Valuable Care, a vision on a new, values based care system

Why was this example implemented?

With a membership of over 2200, LOC is the largest association of care clients’ councils (mandatory for all care providers) in the Netherlands. It has developed a vision of care that links all levels of society, the care system and care organisations.

LOC’s observation is that many well known drawbacks of the care system are rooted in society. Care is structured according to society’s conventions. LOC argues that the dominant vision on care is that the nature of care is ‘repair’: mending and soothing problems that originate because of bad health status.

It is LOC’s opinion that within the current care system real innovation is not possible. The care system itself is failing and does not respond to the desires and demands made on it by citizens and users.  Innovation is not a matter of fixing problems within a failing system, a completely new care system will have to be conceived, one that links society, the care system and care organisations within it. Only then does a sustainable care system become possible, one that promotes the health of citizens and serves those in need. Funding would be based on these outcomes.

LOC offers its vision to all stakeholders in the national care sector, as an attempt to start a national debate on a thorough renewal of the national care system in the Netherlands.

Description

LOC believes that a new society will almost automatically shape a better – and more sustainable - care system.  A new society will be based on well-being and quality of life as primary values; it allows a choice for living conditions that we desire for ourselves; it enables citizens to contribute; it promotes health rather than cures illnesses; it allows treatment and care with maximum means; it regulates funding of care based on the principles mentioned above; individual citizens will invest in their health; for citizens who are not able to do so, collective means and funding will be available from public long-term care insurance.

The current care system is based on quantitative thinking; the client is part of the system and must adjust to it to enable the system to achieve optimal production and output. The current system works to provide the minimum level of care required with as few resources as possible. A new system should be based on qualitative thinking and its aim is to serve the client’s physical, psychological and social needs. Output should be directed towards quality of life as experienced by the client and in accordance with the well-known definitions of health and ageing of WHO.  A new care system will have two important features: prevention (rather than ‘repair’) will be of primary importance, and for individual citizens to take responsibility for their own health.

Within a new care system, care organisations would have to synchronise the four forces that now often operate against each other. These forces are 1) the contributions of individual employees, 2) co-operation within the organisation, 3) internal operational processes and 4) social responsibility and fundability.

Making this a reality requires more than just managers who keep systems and organisations going. Above all, leaders are needed who, together with the people who constitute the organisation and its human capital, are supported in the endeavour by operational processes directed towards healthy, high-quality output, and continuously seek ‘optimal effectiveness’ on all fronts of the organisation. 

What are/were the effects?

It cannot be said yet that LOC’s vision has been adopted widely and is beginning to have its effect on care or on society. However, the vision is welcomed and appreciated by many people in care and society in general including informal carers, formal care providers and managers. LOC is often invited to explain its vision to policymakers both in care and outside. Among these, are important policy makers of ministries and of large care provider organisations, but also small scale care initiatives and associations of people in care. In practice, the working principles of Buurtzorg (see Example ‘Neighbourhood care’) are in direct accordance with the LOC vision. 

What are the strengths and limitations?

Strengths

• The LOC vision links problems in care and in society in a broad fashion, and suggests solutions as well.
• LOC is a very reputable organisation and a regular discussion partner for the Ministry of Health Care. 
• The vision gains some strength in that it connects to INTERLINKS principles that hold for integrated long-term care.

Weaknesses

• A vision such as this one is by nature broad and an undefined tool; it cannot be directly implemented or enforced. Before having impact, a vision needs to be widely disseminated and internalised, and this has not yet happened for the LOC vision sufficiently well. Added to this, LOC has neither power nor authority to translate the vision into a strategy, let alone into projects for implementation.

Opportunities

• Health care authorities in the Netherlands have been urging for a new system and practice. This is what the LOC vision is offering. That it can work is - in part - demonstrated by new ways of care practised in the Netherlands, notably by the much appreciated Buurtzorg home care.

Threats

• The greatest danger for a new vision is that it will be neglected by decision makers. Politicians and decision makers may not be able to change their traditional views on care and let other interests (e.g. those of economy) prevail.

Credits

External Links and References

• LOC (2009) The Netherlands and the Care Sector in 2010 – 2050. Introduction to a Theoretical Framework for a Long-Term Vision. Utrecht: LOC [paper].
• LOC (2009) Valuable care - The future of healthcare 2010-2050. Utrecht: LOC [brochure].