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Let’s turn healthcare into a eCo-system instead of an eGo-system

This article is based on a (Dutch)duo-blog in which Esmeralda de Vries. asked me about one of my slides I always use in my keynotes. I took the liberty to re-write it a little, translating it into English in one.

It’s about a (R)evolution coming up : from a eGo into an eCo system.


Healthcare is from both personal and organizational perspective designed as an eGo-system. People have go to the doctor or come to the healthcare institution, in which almost everything in the workflow is build around the professionals.  The organization’s perspective is leading not patient’s or his/her family, nor informal care. For instance have a look at the way scheduling is been done, the time it takes for an appointment being made and then the actual date you will have you scheduled appointment. Then compare this to how we book our flights;  even seat level, aisle or not, food arrangements are possible, that’s no rocket science anymore. In healthcare it mostly even isn’t possible to get an overview of all the appointments of one patient in one hospitals, but often is settled department by department. An eGo system thus.


Start to see healthcare like an eCo system, where all parties know (about) each other and what they have been done, and are doing. A place where the patient, family and informal care might help to give a boost to not only efficiency but also satisfaction, and perhaps even self-avoiding (the chance) on errors. To literally improve their own health by being a member of the (healthcare)team.

Recently I read on your website: “it was not all about technical stuff, nor about guidlines, or protocols. Also checklists, signing forms haven’t been put central, nor money.It was about the most underutilised resource of all : Patients. They really listened to what patients had to say, and learned from them.” You were then talking about your TEDxMaastricht conference last April.

Since I work with AVAfit model through a number of fits, including environment-fit – I had to adjust my thinking somewhat. Environment-fit which is created by the PEST factors: Politics, Economics, Social and cultural, Technology. Seen from out of the contingency theory I think this is still the most convenient method to translate the dynamics and complexity from the environment into practice everyday. Of course in healthcare with mechanical influences many laws and regulations, protocols, tight budgets and lean innovation continues. But I suddenly realized that “the articulating citizen / patient” from the socio-cultural paradigm has a wider role. Those of clients, suppliers and buyer! Paying patients may therefore decide how he / his care is given and in what form? My surprise came later in the tribulation when I read your quote: “It was not about” ME “it was about” US. “. Try to imagine what this mean for healthcare when we trade in the “ME” -thinking for “US.”-thinking, and help let patients pay attention, migrating from an eGo enter a eCo-system.” Yes, that really woke me up ! Could this be the healthcare innovation that we are waiting for”? But we bow to change  it from operational- efficiencies to customer-orientation: in which the organization is familiar with the “market” needs and wishes of clients and client needs are the most important starting point in making plans. 

What does this mean for current / future staff care? 

Working from and PEST factors may well help in a world made up of environmental factors as they were originally formulated. There is a new order emerging, look at how we deal with the media, see the interaction that is forced upon us. Look at what happened in the Middle East what movement no one had ever dared to predict, and in what timespan. 

I am confident the same will happen to healthcare, Not “IF” but “when”, may be even also invoked by a small spark  of something “big” happening, an epidemic or an economic crisis

In my blog Patients Are Changing seats: the Future of Health you have referred to, one could read MY wondering. I really think we overestimating the speed at which we will be facing these developments on broader scale, but likewise I am confident that the implications are of it at the least are equally underestimated. Whether or not healthcare can obtain a customer-orientation is to be seen, but especially a reallocation of roles, a move that will be reinforced by budget issues, laborproblems like shortage of skilled personnel and substantial increase in healthcare-demand due to demographic factors and increased healthcare consumerism. May be take a look into the interview with me in Lieke de Kwant Medical Contacts (one of the Dutch leading medical magazines) and responses on it. So do you see a really substantial role for the patient as a “buyer” of care in this system? 

But Lucien, the customer-central goes still as most important mission for profit and non-profi,t, no ?  “Attention to the customer is more important than the production process” ( The famous slogan of the Dutch Railroads  “Where would we be without the train” can finally be better changed to “Where would the train be without passengers?”. 

This also applies to care! In June 2011 AVAfit blogs, I described several changes, including the cultural changes by best-practice-teams for good, healthy and affordable healthcare through innovation. Thus, the cell-steered teams are back. They have more control over the shape, order and quality of care. Yes, you look still more to the employee-perspective, but these professionals have almost entirely service-gene in their bodies. They want good care for people! Research shows that they want to end the over-interfering, the nannying, all the paperwork. So there is a need, a sense of change what we now need is the roadmap! And that’s again about a “change”.
At the start of all the new Dutch health insurance system I predicted that buying healthcare is not comparable to doing the shopping or buying a car. “Although the market in healthcare does seem to assert other laws. This is due to the absence of the buyer-seller relationship. If you have a toothache, do not you first “go shopping” to find the right one that fits your dentist to find health insurance. You just want to quickly rid of the pain!. The system of marketforces in healthcare is more complex. And honestly: I do not always understand the information through brochures or the Internet. So that makes it hard to choose and send to me as a patient. 

Dutch culture has a great solidarity with the sick, children and the elderly. But in an economic trap, you see that solidarity shrink to the “real sick” children without parents / guardians and the very elderly in need. Those who help others should buy or can no longer rely on public money, says the average American.  Prof. Ate Dijkstra of NHL is researching Health 2.0 effects in terms of changing employer-employee relations. 


My question to you is: “Is the patient as a purchaser of a trend (wave) or is it a new way forward?” 

“Bad” news Esmeralda : “Patients central” is one of the most hollow phrases that I have met in healthcare. Everybody writes it down in mission statements en so forth, but only very few actually act on it on an organisational level. Step into a random healthcare-institution, look at their typical care process. Patient-central ? Off course not, it never had to be like that, so it never will be like that; in the “old world”, in a world where you can protect you knowledge. But not anymore in a world where 84% of the people visits Dr Google before actually stepping into the consultation-room.

The care is just an eGo system where all the processes have been moulded around the healthcare professional. That’s why we as  Radboud for instance  stopped “putting patients central” and are in the midst of a migration to “Embrace the patient into the healthcare-team” 

Mind you :  THE (healthcare)team, not OUR (treatment) team. 
Although you’re describing good processes, they also are build mainly on the above discussed eGo system. 

Despite the great ambition at the start, the new healthcare system didn’t bring a “market” into healthcare. All healthcare institution usually offer more or less of the same and whenever a health insurance company wants to buy a only certain part at one on two of them, the world looks “on fire”. Let alone the absence of “purchase” of care by the patient himself.  The health care system (without home care that is) misses the classical triangle of business. This because the health insurance contracts in the institution which in turn has an agreement with the caregiver, but where is the patient in this process: you see once again the eGo system !

Neither in the planning phase, nor in the implementation phase patients are involved or even asked. In the “new World” this quickly will disrupt, once i.e. one insurance company will start with a campaign, spreaded through social media on a high pace it will disrupt systems as we know them now. (Might want to read Clayton Christensen’ Innovative Prescription)

But … also I think that after the democratization of the media like TV programs and newspapers to billboards that scream for your interaction, and after democratization of some totalitarian regimes due to the role of social media, it soon turns to into the democratization of healthcare as well. Increasing transparency (like ZorgkaartNederland), introduction Personal Health Records (as my CareNet, Microsoft HealthVault) and the role of the Internet and social media reinforce the elements that slowly but surely there to ensure that the current roles will start slipping. 

This in an era where healthcare (including Consulting forms) are talking and talking on how to improve healthcare, literally doing nothing !


As described in the article in the Pathway issue of American Scientfic in which I was quoted several times, soon it will be the year of “The Rise of the Empowered Patient“. 


Not an optimistic scenario, Lucien. 
The concern is embedded in the process an excessive emphasis on control. While there is a need for innovation, for example, various solutions to the global scarcity. Energy and manpower is scarce, what are we going to do? Managers should consider value-innovation, but they remain to be in-control.  Reflect on how you can create stakeholder value rather than money, is what other services can you offer is also in healthcare. 

But the people as (potential) customer care-consumers will need to take action too. There is that trust or distrust, from the article “The rise of the empowered patient,” back into the  play. 

Patients are apparently agreeing that for thehealth care services there is an obligation of effort rather than an obligation of result. I will not be helped by the dentist for fun, I want especially get rid of my toothache! Man, I hate if, after the treatment and payment of large account, I have to come back to the dentist to eventually get the tooth extracted in the end. Suppose that the automotive would treat you like this with car repair? 
To return to thehealth care, I do see more and more initiatives Life Style programs where people are aware of choices and investing in preventive health and recovery. Employers in health care are not only concerned with health care, healthy finances, healthy working and healthy employees. Like the iHuman Professorship not only researches the possibilities that robotics and automation in providing more opportunities for independent living of elderly and chronically ill, but they see the need for changes in health(care). 

Driven not only by the “now”, but as a necessity for “tomorrow” as well. Trust in health care has many aspects! 
Would you close our duoblog with an advice in the debate on regaining the confidence of the patient? 

Think big, act small, dare to fail … but PLEASE stop talking and start acting!



Lucien Engelen

2 replies

  1. Love, it. We will have to disrupt US healhcare to make a change. Not that we are not changing but we need more disruptive thinkers to make real change. As you mention "it is simple not easy"

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