Quality paradigms and innovation the Dutch case

In my view, the main recent innovations in the Netherlands are conceptual. The Dutch physician Machteld Huber proposed a new concept of health: Positive health. The current WHO definition describes health as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. It fulfilled its purpose when it was launched in 1948. But now, when we live for many years with chronic conditions, it doesn’t fit anymore. According to the WHO definition almost everyone is in poor health. It may lead to unnecessary medicalisation. One can in some respect say that, our health care is of such high quality that almost everybody has some disease, illness or discomfort. But that doesn’t mean we cannot live a good life!

Huber suggested that Positive health is a more useful concept today, ‘the ability to adapt and self manage, in the face of social, physical and emotional challenges’. Asked about what makes people feel healthy, they answered that it is not only about bodily and mental functions, but also about daily functioning, social and societal participation, spiritual needs and experiencing quality of life in general.

This concept of Positive health is currently widely adopted by the health, the long-term, and the social care sector. More than half of the municipalities in the Netherlands have embraced it and a large number of health and long-term care providers are implementing is.

The second conceptual innovation is the Vision on quality, as formulated by the Quality Council of the Health Care Institute. This Council, which is grounded in healthcare legislation, sets the national framework for quality standards. It states that quality of health and long-term care is a moral concept that should contribute to quality of life; a ‘good’ life from the perspective of the person. It is about his or her possibilities for self-direction, being connected to others and have the feeling of living a meaningful life. Thus, quality is normative, personal, contextual, shared with others, reflecting multiple perspectives and interests.

The consequences are that professionals in health and long term care should reflect with their patients or clients on the aims of the intervention in terms of their contribution to the quality of life of the person. And that is not always an easy task. As a physiotherapist once told me, when she was doing exercises with an old lady with dementia after a hip fracture: ‘for me it is not a challenge to get her walking, but the hard thing is to find a good reason for her why she should learn walking again’.

These shifts in quality paradigms have great consequence for elderly care, care for people with disabilities or people with long-term psychiatric conditions, but also in acute care. The reflex to repair everything that can be repaired is not always the right decision. The long-term care sectors are forerunners in this way of improving quality and joint learning.

We see innovations in line with these paradigms. For instance, green farms where people with dementia, learning disabilities, psychiatric conditions, addiction come together and take care of the stock, thereby exerting self-direction, being connected to others and experiencing meaningfulness. Or a nursing home that resembles a village, people with dementia being supported in finding their way to do their shopping supported by technology and a nurse that trains them to find the right clues, and older people receiving an iPad of the home care organisation, which makes it easier to communicate to the support staff, but also to their families and playing digital bingo. It is all about living a life with daily challenges and not always solving them, people making their own choices, being connected to others and feeling meaningful. These are the challenges for social, technological and system innovation, being interconnected. If we only aim at a single category of targets, we may hit the target, but miss the point!

Forum for Health Policy is an important Swedish think tank that published a blog written by professor Henk Nies on the 20th of march. Forum serves as a neutral platform where policymakers, researchers and health care providers meet to discuss and analyse important issues concerning the Swedish health care system. With a strong international perspective and focus on the patient experience, the aim is to stimulate innovation, contribute to new ideas, and assist policymakers and politicians with knowledge and possible policy options.