There are already around 60,000 vacancies in Dutch healthcare and many more are still to come. The shortage of nurses and caregivers is expected to rise to approximately 125,000 by 2030. Shocking figures that underline the enormity of the challenges in healthcare.

This has enormous consequences for patients, such as waiting lists, shortened consultation hours, poor accessibility, increasing costs and lagging innovation. And certainly, also for the caregivers. Think of work pressure, absenteeism, burnout and turnover. Which in turn puts further pressure on the caregivers.

The staff shortages therefore also make working in healthcare less attractive. The turnover to other sectors is enormous: 4 out of 10 Dutch healthcare workers are at risk of leaving the sector.[1] Worse still, forty percent of newcomers to healthcare actually leave within two years.[2]

Many suspect that it is virtually impossible to meet the (future) demand for staff, perhaps you will too. The increasing ageing of the population is also driving up the demand for care, while it is also causing the working population to shrink. In addition, economic growth creates fierce competition in the labor market, because this means that you need a lot of people not only in healthcare.

As a result, everything revolves around “staff shortages”. In panic, out of habit and with no prospect of an alternative, everyone is asking for more staff and less work pressure.

Unsolvable!

“You can’t solve your problems with the mindset that caused them.”

– Albert Einstein

Albert Einstein teaches you that you can’t solve “staff shortages” with the mindset that caused them. What is this current thinking, which has caused the situation of “staff shortages” and makes it “unsolvable”?

If you think that “staff shortages” are your problem, then there is really only one solution: more staff! After which you start thinking, how much more staff? And you define your “problem” as above, for example: “We will have about 125,000 vacancies for nurses and caregivers in 2030, so that is our shortage”.

As a result, the problem seems to be: “not enough people” and the solution is therefore “more people”. Then you think “where are all these people supposed to come from?” and “who is going to pay for that?” This solution requires more people and more money. Both scarce.

Healthcare administrators also don’t really know what else they can do. Recently, Ad Melkert, chairman of the Dutch Association of Hospitals, claimed that their (financial) problems can only be solved if the government gives more money, because “they are working very hard and the efficiency is already very high”.

In my opinion, efficiency means doing the work with minimal effort. That’s the solution to hard work, not the other way around.

Hard work and adding more and more money are forms of symptom control, because it doesn’t change the system, it just exhausts it. This is a dead end. But, how do you get out of this? We really need more people. And, as stated earlier, there are none.

This makes you think: “This is unsolvable (for me, as a healthcare provider or even as an administrator), so the government has to solve it!” As a result, “the problem” moves from a personal, local problem to a large, national problem. Far beyond the reach of the people who experience the problem on a daily basis.

Will this help you to get closer to a solution?!

No, because in the 1990s there was already written about staff shortages in Dutch healthcare. So, the chance that the (national) government will solve it in the short term is not plausible. Especially since they often have other interests, such as limiting their spending.

In summary: Staff shortages seem to be an insurmountable problem and, above all, a problem that is far beyond the control of the healthcare providers themselves.

But then how do we go about solving it?

All the knowledge you need to be successful is already within you. However, how you look at your problems and how you think you should solve them determines whether you actually succeed in improving your situation. We all have assumptions about how our world works and who is responsible for it. As long as you don’t question these assumptions, you will stay where you are and not improve.

So, let’s take Einstein’s advice to heart, take a step back, and change our thinking about the situation.

What is the real problem?

The added value of care is to improve people’s quality of life by providing the necessary care. To do this, you need capacity in the form of, for example, people, buildings, equipment and supplies. Deploying staff is therefore a means to get the work done, not an end in itself.

This, in turn, means that “staff shortage” is not a problem, but a “solution, disguised as a problem!” After all, the only way to “solve” it is more staff.

To help me to look differently at healthcare, its problems and their solutions, I use the management philosophy, popularized under the name “Lean thinking”.[3] [4]

Within Lean thinking a problem is “a gap between the ideal and your current condition”. So, what is “the gap with the ideal” that we call “staff shortages”? Apparently, we want more people. But why? What causes this thought?

You probably have the experience now that you can’t get your work done, that you can’t give all patients what they need or that you don’t expect to be able to do so in the future.

This is your real problem.

“But, why is everyone saying that there are staff shortages? Isn’t that a problem?”

In order to be able to continue to help both current and future patients, you will ideally work with a minimum capacity, i.e. with as few people as possible. You can achieve this by only deploying people for value-adding activities, for what patients really need.

But unfortunately, in the reality of everyday life, a large part of your capacity, of the time that is available, is also lost to activities that are not contributing to what your patients need.

This means that there are actually two problems:

1. Visible to everyone: Not all patients always receive the care they need.
2. Beneath the surface: Not all of people’s available time goes to the care patients need.

To solve the first problem, to ensure that all patients receive the care they need, we have been working harder, doing waiting list mediation and calling for more staff. This is symptom control and follows the old, classic management thinking that has brought us into this situation.

Lean thinking teaches you to shift your attention to the problems under the surface, which have remained hidden until now. It helps you to make those problems visible, and then tackle them at the source.

In short: You solve the underlying problem, you ensure that healthcare providers no longer waste their time on bureaucracy and complex processes, and with the freed-up capacity you solve the visible problem, you will provide care to underserved patients.

In this way, healthcare providers can solve their problems themselves, within their existing capacity. So, without extra people or budget.

With Lean thinking, you change how you look at a problem and where you look for solutions.

Instead of saying “we don’t give all patients what they need, because we don’t have enough people” (old thinking), say: “we don’t give all patients what they need, because we don’t deploy people in the right way” (Lean thinking).

What do you see and think now?

Do you agree?

Or is my hypothesis wrong and does all your time and that of your colleagues always go to the right patient care, at the right time?

P.S. in a future article, I will substantiate my hypothesis and show how this change of thinking helps to get rid of all excess vacancies in healthcare.

Arnout

[1] From a presentation by Prof. Bianca M Buurman, president of V&VN, during Radboud Grand Round.

[2] Eindhovens Dagblad, 20-06-2021 [ Dutch newspaper ]

[3] Lean is the name given to the system by which Toyota organizes its processes, based on the values and principles of continuous improvement and respect for people. The essence of their system is that you make your problems visible and then challenge people to use their creativity to solve problems at the source, and thus eliminate waste, with the end goal: the highest quality, the shortest lead time and the lowest costs.

[4] Why and how I use Lean thinking during my work in healthcare, you can read in detail in my books Lean Thinking in Health Care (2023) and Lean Thinking for Emerging Healthcare Leaders (2020).

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