consultations, closer cooperation with care partners, and standardised nursing departments and outpatient clinics, the hospital expects to be able to cope with a more compact building.
Hans den Hollander, Chairman of the Tergooi Executive Board, explains: “As we are starting our new building this year, this is the perfect time for us to implement the change to deliver care in the right place. In doing so, we can continue to improve the quality of our care and respond to the needs of patients, whilst keeping hospital care affordable”.
Care Close By
Tergooi and Zilveren Kruis have already begun with the Zorg Dichterbij program. Part of this includes telemonitoring for chronic heart failure and chronic lung diseases (COPD). More and more doctors from the hospital are also providing consultations via video. Furthermore, treatments are being moved towards the home, for example, with kidney dialysis.
The precondition remains that home treatment is only an option if it is medically justified, says Olivier Gerrits, Director of Healthcare Purchasing at Zilveren Kruis: “Our policyholders prefer to have healthcare as near as possible. We attach great importance to stimulating the movement of care to the home, together with caregivers. So that illness has as little impact as possible on the lives of our policyholders. For us, Tergooi is an example of how we can implement that vision in a sustainable and modern way”.
Right Care, Right Place
In September 2018, the health insurance company announced that it would be investing more in applications that could move healthcare from the hospital to the home environment. In October, Zilveren Kruis announced that it would link its healthcare procurement policy and its focus on “the right care in the right place” to the Medical Specialist Care Outline Agreement 2019-2022.
The Outline Agreement for the hospital sector states that the growth in hospital expenditure must be reduced (via digital care applications, amongst others) in order to reach 0 by 2022. Purchasing Director Gerrits stated at the time that relocation of care to the home (the right care in the right place is also a spearhead of the NVZ and a cabinet ambition) will result in the greatest savings. Even more than just moving care from the second to the first line.
At the beginning of August, the health insurer reported that following a successful pilot with Hartwacht at the Dutch Cardiology Centre, they would also make agreements with hospitals across the Netherlands for telemonitoring heart patients. In accordance, Zilveren Kruis offers hospitals three-year contracts.
In February 2019, Zilveren Kruis signed a multi-year agreement with the Isala Hospital in Zwolle, to further improve the content of healthcare and meet the rising demand for care through the use of e-health, such as telemonitoring. Gelre Hospital followed in March. In addition, just like CZ, the insurer encourages the use of online treatments in mental health care to reduce waiting lists.
Healthcare organisation Omring, Dijklander Hospital, Northwest Hospital Group, GGZ North-Holland North and GP organisations are joining forces with VGZ, part of which includes Univé Zorg. Together, they are working on “sensible care”. This relates to better quality healthcare for the patient that remains accessible and affordable.
These institutions can no longer accept the shortage of nurses; the decline in this region caused by the increasing aging of the population. After all, growth requires new, different and creative solutions, and these organisations, and their doctors and nurses, are working on this collectively with VGZ. The basis for the special regional cooperation comes from the office floor itself: doctors, (district) nurses and psychologists are working together with VGZ on over 100 ideas, all contributing to better care for patients. As most residents in North Holland are insured with Univé, they will certainly notice new forms of healthcare arising in the long term.
The healthcare providers involved have signed long-term agreements (or an intention thereto) with VGZ. In doing so, the organisations won’t have to renegotiate their contract with the health insurer every year, and can instead focus on improving care for the client at lower costs. After all, they have certainty for the coming years and a basis of trust. This has already produced good results in various places across the country.
Omring: Together the best care, close to home
In collaboration with VGZ, Omring is working on a new and faster method of compression therapy (support stockings), fall prevention for vulnerable seniors, more efficient supra-regional triage via an app, amongst other things, and oncological treatment at home, which patients greatly appreciate.
Northwest Hospital Group and Dijklander Hospital: Medicines, primary care and wound management
The Northwest Hospital Group has already enjoyed success in its approach to expensive medicines, in improving first-line care so that patients no longer need to visit a specialist, and with its coordinating function for complex wound management, together with nine general practices. Experts from the Dijklander Hospital are working on better wound care through video calling, together with Omring nurses. This saves the patient a lot of appointments and travelling. At the same time, district nurses will be trained accordingly.
GGZ North-Holland North: Mobile care
GGZ North-Holland North has drastically shortened waiting times thanks to its approach to personal and recovery-orientated diagnosis. The direction for the treatment is expressly placed with the client. The organisation has also successfully integrated e-Health, in anticipation of specialised healthcare providers.
GPs pilot: More time for the patient
In West Friesland, seven GPs are participating in a “more time for the patient” pilot. In other regions, this approach has already led to better quality care, an increase in patient satisfaction, a rise in work satisfaction for the GPs, and a decrease in the number of referrals to the hospital.
Patients with the lung disease COPD are now able to send measurements from home directly to the outpatient clinic of pulmonary medicine. Pulmonologist Pathman Pasupathy explains the procedure: “Every week, patients fill out a questionnaire on their tablet and send in their saturation values. If their situation deteriorates, we will be notified and, if necessary, we will contact the patient via video calling (iPad)”.
Zuyderland is using Luscii for the project. The pilot is intended to gain experience in the remote monitoring of COPD patients. Monique van de Kragt, a physician assistant at the clinic, says that she is happy with the trial: “For patients who already have less energy due to their illness, it is of course fantastic that they do not have to come to the clinic every time. This pilot also strengthens our vision that we wish to manage healthcare as close to the patient as possible. It’s great that we are able to experiment with this”.
COPD is characterised by lung attacks that often lead to hospitalisation. Pasupathy: “As we have more insight into the condition of the patient through this pilot, we hope to prevent such lung attacks and, subsequently, hospital admissions”.
The pilot is being carried out in collaboration with health insurer CZ and will run for the coming six months.
The Netherlands scores well internationally in the field of healthcare. But unfortunately, spending on healthcare is rising faster than the rest of the economy. This is simply not tenable for the future. Furthermore, differences in the quality of care are often not clear. Through sound healthcare procurement, CZ hopes to contribute to future-proof healthcare in 2020.
Responsible and Close by
The common thread throughout our 2020 healthcare purchasing policy is ‘Responsible and Close By’.
- ‘Responsible’ ensures that CZ group will only contract healthcare that is both affordable and in line with our quality vision. In accordance, we apply appropriate yet ambitious standards.‘
- Close by’ is the starting point of the healthcare provision: either at home or close to home if possible. And further away if it guarantees better quality care. By ‘close by’, we also mean: in keeping with the wishes and choices of the insured in regard to their treatment. For example, through joint decision-making processes and the deployment of new (distribution) forms of diagnostics and digital support. In this way, we make treatment less stressful and much more person-orientated.
Vision of quality
CZ attaches great importance to high-quality care for its policyholders. This vision is reflected in our healthcare procurement policy and documents of value.
Vision of healthcare purchasing
Healthcare must be of good quality, affordable and accessible. Now and in the future. That is why CZ makes agreements with healthcare providers to ensure high-quality care that meets the needs of patients, is delivered in the right place, and maintains a reasonable price.
Purchasing in consultation with the healthcare field
Healthcare purchasing is not a stand-alone activity, in which we single-handedly decide what is right. Instead, we are involving and collaborating more and more with the healthcare field: patients, healthcare providers, municipalities and other stakeholders. By innovating, collaborating and continuing to work on structural progress, we can improve healthcare in the Netherlands and give substance to “Healthcare that goes further”.
Providing senior patients with quality care is becoming increasingly difficult. The growing elderly population is putting a strain on healthcare systems, as doctors and nurses no longer have the time or resources to meet demands. Bjørn Moesgaard Lou Kristensen, an employee of Eldercare in Kokkedal, Denmark, knows this predicament all too well.
A year and a half ago, Kristensen sought out a solution for senior citizens in the Fredensborg area, stating “We just knew that we had to do something”. Replacing home visits with remote contact appeared to be the perfect answer to the problem. Using Luscii’s videocare software, the team in Kokkedal have successfully integrated the project into their daily routine.
Benefiting daily life
Kristensen works with senior citizens suffering from a range of illnesses, including Alzheimer’s and dementia. Such patients are typically visited in the morning, allowing caregivers to prepare food for the day ahead. By then giving the patients a videocall around lunchtime, the carers can ensure they have eaten, drank enough fluids and have remembered to take their medication.
One patient in particular, an elderly lady with dementia and psychiatric issues, looks forward to Kristensen’s calls every day. Her physical visits have been reduced to just once a week, during which caregivers are able to clean and administer medication. The rest of the week, she is contacted via a screen three times a day. This allows Kristensen to not only make sure she is taking her tablets, but also enables him to visually check her appearance. He even requests that she walks around the dining table a couple of times while they chat, to show she is physically active. Something which he simply wouldn’t have the time for during a home visit.
And that quality of contact has been the driving force throughout the project. Kristensen explains, “I have been in this line of work now for 22 years, and I know what it takes to visit a patient. But the difference here is the eye contact. During a videocall, you are with that person 100%”.
Persuading some seniors to get on board with the technology required has been tough at times, according to the Eldercare team. Additionally, figuring out the right way of how to proceed has cost the most time and effort. Several organisations in neighbouring towns and cities are looking to Kokkedal for direction, having also adopted video monitoring, in seeking an effective and successful approach to delivering this new type of care. The target is to have set up at least 100 citizens with video calling by the end of this year, with a total of 20 patients in every town or city across the area.
Despite initial difficulties, once fully up and running, the reactions from both caregivers and patients have been very encouraging. Aside from providing more direct contact, remote monitoring also saves precious time for healthcare professionals. Kristensen values this new wave of e-health development, citing “This is the future. It is here to stay”. Having recognised the positive effects such modern advances can have, he hopes to expand his vision even further by ensuring the best quality care for everyone who needs it.
In the coming six months, the Reinier de Graaf hospital, together with the e-health company Luscii, will conduct a pilot of home measurement for patients with the chronic lung disease COPD. With the help of these measurements, caregivers can provide medical advice remotely. Therefore, COPD patients will need to visit the hospital less often.
Prevent hospitalisations due to lung attacks
COPD is a disease in which the lungs are damaged. This makes it more difficult for patients to breathe and reduces their energy levels. Patients with COPD often suffer from lung attacks, in which they experience shortness of breath, coughing or excess mucus production. As a result, they often need to be hospitalised.
25 COPD patients are taking part in the pilot. The participants will receive a tablet, through which they use an app to complete a weekly questionnaire concerning their quality of life. They will also measure the oxygen content of their blood through a device known as a saturation meter, which is connected to the tablet.
A specialist lung nurse then examines the results in the hospital. If these exceed certain threshold values, the nurse will contact the patient via videocall. In this way, the nurse can literally see how the patient is doing and he or she can, for example, adjust the medication in consultation with the treating specialist. Therefore, the patient doesn’t need to come to the hospital as often for a check-up or treatment. This journey is a major undertaking, especially for patients with COPD. Remote care is subsequently perfectly suited for this group of patients.
Bring healthcare close to the patient
“With this pilot, we want to bring healthcare as close to the patient as possible”, says project leader René de Brouwer. “In addition, we can ensure that COPD patients gain more control over their own health. This project is a great example of how we, at Reinier de Graaf, want to provide the right care in the right place”.
Evaluation will take place during and after the pilot. The experiences of patients and caregivers are the central concern. Scientific research into the results of remote monitoring is also being carried out in collaboration with Luscii. If the pilot is successful, the Lung Diseases department wish to monitor more COPD patients remotely.
Healthcare insurer Zilveren Kruis and Isala Hospital are joining forces to further improve care quality and meet the rising demand for healthcare. To achieve this, they have once again entered into a multi-year contract. Isala and Zilveren Kruis share the vision that part of the care should be organised differently for this purpose.
Quality and safety
Rob Dillmann, Chairman of the Board of Directors at Isala: “We have a large number of challenges in the region that we can only solve together. Our vision is fully in line with that of Zilveren Kruis. We have agreed to move 10% of healthcare to the home in the coming years, whilst guaranteeing both its quality and safety”.
Dillmann continues: “By moving a part of healthcare to the home, the patient is better served. Research shows that patients are happy to receive care at home. E-health and connected care play a crucial role in this. Even from a distance, personal contact can be maintained between the patient and the healthcare professional via, for example, video calling. Above all, the patient benefits from more control over his or her own health. This in turn contributes to earlier recognition of problems, so that more hospital admissions can be prevented. And that is also a relief for the patient and his or her relatives”.
1,000 COPD patients will be telemonitored
Up until 2022, around 1,000 COPD patients will be telemonitored, so they only have to go to the hospital if they really need treating. People who are eligible for cardiac rehabilitation or who have cancer can also receive part of their treatment safely at home.
Olivier Gerrits, Director of Purchasing at Zilveren Kruis, adds: “By bringing more care to the home together, we can prevent unnecessary hospital visits and admissions. This also relieves the doctors and nurses. In the case of telemonitoring of chronic heart failure, it has now become clear that quality of life is improving, the number of hospital admissions is falling, and we are spending less on premiums. That reversal is also badly needed. A win-win situation for everyone”.
Together with patients(associations), hospitals and other partners in healthcare, Zilveren Kruis wants to have succeeded in bringing 10% of care to the home by 2021. This urgency comes from the growing patient flow and rising healthcare costs.
The Dutch Ministry of Health made a video on the first phase of this unique project:
2018 – COPD monitoring and videocare at Isala hospital using Luscii from Luscii on Vimeo.
ASSEN – In February, the Wilhelmina Hospital Assen will begin home telemonitoring for patients with chronic heart failure. They will initially start with a group of twenty-five people. At the moment, these patients have to go regularly to the hospital to have their blood pressure and weight measured. With the help of a blood pressure monitor, a weighing scale, and a tablet or computer, this is now possible at home.
“We do not want patients to have to come to the hospital if it is not really necessary”, says project manager Tineke Ottens. “Most people can easily measure their blood pressure and weight, and fill out a questionnaire. This data is sent to a department with specially trained employees. If there are any uncertainties or questions, they then contact the patient via videocall. Subsequently, the heart failure nurses of the WZA have a central role to play.” In order to make telemonitoring a possibility, the WZA has teamed up with Luscii, the Dutch market leader in the field of home measurement. Luscii patient apps work on Apple, Android and Windows, and the company offers a helpdesk for the predominantly older patients, and even provides installation and explanation at home if necessary.
The benefits are great: the patient does not have to go repeatedly to the hospital and can organise his or her own agenda with much more freedom. The patient also has more insight into his or her own data: they can see their blood pressure level or weight for themselves. The fact that direct contact is available also gives a feeling of safety.
The patients taking part will first receive extensive instructions on how to use the equipment. “Even someone without experience of using a tablet or a computer can get started. Older people also often discover that they can do a lot more with the iPad. Sometimes a world opens up for them”, says Tineke Ottens.
Telemonitoring is a fantastic step in the development of eHealth: care via the internet. “We show that people can stay at home more safely and with total self-control through the use of remote expert care. Ultimately, that is what everyone prefers.” In addition to chronic heart failure, this form of telemonitoring can also be offered to people with COPD or sleep apnea in the future.
How a company can become a forerunner through focus and a new method of organisation: Luscii.
June 2018. The Luscii team separates from parent company FocusCura, in which it started. The goal is to give the Luscii team plenty of space to develop their ideas and attract talent from all over the world.
Luscii is a digital healthcare platform that enables healthcare providers to supervise patients with a chronic condition from a distance. In this way, they can intervene earlier and prevent hospital visits and admissions. This is necessary as, in the Netherlands, we will soon have a shortage of hands and a large group of elderly people to look after. With the right care in the right place, we can still offer the same ‘warm’ care to an ever-growing number of patients.
Establishing a company without managers
After gaining independence, the Luscii team used maximum focus and space to organise things in their own way. Joris Janssen was given the freedom to take the digital team to the next level. He opted for self-organisation, having already tasted it at a start-up, and by learning how he didn’t want to lead a team at larger companies. Through opting for self-organisation, he did not become a manager. “What a relief! You no longer have to worry whether everyone has the opportunity to do what he or she has to do. Self-organisation is scary if you are not good at letting go. And that I can do well”, says Joris.
Structure is still a necessity
“When a structure was needed to stand on our own two feet and to give self-organisation some shape, Holacracy was the logical step. Above all, we simply had to have something. And we wanted to implement a structure that others were already using. A big organisation like Zappos had already adopted Holacracy and Ruben Timmerman of Springest came here to share his insights.
Especially when everything is new, there is a need for structure. Some employees were already used to self-organisation, but there were also ten people that came from the old branch. It was precisely for these people that Holacracy was the perfect bridge to make the structure of self-organisation clear”.
Koen Bunders guided Luscii in their first steps towards structured self-organisation. “The implementation in the circles that I was involved in went very smoothly. I think that Joris and Daan’s clear choice for this tool helped a lot. They show that they also take on board the new rules themselves. They give others the space to take full ownership of their roles, and also remain approachable within their own position(s). This form of leadership helps tremendously”.
“For others, however, it was as if they had taken a step back; as if there was too much structure. The emphasis at the start is on meetings, which are often regarded as ‘overhead’.
Those in question may not have realised that they could solve the problem themselves. They experienced the agreements as something imposing, while, in reality, the agreements are liberating. Free rein is given within the agreements, and a process is available through which you can resolve any minor or major dissatisfaction”.
Learning self-organisation under professional guidance
“Koen Bunders from Energized.org led us through two larger circles. In addition, there is also a sub-circle, which began by itself. I am very happy with what Koen did. The added value of guidance is that you really get the hang of it. You can read how it works and understand it too, but at some point, you just have to try it. Someone with experience – such as a Holacracy coach – keeps you on your toes and can see potential pitfalls. I think that if we had received no guidance, we would have got stuck in those pitfalls. Maybe we would have even stopped.
You cannot acquire everything from the constitution. That only deals with the work that has to be organised. Therefore, everyone must be aware of the distinction between person and role. Writing good policies or suggesting the possibility of a new circle at the right time, are some of the things we really needed Koen for”.
The transition from traditional structure to self-organisation
“The people in the office in Driebergen, where Luscii was created, sometimes say that they find it quite strange. Some even laugh about it. I think there may even be those who consider us crazy. It does take time. People in more traditionally structured organisations naturally feel the need to place it in their mental model of a traditional hierarchy. For example, we are asked who the HR manager is. But we split all those operational tasks and we make a role, for instance, for issuing invoices. As we are continuously adapting our organisation to what is required, it may happen that a person changes role. I think that through these roles, everyone can develop exactly as he or she wants, and they can do what they are good at. If the administration aspect of the stand-in changes, this can be confusing for someone outside a holocratic organisation.
When I look from my current perspective, I realise how tiring a traditional way of working is. I can never go back. I would never again be able to work in a structure that does not clearly offer as much as Holacracy. Why would you want that?”
Koen also sees that the organisation is well developed. “Now that the members of the organisation have mastered the use of the new tools of self-organisation, I am curious to see how they will use them. Recently, a member of the Luscii team came to me with worries about how the organisation had been shaped historically and how that brought tension to today. As a coach, I offered her various options through which she could individually alleviate some of the tension in her role or even resolve it by making a proposal. It was wonderful to see the boost it gave her to realise that this problem could finally be resolved. To my great joy, I heard that she recently submitted her proposal and that it was accepted! Holacracy makes it very easy to solve problems quickly, safely and reliably. Even if the proposal has a big impact. If no reason can be found during the decision-making process that the proposal could cause damage, then it is adopted. Practice will then show whether it works effectively, and adjustments can always be made”.
You have to give yourself, as an organisation, the space to be able to change. Which is certainly important for a company like us. We have so much to discover. It is great that different people from different perspectives can explore how best to serve the market. Then you basically have much more brainpower to work on the organisation.