The Change and Improvement Program 'Enabling New Initiatives': Little Grip, and a Lot Of Trust

The goal of the program Enabling New Initiatives was to break for the Dutch Erasmus Medical Center the trend of increasing costs and decreasing funds for new initiatives. And when we started there was no one around to tell us how to perform that trick.

The Challenge
Heading a change and business improvement track at the Erasmus University Medical Center (EMC) without an upfront complete and smart program of concrete plans. That was the big challenge of program manager Erik Booden 2 years ago. How do you keep your impatient principals satisfied? How do you create a basis among all the diverse personnel in such an enormous organization of more than 8,000 employees? With little grip, a lot of trust, and clear rules of the game Erik and his team realized enormous changes and even more important, improvements in Rotterdam.

Grip? What Grip?
Often we were asked: How do you keep grip on all improvement initiatives? That question surprises us. We do not think in control terms. We got a lot of trust and room for maneuvering from the Board of Directors (College van Bestuur). They knew from the start that it was very unsure whether this track could meet its ambitious goal. Even better, in order to finance the first activities, they used a substantial amount from the reserves. The objective of the Enabling New Initiatives program was to free 10% of the resources occupied by on existing activities. The new developments were the kernel of the strategic vision.

Resistance To Change
At the beginning, this approach introduced a lot of resistance. Only when we incorporated the really strategic goals and values of EMC, like patient satisfaction, employee satisfaction, and customer satisfaction more solidly in the program, things got better. Effectiveness of process operations then became more a complete and multidisciplinary view. The program became much more powerful, and the basis became much stronger. Also, the employees saw for themselves the relations between Isst and Soll, and they were much more motivated to join enthusiastically.

The Rules Of the Game
Who has a vision of an upfront completely thought-through program with specific benefits, many concrete and detailed plans, is wrong. What was actually needed from the beginning? In the first place: The rules of the game. The 10% cost reduction was for 60% to be kept by operational and staff departments. They were to be used for new own activities in order to realize strategic goals. 40% was to be spend on central improvements like ICT. There was also a sense of urgency: The operational professionals like medical doctors, nurses, and support staff knew that EMC had a bad reputation on some of the strategic perspectives. Besides that, the health care market was developing fast, and they had to do something about closing the gap as well. And last but not least, EMC had many difficultly to fulfill vacancies, because of the overall scarcity of personnel in the Netherlands.

Improvements? What Improvements?
The second step was together with the employees consider effective improvements like: Patient satisfaction, employee satisfaction, shorter queues, better process interaction, other distribution of tasks, and better information delivery. With the help and support of the Enabling New Initiatives program office we provided each department with tools to check their own organization on the reference perspectives. That delivered a lot of insight and involvement. We then asked the employees to think through measures and report them in a formal way.

Financing the Program
How do you keep an impatient principal satisfied? The Board of Directors usually wants results the next day. And that was a tight line to walk on. In the first year, the budget came from the reserves, what was a risk for the program. In the second year all departments had to offer 1% of their total budget in order to finance the program. The consequence was of course the everybody started to ask for results. We learned to stand that pressure. How much pressure a management team or the Board of Directors ever applies, that will never be sufficient to build a city like Rome in only one day.

The First Results
After being busy for more than 2 years, how far are we? A lot of goals are reached, and a lot of things improved. Today, a medical staff thinks it is normal to get a patient satisfaction mark of an 8 or more, on a scale of 1 to 10, with 10 being the maximum. Also, on criteria like prestige and efficiency we cached up, and do a lot better than many other Dutch health care institutions. The estimated cost reduction is about MEUR 30 on a yearly basis, which comes pretty close to the original 10% goal. According to independent specialized consultants, the program already offers large benefits, while the large gains are expected in the 2008/2009 time frame.

Who Induced the Results?
As this Enabling New Initiatives program was the only important organization wide intervention in this period, all benefits must be caused by this program. And possibly the main reason? All employees, from attendant to surgeon, look together in the same mirror, intensely, and at the same moment. We think that this collective movement has a major impact on the course of this immense medical ship!

About the Authors
This guest blog is written by Olga Warffemius and Erik Booden on a personal title. Both are program managers of the large, institution wide program Enabling New Initiatives (Ruimte voor Nieuw) at Erasmus University Medical Center (EMC), Rotterdam (Netherlands)

Contact Olga Warffemius at

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