Authors of this article: Janneke Ruiter, Sanne van Hoofwerff, Myrna Stevens, Eric Rozemeijer
Janneke, former nurse, unit manager, projectlead, now working as innovation coach within the NWZ portfolio organization. 7 years’ experience in the agile way of working.
Sanne, former head of communication. In 2020 program manager of “Digital Hospitality Hospital” (‘Digitaal Gastvrij Ziekenhuis’) and now program manager of Stroomversnelling.
Myrna, former oncology nurse, product owner. Since 2020 innovation coach of the program “Digital Hospitality Hospital (‘Digitaal Gastvrij Ziekenhuis’) and innovation coach within the NWZ portfolio organization. 5 years’ experience in the agile way of working.
Eric, senior manager at Eraneos. Obeya Sensei. Over 20 years of expertise in Lean, Agile and Obeya. He pioneered the implementation of Obeya at the management level in the Netherlands in 2016 and is instrumental in shaping Eraneos’ Obeya practice.
Transformation in Healthcare:
A practical case of how Noordwest Ziekenhuisgroep is transitioning into a future-proof organization with Obeya
The Dutch healthcare sector is facing a huge challenge. There is a growing demand for healthcare and at the same time healthcare professionals are becoming scarcer.
This requires making strategic choices and reorganizing the way that healthcare is given.
In order to keep healthcare up to standards, accessible, and affordable for the future, agreements have been made between the Dutch Government and a large number of parties in the healthcare sector in 2022: The Integral Care Agreement (IZA[1]).
Noordwest Ziekenhuisgroep is one of the first Hospitals that has started in 2023 their own IZA Transformation program: Stroomversnelling (“rapid advancement”).
The execution of this hospital-wide transformation program is managed in a very effective, transparent, and innovative way: Obeya.
In this article we will give you a sneak preview of the key success factors for managing a complex transformation program using Obeya.
Furthermore, we will explain how we achieved a culture of safety, openness, and learning within the program using Obeya.
During the Obeya Summit Sanne, Janneke and Myrna from the Noordwest Ziekenhuisgroep and Eric from Eraneos will further elaborate on the succesfactors to manage a complex transformation program with Obeya.
On top of that we will also perform a real-life role-playing demonstration to show you how performance dialogues are conducted within the Obeya of Noordwest Ziekenhuisgroep.
[1] The Integral Healthcare Agreement (IZA) is an agreement between the Dutch government and various parties in the healthcare sector, such as health insurers, healthcare providers, patient organisations, and the government. It was concluded in September 2022 with the aim of future-proofing healthcare in the Netherlands while keeping the quality of healthcare high. The agreement focuses on various problems in the healthcare sector, such as rising healthcare costs, staff shortages and the increasing demand for care due to an ageing population and chronic conditions.
About Noordwest Ziekenhuisgroep
Noordwest Ziekenhuisgroep is a hospital organization with locations in Alkmaar, Den Helder, Heerhugowaard, Limmen, Schagen and Texel.
With 770 beds, more than 4,500 employees, 550 volunteers and approximately 340 medical specialists, Noordwest Ziekenhuisgroep is one of the largest hospital organizations in the Netherland.
Noordwest Ziekenhuisgroep is a top clinical hospital. For several treatments, we are among the top in the Netherlands for both quality and quantity. In the larger region of Noord-Holland Noord, Noordwest Ziekenhuisgroep is at the forefront when it comes to introducing new research methods, techniques and treatment methods. The scale of the hospital also makes it possible to do a lot of scientific research.
We believe that everyone should be able to count on care. Caring for each other in North Holland North. That is Northwest’s mission. Now and tomorrow.
Don’t Miss Out on the Story of Janneke, Sanne, Myrna and Eric at the Obeya Summit!
Key success factors
Clear objectives and ownership
The whole transformation program has a duration of 4 years and is organized around 4 strategic goals with clear objectives, KPI’s and a structure of 20 themes.
Each of the 20 themes has a product owner, a business owner and a medical lead who are jointly responsible for achieving the objectives of their theme. They are also responsible for ensuring that the achievements are sustainably embedded in the daily way of working.
A product owner, a business owner and a medical lead have a multidisciplinary team at their disposal for half a day every week.
All these teams work together in person on the same day to guarantee mutual knowledge sharing in the best way.
This way, we use the scarce resources that we have at our disposal in healthcare for the realization of these kinds of large programs in the most effective way.
Clear objectives and ownership
The whole transformation program has a duration of 4 years and is organized around 4 strategic goals with clear objectives, KPI’s and a structure of 20 themes.
Each of the 20 themes has a product owner, a business owner and a medical lead who are jointly responsible for achieving the objectives of their theme. They are also responsible for ensuring that the achievements are sustainably embedded in the daily way of working.
A product owner, a business owner and a medical lead have a multidisciplinary team at their disposal for half a day every week.
All these teams work together in person on the same day to guarantee mutual knowledge sharing in the best way.
This way, we use the scarce resources that we have at our disposal in healthcare for the realization of these kinds of large programs in the most effective way.
Effective rituals and routines
The Obeya way of working is an extension of the Lean and Agile way of working, that has been used within Noordwest Ziekenhuisgroep throughout the recent years.
The Agile program structure used within Noordwest Ziekenhuisgroep was translated into the desired meetings and rituals. Every Tuesday morning a program management meeting takes place and every Tuesday afternoon the team meetings take place in the Obeya.
Work in progress is planned according to a quarterly cadence with all stakeholders to respond to interdependencies and changing priorities.
Progress is managed on a weekly basis. Problems are solved on a daily basis.
All the rituals and events take place in the Obeya. The place to learn, share, manage and act together!
Multidisciplinary teams in the lead.
When you change the way healthcare is provided, it is crucial that the quality of healthcare is guaranteed.
When we formulated the objectives of the program, we considered which program organization, and which teams were needed to achieve these objectives.
The key here lies in putting multidisciplinary teams in the lead, so that the right expertise is brought to the table when designing new work processes, care path or new innovative solutions.
This also ensures that a group of early adopters is created who can take a pioneering role.
Experiment, test and scale
Furthermore, we created a program approach with the focus on small incremental steps.
We conduct pilots to test new work processes and/or healthcare paths and fine-tuned them on a small scale to scale up to the maximum with confidence.
This approach is combined with internal and external assessments, so that we can ensure that upscaling will succeed.
Regional cooperation
The hospital is not the only place where care is provided. The hospital is part of a regional network of care providers who all take on a part of the healthcare. Think of general practitioners, nursing homes, care homes, home care, but also primary care paramedics.
They, too, face the same challenges. In our approach, we ensure that we involve these parties at an early stage. So that, together we can create future-proof solutions and deliver healthcare to patients and clients with the capacity, activities and processes across parties in the region.
Finally, we also see that good initiatives have been developed in other regions that can be copied. After all, it would be a shame if we reinvented the wheel. Here, too, there is a mechanism in-place that safeguards this.
How we created a culture of safety, openness and maximum learning with obeya
(Psychological) safety
(Psychological) safety is crucial for ensuring that team members feel comfortable expressing their ideas, concerns, and mistakes without fear for punishment or ridicule.
We embedded this into our Obeya way of working via:
- Encouraging open dialogue: an open dialogue where everybody can speak up openly is not very natural. In the Obeya we have facilitated regular discussions where everyone’s input is valued. We have actively invited team members to share feedback or dissenting views in order to encourage an open dialogue.
- Normalize vulnerability: Needless to say, making mistakes is not something very common in hospitals. Making mistakes can cost human lives. During the Obeya sessions we have encouraged vulnerability (such as admitting mistakes and asking for help). It sets a tone that it’s okay for others to do the same. We have created a mindset where failures or mistakes are viewed as opportunities to learn, not occasions for blame.
- Openness to problems: Hospitals in general have a strong hierarchical culture. We have acknowledged team members when they bring up problems early, showing them that these behaviors are valued.
Openness and Transparency
The Obeya room was designed to give everyone a clear, visual representation of the goals, progress, and challenges of the program. This transparency has helped to align the teams to focus on the shared objectives and to collaborate.
- Visuals: Openly sharing progress and/or blocking issues was not very common before the program started. With Obeya we have openly shared progress, KPIs, blocking issues and milestones. This made it easy for everyone to see how the Program was evolving.
- Weekly stand-ups: On team-level we were used to weekly stand-ups but not on Program level. With Obeya we have conducted weekly stand-up meetings in the Obeya on program level to review work, discuss challenges, and coordinate efforts. We have ensured that every voice is heard.
- Ownership of goals and metrics/KPIs: In the past everybody wanted to be involved but nobody took ownership. Appointing ownership has always been difficult and complex. In the Obeya every goal, KPI, work item has an owner. And in the Obeya everyone had visibility into the Program goals, who is responsible for the goals and what dependencies exist including status. Working with Obeya created ownership and accountability at all levels of the organization.
Maximum Learning
By creating a culture of maximum learning, the Obeya has become a learning hub where teams reflect on successes, failures and continuously seek improvement.
- Continuous improvement: we have established regular reviews to identify what worked, what didn’t, and what can be improved.
- Lessons Learned: we have highlighted not only successful outcomes but also lessons learned from challenges or failures.
- Problem-solving mindset: we have encouraged the team to deep dive into root causes during Obeya meetings to address issues collaboratively.
Leadership and stakeholders Involvement
Leadership played a crucial role in driving the desired culture through their behavior and engagement within the Program and the Obeya.
- Leadership engagement: Leaders were present in Obeya sessions and quarterly meetings to support teams, remove roadblocks and offer guidance. Board members, Business Owners and Medical Leads participated in strategic discussions ensuring alignment across the organization.
- Stakeholders’ involvement: Key stakeholders (e.g. Work Counsil, Regional Parties, Insurers) attended Quarterly meetings so that diverse inputs were considered.
Leadership involvement is now part of the way of working/cadence within the program. Before that, leadership was sporadically present at meetings.
What’s next? How do you really get the movement going: the stroomversnelling (“rapid advancement”)
The agile and Obeya approach has been embraced to give direction. This way of working provides the desired agility and transparancy that is needed. The end goal is clear but the road to it has not yet been fully mapped out.
The people involved set out together to follow this road step by step with the ultimate goal of gaining momentum and getting to the rapid advancement (“the stroomversnelling”), where people dare to get on board and embark on the journey together. All with the aim of keeping healthcare accessible.
Hope to see you on November 15th!
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