Pilot phase: fi nal project plans and fi rst learning session (June-July 2007)

Final project plans

The selection advice regarding the fi rst round of transition experiments in health care did not directly lead to a political decision about the selection. After several weeks of uncertainty, the Ministry demanded that the ten selected care institutes would be requested to “submit a fi nal project plan to strengthen their project proposals and lay the foundations of a business case”. The Programme Team emphasised to the care institutes that the original project proposals would remain a starting point, but these fi nal project plans were primarily aimed at “speeding up the process of contracting and fi nancing and to stimulate a positive outcome of this process”. The format of the fi nal project plan was provided by Ernst&Young and mainly included general project management aspects (e.g. project goals, results, regulatory and fi nancial conditions, activities and planning and budget), added with several aspects related to Transition Management (e.g. learning goals, transition goals, transition eff ects in terms of diff erent culture, structure and practices). Contrary to the Transition Management approach, the

1. Assertive Community Treatment (ACT) for young people in Rotterdam:

Multi-disciplinary and outreaching ACT-teams support youngsters with psychiatric problems

2. Transmural network STEM: Starting up a societal dialogue about dying

3. WEIS in the neighbourhood: Improving the quality of life in districts

4. District care (“Buurtzorg”): Innovative autonomous teams of district nurses

5. Permanently better: Providing care to long-term psychiatric patients in their

own environment (with FACT method)

6. Case manager dementia: Case managers who support people with dementia to live

at home as long as possible

7. At home with dementia: One point of support for treatment and counselling in all

phases and aspects of dementia

8. Smart Caring Community (Omkeer 2.0): Developing an ideal social support system in a city district

and rural area

9. Video networks – a plan for scaling-up: Further developing and scaling up “telecare”

10. Meeting place Prinsenhof: A self-organised district meeting place for senior citizens

and disabled people

care institutes were requested to describe their project proposal as SMART (Specifi c, Measurable, Acceptable, Realistic and Time-restricted) as possible. This was the fi rst time that the Programme Team applied this existing ‘project management’ model to the management of the transition experiments. However, within Transition Management (which is about experimenting, searching and learning about unknown pathways) it is not desirable to formulate a project plan in a SMART way, because the outcome of a transition experiment cannot be predicted a priori. Hence, the requested fi nal project plans were in confl ict with the central TM approach of the Transition Programme. This is illustrated by the fact that several care institutes complained about the request to formulate their project plan as SMART as possible, because they were convinced that this was not possible and would limit their creativity.23

First learning session

A week after the completion of the fi nal project plans, the Programme Team organised the fi rst learning session of the Transition Programme in Long-term Care. This session was attended by all selected care institutes, several representatives from the Ministry of Health, Welfare and Sports and the care sector organisations, and the NZa (the Dutch Healthcare Authority). The learning goals were:

1. To provide a shared thinking and working framework for the Transition Programme: the policy and intentions of the Ministry and a fi rst exploration of the system barri- ers in health care;

2. To exhibit the unique main aspects of the diff erent transition experiments (to inspire and to synchronise and exchange);

3. Letting policy and practice meet each other, by inspiring contacts between actors involved in the programme.

Following up the ‘failed’ instruction meeting, an important underlying process goal of this fi rst learning session was to inspire and put positive pressure on the Ministry to support the transition experiments fi nancially. Therefore, the Programme Team had spe- cifi cally requested the care institutes to present their transition experiment with “heart and soul” and to put the essence “on the stage”.

The 10 presentations were very authentic and exceptionally creative, personal and convincing. For example the “hearth and soul” presentation about STEM (the Dutch ab- breviation for “Dying Your Own Way”) involved a live interview with Corrie, a woman with cancer who made a strong personal plea for a more dignifi ed and humanised type of care system, with attention for the personal wishes of clients.

23. Eventually, all care institutes completed their project plans (with support of the Programme Team). The requested SMART formulation did not strongly infl uence the content of the transition experiments, because the original project proposals remained a starting point.

168 Chapter 6

Several shared ideas emerged from these “heart and soul” presentations, such as giv- ing back power to the client and the care professional and making use of the power of relationships and neighbourhoods to take care of each other in social networks. Together these presentations had a profound personal impact and underlined that the end user truly is in the heart of the programme.

The presentations about the transition experiments were preceded by a speech about the policy and intentions of the Ministry of Health, Welfare and Sports. The quotes of its director of care (Arnold Moerkamp – represented by another civil servant) were exem- plary for the complex political fi nancing and contracting procedure for the transition experiments in health care:

– On the one hand the Ministry stated that still no decision on the fi nancing of the ex- periments had been made and on the other hand it stated that the Ministry wanted to start as quickly as possible.

– As a reason for the complicated fi nancing procedure, the Ministry stated that they wanted to get rid of “pilotitis”, referring to their observation that many subsidised experiments never transcend the status of experiment and never get structurally embedded (after completion of the experiment).

– Contrary to only providing subsidy grants, the Ministry wanted to involve the cur- rent fi nancing system (e.g. care insurers and care offi ces) in the experiments, right from the start. The Ministry stated that this approach would have an advantage, as it would enable learning about how the system works or does not work.

The Ministry valued the commitment of the 10 selected care institutes, illustrated by the quotation: “In fact you off er us your contribution to the transition”. But the Ministry did not make any long-term promise to support the 10 transition experiments. To re- duce the perceived risks of the care institutes in case no grant contribution would be provided, the Ministry did make a short-term fi nancial promise to compensate for the extra activities that were conducted in the context of the Transition Programme (this was strongly recommended by the Programme Team, to build up trust amongst the participating care institutes).