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Innovations in Health & Care Education in the Netherlands

Innovations in Health & Care Education in the Netherlands

9 March 2017, by Arwin Nimis

In 1948 the World Health Organisation (WHO) defined ‘health’ as ‘a state of complete physical, mental, and social well-being and not merely the absence of disease, or infirmity’. This definition has been in use for a long time now, but a new one is emerging. It has been suggested by Huber under the label ‘positive health’ and currently is under discussion in many countries. It defines ‘health’ as ‘the ability to adapt and self-manage in the face of social, physical and emotional challenges’. Disease does not feature and ‘health’ is seen squarely as the ability to make something out of life, irrespective of physical constraints. It is about the quality of life.

This new definition comes at a time when societies are confronted with an ageing population with more diseases, who are now being asked to deal with that. We recognise that an ageing population is faced with so-called ‘multi-morbidity’, the occurrence of more chronicle illnesses at the same time. The central question then becomes how as a society we can deal with this effectively and efficiently, with a focus on the citizen. From this question flows the need for innovations in care and health and the translation of this in our education.

The 1948 WHO definition results in medicalisation; innovations are focussed on total wellbeing, on curing an illness, which often results in additional costs. Huber’s new definition sees innovation in a broader perspective: how can one deal with an illness in a broader sense, rather than ‘just’ focus on a cure? This makes inter-professional collaboration across health and care essential. A more entrepreneurial attitude is demanded from professionals to move from ‘caring for…’ to ‘ensuring that…’. A precondition for this is the clever use of technological progress and ICT applications. Using apps for administering medication and calling on the right professional at the right moment in time are examples of this.

Prevention also increases in importance. Like in the old days many cars would end up on the side of the road and the RACV would continuously en route for the repairs needed, today there is a much stronger focus on preventive maintenance and the avoidance of breakdowns and accidents. Cars are subject to annual road testing, are under the continuous watchful eye of the on-board computer, tires are becoming increasingly advanced to optimise grip and control, and energy efficiency is continuously being researched. In similar vein health and care professionals need a stronger focus on prevention rather than on billable hours. Innovations in health and care and healthcare education are more than the introduction of new gadgets to solve a one-dimensional problem or disease. It requires a focus on what our society needs given the challenges of ageing described above combined with the containment of health and care costs. This requires cross- and multi-disciplinary collaboration.

During a recent study visit to Norway we discussed with 30 executives of healthcare education programs in which areas the majority of innovations are and should be taking place. Their view corresponded with the same top three identified above:

1. Interprofessional collaboration in care & health;
2. Technology and ICT in healthcare; and
3. Entrepreneurship.

The Dutch Committee on Innovation in Healthcare Professions & Education in its first report in December 2015 introduced a continuum from prevention to community care to low complexity care to high complexity car. Although not void of critique, it can be used as a model to identify which innovations can take place where: those focused on collaboration, technology or entrepreneurship. With respect to community care and low complexity care, the focus is primarily on care provided through district nurses, welfare workers, ergo therapists and other paramedics. High complexity care is characterized by hospitals and specialists.

As can be seen from the figure above, in particular in the phases of preventive and community care innovations in inter-professional collaboration are of importance. When care complexity increases, technological innovation becomes more important. Entrepreneurship features throughout the continuum. Some further examples may help to clarify the figure.

1. Preventive care

In the preventive phase we have seen the rise of innovations in the area of ‘wearable technologies’. Monitoring yourself with all kind of technologies increasingly is becoming common. ‘Quantified Self’ was the US movement that first introduced this. Self-measurement and controlling your own data, but especially combining all this measurement data (‘big data’) for groups that can be classified in different ways, provides incredible new insights. This, in turn’ allows for ‘personalised health’: tailored solutions for a particular intervention based on the many experiences of other people with comparable characteristics. We also see this increasingly being featured in education programs. Mostly still as specialist subjects or ‘minors’ and not yet as an integrated approach throughout the curriculum, but that appears just to be a matter of time. In this, privacy aspects and the influence of multinationals who invest massively in this area, such as Apple and Microsoft, needs to be included.

2. Community care and low complexity care: focus on inter-professional collaboration

Especially in community care and low complexity care innovations for inter-professional collaboration and new organisational concepts are needed. This included using new but also ‘older’ technologies and ICT in novel ways. One can think of “Neighbourhood Care” in which small teams comprising professionals with differing backgrounds and with strong autonomy and responsibility provide care to the home. Or the use of Telemedicine through rehabilitation centres, with exercises being done at a distance, 24-hour contact becomes a possibility, and in which the client together with a team of professionals, maintains his or her own dossier. Eventually, also Electronic Patient Dossiers (EPD), will be featuring more prominently, despite concerns around privacy and current resistance in parts of our societies. In this view, it is not about technology as such – which currently is the case – but about acceptance and collaboration between professionals with ultimate advantages for the client.

All of this has major implications for our educational programs. New approaches are being introduced whereby professionals from different disciplines collaborate on ‘real’ problems and projects together with researchers, often ‘on location’. These are known as InnovationLabs (such as Hanzehogeschool Groningen) or Sparkcentres (such as Hogeschool Arnhem-Nijmegen). Experiments and experiences have shown that these innovations are best introduced in the later stages of the curricula, when students have developed a certain professional identity and can use this as the basis for collaboration. This collaboration based on professional identity dos require that both health and care education uses the same language. This, in turn, requires innovation. Current preferences are to design curricula on the basis of CanMEDS, a framework through which competences are shared. Finally, we see innovations in the master trajectories, such as the Master Healthy Ageing Professional, in which the focus is not on yet another management program. Rather, nurses, welfare workers, paramedics and sport science students are challenged to develop broad-based innovations. Core in this is their role as ‘change agent’ in their organisation, crossing disciplinary borders and adopting technologies outlined above.

3. High complexity care: focus on technology in healthcare

Increasingly high complexity care is characterised by a growing influence of technology and ICT. The University of Twente was very advanced in its thinking when it introduced Technical Medicine at the turn of the century. At that time barely accepted, the program today is very highly rated. The second advisory report of the Committee on Innovation in Healthcare Professions & Education, December 2016, is titled ‘Different perspectives, different learnings, different actions; cross-disciplinary teaching and learning in health and care in the digital age’. The main theme in the report is ‘living, learning and working with technology’ indicating that this is not yet a common feature across all healthcare programs in the Netherlands. As in other countries, flipped classrooms and MOOCs and the like are well accepted. But introducing technology in the curricula is less so. Yet big gains can be made through so-called ‘substitution effects’: transferring (clinical) treatment from medical specialists to healthcare professionals. An example is the increased technological capabilities for radio therapists. Where in the old days a radio therapist/specialist was forced to deal with a vague photo, todays medical imaging analyst can detect (and discard) a lot more before the more expensive specialist needs to be brought in.

4. The full continuum: entrepreneurship

Finally the theme of ‘entrepreneurship’ that runs through all aspects of health and care. We have witnessed the emergence of increasing numbers of digital forums and platforms that offer clients an increasing number of options and possibilities to design and coordinate their care schedule and health care providers. This profoundly affects future health care professionals and thereby current education programs. Increasingly, entrepreneurship education is part and parcel of health care education. This is not brought in through the narrow focus on starting your own business, but much more by incorporating an entrepreneurial attitude and using the opportunities that the future will bring. Use is made of business studies methods such as ‘scrumming’, ‘theory U’ and ‘effectuation’. A couple of years ago absolutely ‘not done’, today embraced by many educators who are being asked to link this to real problem-based health care cases.

Arwin Nimis is Dean at the School of Health Care Studies, Hanze University of Applied Sciences, Groningen, the Netherlands.

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March 20th, 2017 at 4:05pm
Dr Ann Lawless
Thank you Arwin for this interesting insight into developments in the Netherlands.

What are the current developments in health advocacy and health activism by health consumers (also known as clients, patients) in the Netherlands?

In Australia there are (as always) re-organising of the patchwork health system and one of the emerging trends is health consumers entering the health research arena as co-designers and co-creators of knowledge.
March 24th, 2017 at 8:54am
Arwin Nimis
Dear Ann,

We have - like you, I suppose - been talking about 'patient centred care' for quite a long time. And I say 'talking', because was the patient really our main focus?

Huber, which I mentioned in the blog, has started the Institute for Positive Health. She has made an instrument for patients. With this instrument patients can judge their quality of life and possible actions (paramedical, medical, psychological, no action) that have to be taken to make it better. She found that often these actions are non-medical and (therefore) cost-effective. This is a good example of patients entering the health (research) arena, but in another way then they used to. Collecting big data via 'citizen-science' is yet another way patients are entering the arena and co-creating solutions.

For education it means more Interprofessional Education (IPE) to put the patient really central and let her/him enter and engage with our education programs and processes. This now is our (difficult) goal. In the Nordic countries, the UK and Canada this concept is gathering momentum. I don't know what is happening in Australia I must confess. (For an example see CIHC, a national interprofessional competency framework). Finally, to achieve and embed this new kind of education, more practice of and for our students is needed in the community and healthcare organisations. This is yet another way to involve patients more in education and researching its impacts with a view to improving both teaching and learning and professional practice.
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