Innovative healthcare: fewer rules please

The government is in charge of issuing regulations in healthcare. “This promotes recalcitrant or docile care professionals, not innovative ones,” says Jo Caris. 

Image: © Nationale Beeldbank

Strict parents bring up two types of children: obedient goody two shoes or recalcitrant brats – conformists or runaways. We do not want either type. We do not want either type. We prefer critical, active, and alert people.

Peij (2005) distinguishes in the management of companies between focusing on rules and regulations and emphasizing values. You encounter an emphasis on rules and regulations in static organizations. Such organizations focus on efficient production and profit optimization in the here and now. They do not focus on innovation and development. The premise is discontinuity: If circumstances change, then the organization will terminate its activities and perhaps its existence. One such example is a snack bar in a new housing development. The quality does not need to be high, but the prices can be. They will sell anyway while the area is still developing: The residents do not have time to cook and go for a quick bite. Once the development is finished and inhabited, the snack bar will disappear.

Static organizations have the right to exist, but not in the healthcare sector. There, we want continuity of supply and striving for quality optimization. We want nimble and innovative organizations that develop and adapt to the needs of patients and clients. In such organizations the management needs to emphasize values rather than rules.

Our government (authorities) strongly focuses on rules and regulations. This sends a twofold message. Although the government wants healthcare companies to adapt and develop (the minister is surprised about the limited innovation in healthcare), it focuses on rules which suit static businesses. The government creates – without wanting to – obedient children.

The government also gives a chance to the "children who may sometimes be recalcitrant" by allowing "private discounters" in home care, at PGB (personal budget) mediators, and in childcare. These parties – like snack bars in new housing developments – are motivated to a large extent by profit. Insurers, care administration offices, and municipalities are easily tempted by the low rates made possible by poor working conditions, the highest possible production, and no emphasis on development. There are also signs in the cure sector that healthcare providers exploit cost containment without any consideration for long-term development.

Good compliant companies are the victim here, because they constantly try to satisfy both demands: limiting costs and ensuring high quality.

If this is so obvious, then why does it happen?

Such things are always complex and will not have a single cause. But the dynamics along the axis of the press, public, and politicians has certainly something to do with it.

Journalistic media love to jump on untoward incidents in the healthcare. In a sector with millions of workers and clients it is only natural that such incidents happen daily. If once every 100,000 procedures something goes wrong, then all the TV stations and newspapers letches onto such incidents, packing their reports with indignation. After all, “only bad news is real news” and “one-liners are mandatory.” That outrage then spills over to the public. Politicians, who always try to win the favor of the voter, translate that outrage into one-liner solutions: a new regulation.

We do not have to quote the many examples here. There is now a dichotomy among healthcare providers: the grabbers who take advantage of the loopholes in the rules and the good guys who desperately try to keep their head above water.  These are the children of a rules-governed education.  We do not want them either. We want strong, critical, constructive, and innovative businesses.

The authorities must focus on that!

The second aspect concerns society with a large degree of liberalization where authorities have become less effective.  Everything that is not explicitly forbidden is allowed. And anything that is not clearly mandatory is not necessary.

Even little children ask "why" when they are not allowed something or when they have to do something. It is clear that we need rules in order to approve or reject something.  Apparently, people can no longer be held to values (integrity, honesty, respect, cooperative and social behavior) without precise written instructions on what is allowed and what is not. This has led to extensive juridification – a stack of rules with exceptions and exceptions to exceptions. Such a system of rules and regulations can sometimes work, but sometimes it is unnecessary or, just as often, unjust and is counterproductive.

Have we now trapped ourselves?