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.
This press release was published by Isala Hospital on 15 February 2019
The role of Luscii in Isala Hospital:
Luscii provides hardware, software and patient support for the monitoring of the COPD patients in Isala Hospital. The Luscii platform is used by the care teams in the hospital to monitor their patients and get notifications in case of increased health risks. Patients who are enrolled will download the Luscii vitals and Luscii contact apps on their iPhone or iPad to sent in their measurements and have (video)-communication with the nurses or pulmonologists. Also, after enrollment, Luscii is responsible for all logistics (sending the measurement devices), service and (installation) support for patients within the Isala Telemonitoring service.
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.
Imagine no longer having to go to the hospital, but simply having a conversation at home with your lung nurse about how you feel. From February 2019, this will become a reality for 25 Treant patients with the chronic disorder COPD (lung disease). During this month, the healthcare group will begin a trial in which patients receive a tablet, on loan, through which they can transfer their medical information to the hospital. If this information requires further discussion, the lung nurse will contact the patient via ‘video calling’.
Treant, in collaboration with the healthcare innovation company Luscii, is starting this pilot to gain experience in monitoring COPD patients from a distance. Lung specialist, Steven Rutgers, is pleased with the new scheme: “For patients who already have less energy because of their illness, it is of course fantastic that they will no longer have to come to the clinic every time. This pilot also strengthens our vision to concentrate care as close to the patient as possible. It is great that we can experiment with this possibility.”
How does it work?
Every week, patients use the tablet to fill in their information, such as blood pressure, weight and physical activity. They also report how they are feeling. They then send this information to the hospital. A specialist nurse will take a look at the data and, if necessary, will contact the patient. Through the use of ‘video calling’, healthcare professionals can see how the patient is doing and, in consultation with the pulmonologist, can adjust the medication if necessary.
COPD is a lung disease in which the lungs are damaged. The lungs cannot absorb sufficient oxygen, leaving the patient with shortness of breath and less energy. COPD is characterised by lung attacks that often lead to hospitalisation. Rutgers: “As we receive information about the condition of the patient more often during this pilot, we hope to prevent such lung attacks and subsequent hospital admissions”.
The pilot was made possible by healthcare insurer Zilveren Kruis and will last for six months. The pilot reinforces the agreement that Treant holds with the healthcare insurer to develop initiatives that bring care closer to the patient. A good example of the right care in the right place. In collaboration with the healthcare innovation company Luscii, scientific research will also be conducted into the results of remote monitoring. To start with, remote monitoring will be available to just 25 COPD patients treated at Scheper in Emmen. If the pilot proves successful, in the future, more patients will be able to pass on information to the hospital via video calling.
This press release was published by Treant ziekenhuis on 4 December 2018 (https://bit.ly/2RhyywZ)
When keeping an eye on your health, you do not always have to go to the hospital. The home measurement of, for example, heart rate, blood pressure and weight, is on the rise. And that is a positive development; as it gives people more control over their health. The Jeroen Bosch Hospital is therefore starting a trial of home measuring for people with heart failure and patients with the chronic lung disease COPD. The trial will run for six months and is a collaboration between the Jeroen Bosch Hospital and Luscii, the hospital branch of FocusCura.
A total of fifty people will take part. One participant is Mrs. Liefmans*, who lives with COPD. Twice a week, she will measure her heart rate and saturation (amount of oxygen in the body) from the comfort of her easy chair. In addition, she will complete a digital questionnaire; has she had any difficulty breathing in the past few days? How much has she moved? All the information that helps indicate the status of her health.
All data is sent digitally to her lung nurse, Joke Spierings, in the Jeroen Bosch Hospital. Has something deteriorated? Then she can contact Mrs. Liefmans immediately via video calling on a tablet. “By monitoring more often, we can spot a potential lung attack earlier. This way we can take action together and prevent any hospitalisation”, says Spierings.
“Thanks to home measurement, I know exactly how I am doing”
Previously, Mrs. Liefmans did not have such a precise insight into her health. She went to her GP and visited the pulmonary doctor for a check-up once a year. She only saw her lung nurse in the hospital after a lung attack.
“If I did not feel well, I often thought: it’s not too bad, I’ll see how it goes and then visit the doctor”, says Mrs. Liefmans. “But, by that time it was too late, and before you know it, you’re in hospital”. She was still there three months ago. Thanks to home measuring, she expects that this will no longer happen so quickly. “I want to be able to take steps earlier, so that my health does not deteriorate further. Thanks to home measurement, I know exactly how I am doing. That gives me peace of mind. And because I can always consult with my nurse if things get worse, I feel that I really have control”.
Spierings is also enthusiastic: “This program supports self-management of people. Thanks to the information provided by home measurements, and advice from our side, patients are able to make the right choices. Taking control of your health despite being ill; that is our goal.”.
* Mrs. Liefmans is a fictitious name.
This press release was published by Jeroen Bosch Hospital in Dutch on 29 November 2018 (https://bit.ly/2RhyywZ)
Even our deputy prime minister, Hugo de Jonge, is calling for more speed when it comes to e-health, for example, with home measuring. But where do you start? In this article, we provide an action plan to help you make the right choices with the current healthcare purchases for 2019.
This action plan is based on a combination of practice and science. I learned by trial and error during projects with both FocusCura and Luscii. I studied ICT implementations during my PhD at the University of Twente. This is how I discovered that successful implementations almost always follow a fixed pattern.
My most important lesson: a successful implementation is determined by the execution. The transformation of a dream into the reality of new daily care. Thomas Edison already said it best: “Vision without execution is hallucination”. So, let’s get started!
Preparation: define your dream and be specific
Start by making your dream concrete. Do you wish to give your clients more independence by staying at home with technology as an alternative to the care home? Do you, as a hospital, want to prevent unnecessary admittance for chronic patients?
You don’t have to come up with everything yourself, there are many good examples inside and outside the sector that can inspire you. Make your dream tangible for your organisation or department. Who are you doing it for and at what point will you consider it a success?
There is a big pitfall that I have often fallen into on this point. If you share your dream with care recipients and caregivers, you will notice that organisational limitations or financial restrictions will become the guiding principle. So, turn this around. Discuss your dream and find out whether they share it, but also show leadership to align the preconditions with your preferences.
Step 1: choose your partners and gain experienceNow it is time to involve others. Like the insurer. And partners that can offer competencies that you do not have. And no, in the year 2018 this is not the domain of the purchasing or IT department. It is a strategic choice. Does your partner already have agreements with insurers that you can take advantage of? Which partners can bring practical experience so you don’t have to reinvent the wheel? Choose a partner that suits your culture, as you are about to embark on a journey with one another.
Together, you begin with a proof of concept. As a first step to learn how your vision works in practice. At Luscii, we call this the experience phase. We approach the care process differently with around 25 care recipients by using our technology. That number is small enough to not have to disturb things too much. Yet it is still large enough for users to experience whether this will give them what they need. The dream comes to life and the caregivers involved become frontrunners, or idea champions, as I labelled them in my thesis.
After around four months, you can evaluate whether your idea works and create a follow-up plan to mix up the care path, which will involve financial agreements and technical integrations. If it appears in the evaluation that it does not work, then make alterations or stop. The latter sounds hard but I see many projects that remain dormant and that makes no sense. Show leadership in these cases and keep going, or stop and start again. If you continue, this also means that you choose not to keep the innovation free of obligation.
Step 2: continue and eliminate thresholds
Now that you are continuing, progress to around 150 users. This intermediate step is conscious. At this scale, it is impossible to do everything ‘on the side’, so your care path now changes completely. But with this intermediate step, you can keep the change manageable.
In this phase, you will invest more, for example, in a project leader or time for caregivers to work on new protocols, ICT integrations and/or training. Don’t be afraid to stick your neck out here, but also continue to measure whether you are achieving your goals.
At Luscii, we do this by measuring three-monthly parameters, such as satisfaction of patients and caregivers, reduction of clinic visits and admissions, and the amount of time Luscii saves for nurses. With the help of a ‘data dashboard’, you can monitor continuously and compare outcomes with data from other healthcare organisations. So that you can learn from one another.
Step 3: new service is a reality
Now you are ready to change the direction completely. If all has gone according to plan, you have now reached a critical number of care recipients and caregivers involved in shaping the new working method.
By making small interim steps, you have shifted from ‘innovator’ to ‘early majority’ in the innovation model. The ‘project’ is over and your new service has become a reality. Your idea champions, the caregivers of the first hour, are probably already eager for the next stage. In current times, innovation never stops. You will start step 1 again after step 3 is complete: constant innovation is the future for continually meeting the wishes of clients, employees and everyday reality.
The future is now
If you want more tools to make e-health a success, take a look at the Playbook that we made with Menzis or download my thesis. Do you have suggestions for improving the approach yourself? If so, I am very curious to hear your thoughts.
This blog was published earlier in Dutch on Qruxx tech: https://tech.qruxx.com/drie-stappen-voor-succesvolle-introductie-van-e-health/?_ga=2.15733042.529853116.1543238273-1213197350.1530525548