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.
This press release was published by Reinier de Graaf Hospital on 12 March 2019
We thought it was time for a present. We invited a few healthcare providers who are using Luscii for an interactive workshop in which we learned how to share our story in the best way. It would be wonderful if people who are using Luscii in their working environment share their stories and inspire others to use our health platform.
When everyone arrived, we had the time to get to know each other and had some lunch. The group was very divers. Nurses, doctors, department heads and we from Luscii. After we ate lunch together, we started with the workshop on the second floor of the building. In the area there was a podium with a few lights focused on it. Some participants are regularly on stage, but it is always exciting to speak for an audience. We learned to share stories through story telling.
It was an inspiring and fun afternoon and we learned a lot from each other
It was an interactive workshop in which we learned how to apply the most important laws of communication to our own story. We’ve heard some impactful but also funny stories this day. For example, there was a nurse who told us she had a patient that needed to be monitored once a week. Because of her condition this hospital visit makes her very tired and took her three days to recover. This condition was taking over her life. When she started using Luscii this all changed, because she is monitored at home and we can contact her when needed. At the moment she is less tired, and she can spend more time with her grandchildren. It is very nice to hear this kind of stories, because this is why Luscii exists.
We ended the workshop with a drink at the restaurant downstairs. We would like to hear more, so please share your story about Luscii.
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 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.
We are very happy to announce that this week a new Research Assistant started at Luscii! Fenna Jonker, who’s currently finishing her Bachelor’s degree in Health Policy and Management at the Erasmus University, will assist Luscii’s team with conducting different research projects.
A number of hospitals in the Netherlands have started with the Experience phase of Luscii telemonitoring. To gain insight in the feasibility of telemonitoring of patients with Heart Failure or COPD, different research projects with care professionals are being conducted. This will make it possible to learn and see whether adaptations are necessary to the current care pathway of the hospitals to prepare and scale remote patient monitoring. Fenna will help us with gathering, structuring and analyzing these data.
Fenna considers continuing a master’s degree in Healthcare management. In the meantime, she hopes to learn here more how eHealth solutions can be implemented successfully for different hospitals. “I am also very curious to learn more from a business perspective, since I don’t have any experience as a student yet”.
Good luck Fenna!
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.
Joining forces supports hospitals in moving care towards the home
Luscii, the e-health application for remote monitoring once developed as part of FocusCura, continues as an independent company. Healthcare entrepreneur and FocusCura founder Daan Dohmen, has acquired the majority of the shares and formed a strategic partnership with Omron Healthcare, known among other things, as the largest manufacturer of blood pressure monitors in the world. Part of this cooperation includes an investment, with which Luscii can accelerate its development further in the coming years. Omron will also support launches in more European countries, as the two companies announced today.
In European countries, efforts have been made for some time to make e-health available for chronic patients in order to prevent hospital visits and admissions. Despite that, a breakthrough is yet to be achieved. However, Luscii is one of the first digital healthcare concepts capable of bridging the important barriers in implementation. For example, Luscii successfully managed to integrate with large electronic patient records and secured reimbursement from insurers for their concept. Scientific research showed that using Luscii for specific target groups, such as patients with COPD, heart failure and resistant hypertension, can reduce hospital costs significantly and make patients feel safer.
FocusCura will continu its activities in home care under CEO Raoul Zaal. Dohmen handed over the CEO’s baton to the former Booking.com and Essent director a year ago. Under Zaal’s management, the number of users of FocusCura innovations continued to grow and 2018 ended with a strong operating result. Dohmen remains involved as a consultant and shareholder of FocusCura. Just like Medux, known for it’s brands Medipoint and Harting-bank.
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)