“I really had to learn to sit on my hands”

1. What was the issue that led to Turner being brought in? And what made it so complicated?

In the spring of 2021, at the initiative of the accounting firm Verstegen, Turner was asked to conduct an organizational assessment of the Klimmendaal rehabilitation center. In the last quarter of 2020, director Martijn Kuit was unexpectedly forced to revise the positive forecasts downward. There were several causes for this, all of which were exacerbated by the COVID-19 pandemic. To fully understand the situation, we need to go back to early 2019, when Martijn Kuit was appointed as director.

When he took office, Kuit found an organization that was still coming to terms with a merger that had taken place several years earlier. Communication was poor; the various departments and locations didn’t communicate well with one another: a “silo culture,” he explains. Klimmendaal was primarily focused on itself. This also has to do with the organization’s history. The organization was founded in 1899 and was originally a traditional rehabilitation center with a large private campus on the outskirts of Arnhem, where patients stayed during their rehabilitation.

But times have changed. Just as in hospitals, patients are increasingly being treated at home or close to home. Klimmendaal collaborates with various other healthcare institutions and has a total of about twenty locations: two of its own facilities and a number of spaces in hospitals, nursing homes, and even special education schools, both in Gelderland and in Salland. Collaboration throughout the care chain is therefore becoming increasingly important. And that calls for a different approach: autonomous teams, entrepreneurship, and reaching out to the community. The organization needed a cultural shift. Kuit, a former academic who previously worked for a mental health institution, decided to take the initiative. “Due to the internal focus, there was a lack of decisiveness and a sense of responsibility. Before me, there were administrators who operated in a fairly bureaucratic manner. I, on the other hand, am an advocate for delegating responsibility to lower levels of the organization. And I also expect that responsibility to be taken on.”

Together with the management team, Kuit drew up a new strategy, symbolized by a climbing wall. Klimmendaal had to rise to the top. To improve collaboration between the various locations and departments—clinical staff, finance, and facilities (including IT)—Kuit appointed a number of regional managers: three for adult rehabilitation and two for the pediatric departments. They were given a high degree of autonomy. Each team was also assigned a team manager. To facilitate the transition, the new managers were offered a leadership program. “An important task for the regional managers is to reach out,” says Kuit. “To strengthen ties with regional partners. It’s a complex role, because they also manage the team coordinators—the layer below them.”

But then the pandemic hit, bringing with it all the associated problems. That didn’t make the regional managers’ jobs any easier, because some of the employees started working from home. Internal communication deteriorated, sick leave increased, and fewer people took vacation time. “It was, of course, a difficult year with COVID-19. Through September, the year-end forecast was still very good—well in the black. But we had to revise that in October. A number of issues came to light that suddenly brought the year-end forecast down to zero. Our finance colleagues weren’t sufficiently informed about developments within the care units, so they didn’t have a clear picture of the numbers. It wasn’t that we were in danger of going into the red, but there was a significant discrepancy compared to the earlier forecasts.”

2. What led to the breakthrough? In terms of content, change management, and/or project management?

The problems that began to emerge in late 2020—which led to the revised forecast—were the main reason Klimmendaal decided to bring in Turner. Turner was asked to conduct an organizational assessment. His advice was unusual for a consultant. Instead of pushing for new change initiatives, Turner said it would be wiser to take a step back. “One of the findings was that not all teams were on the same level,” says Kuit. “On top of that, we’d just come through a year of the pandemic, so there was a lot of fatigue within the organization. We are indeed ambitious as a group. I was able to put together an almost entirely new management team, and some of the regional managers were also new to the company. So you could see that we reinforced each other’s ambition.”

3. How did the execution come about?

The new employees, the ambitious change agenda, the post-merger turmoil, the post-COVID fatigue: it was all too much. The organization had about thirty objectives. Turner recommended reducing that number to ten initiatives and identifying three top priorities from among them. “Last November, we switched to a new EPD, and we said: that really has to be a top priority,” says Kuit. “The same applied to capacity management and the treatment programs. Those three are very closely intertwined.”

It took some getting used to for Kuit. “In the end, it was the conversations with my coworkers that convinced me. They also told me that it was all a bit much and that the work was tough. At the university, I’d never experienced that before—people putting the brakes on. There, nothing was too crazy. People were tripping over each other with ambition. In Healthcare, things work differently, so it took me a while to adjust. I really had to learn to sit on my hands. A learning experience, you might say. But I realize it was good for the organization.”

Klimmendaal has also begun to focus more on getting employees on board with the changes. Kuit and his management team are working on setting a good example, and the leadership program plays a role in that as well. One component of this program is building leadership coalitions—groups of people who champion the new initiatives and try to convince others of their value. This is a tool that Turner always recommends as well. “Incidentally, there’s little wrong with the spirit within the organization,” says Kuit. “Our employees are generally more engaged than average and exceptionally loyal.”

Finally, Kuit has decided to structure this year’s priorities in a different, more“agile” way. “We’ve chosen not to fully flesh out the plans for the entire year, but to build in moments of reflection throughout the year so we can assess together where we stand, what has happened, and how we’ll move forward. We have outlined the key objectives for 2022, but we’ve only fleshed them out for the first quarter. We’ll do this every quarter: at the end of each quarter, we’ll take stock and draw up a plan for the next quarter. This way, we take a moment each quarter to pause, reflect, and reprioritize.”

4. Are there benefits for all stakeholders—customers, shareholders, employees, management, and society?

The focus on a limited number of initiatives has brought stability to the organization, and that—so soon after all the challenges posed by the coronavirus—has been very beneficial for Klimmendaal. The numbers are looking better again, although the organization remains dependent on factors beyond its control. For example, funding for the treatment of people with chronic pain and cancer patients in recovery is under pressure. The Dutch Healthcare Institute is not convinced that there is sufficient“evidence” that these treatments are actually effective. If reimbursement for these patient groups is discontinued, Klimmendaal will need to be able to rely on the entrepreneurial spirit within the organization. Better collaboration with other parties in the care chain can help in this regard. Klimmendaal is also seeking partnerships with rehabilitation organizations that are not geographic competitors in order to negotiate more effectively with insurers.

Patients also experience benefits from the changes and the renewed focus. During the COVID-19 pandemic, all employees received new laptops to make video calls easier. This is part of a trend that had already begun before the pandemic, including at other healthcare institutions: providing treatment as close to home as possible—and preferably at home, if at all possible. “The pandemic has accelerated this trend. At the same time, we’re also exploring which apps we can use to support rehabilitation at home. We’re looking into virtual and augmented reality, as well as various sensors, such as smartwatches. So patients will benefit from that as well.”

On a personal level, it has also given Martijn Kuit some new insights. “I have a technical background—I trained as an engineer. It has taught me to seek connections, engage in conversations, and listen. Of course, I knew that was important from the time I first started working in Healthcare, but I’ve noticed that it’s becoming increasingly important.”

An additional benefit of the Turner consultation is that Klimmendaal has learned to bring ongoing initiatives to a better close, Kuit explains. “Not being able to properly close the loop is a classic pitfall. This approach, with a limited number of changes, makes it easier to see things through. And it also helps get employees on board with what’s important to the organization.” At a recent policy meeting, Kuit once again emphasized that managers shouldn’t focus solely on the things that aren’t going well. “When my sons come home with a report card, I have to be careful not to focus only on the less-than-stellar results. Of course, we’ve had to deal with uncooperative teams and locations that underperformed compared to others. Sometimes that means reassigning someone or even parting ways. But that has been a rare occurrence. At Klimmendaal, a lot is going well. I’ve seen the organization undergo tremendous development over the past three years, particularly among the medical staff. There’s been a rejuvenation there, and it helps immensely to have a medical staff that’s forward-thinking and isn’t afraid to support certain decisions and make them on their own.”