Nurses Noëlle Huijbers and Marc Grevelink have finally got rid of their old-fashioned pagers. Those pagers, think cell phones from the late 1990s, are ubiquitous in hospitals, and go off all the time. Every time a patient presses the red button on the ward (pain, thirst, urination, the IV pole starts beeping), it leads to a jingling in the pocket of a white coat. But as of today, Huijbers and Grevelink are working with a special care telephone, a type of smartphone.
On that – innovation – only the alarms of their own patients come in. If such an alarm comes at an inconvenient moment, they can suppress it, after which the alarm is automatically forwarded to their buddy – a fellow nurse with whom they take care of the patients. It will lead to fewer times when they are disturbed, the nurses believe, and less alarm fatigue.
The hospital has made every effort to reduce the workload for nurses in other ways as well. The medical devices in the patient rooms are also connected to the care telephones, so that the nurses can monitor the IV poles and the heart monitoring remotely. If the fall detection gives an alarm signal, they can switch on the camera above the patient bed on their phone (if the patient has given permission for this), to see if there is a false alarm.
patient tablet
If patients want a glass of water or a currant bun, they can request this directly from the nutrition assistant via a patient tablet (with Netflix, YouTube, Disney+ and Videoland – log in with their own account – and light, heating and curtain controls) nurse again a non-care task.
‘It will take some getting used to at the beginning’, says Huijbers, ‘both for us and for the patients, but I am convinced that this will make our work more pleasant.’ The furnishing of the new patient rooms and all the furniture and gadgets that go with them were ultimately thought and built for six years, with the close involvement of doctors, nurses and patients.
On Monday, the new main building of the Radboudumc in Nijmegen will open its doors to patients and visitors. With daylight in every (work) room, only single patient rooms, warm wooden floors and an interior design that grows with the floors: water plant wallpaper on the ground floor, leafy roof lamps on the seventh floor and meeting rooms with the names of birds of prey. The new building will make the university hospital 50 thousand square meters smaller than it used to be, the main pedestrian route will be reduced from 1,200 meters to 200 meters in length, and the hospital will have about 70 fewer beds at its disposal.
That sounds counter-intuitive in times of an aging population, increasing demand for care and a pandemic, but according to board chair Bertine Lahuis ‘there is no other option as an academic hospital these days’ than reducing the number of beds. ‘This building reflects the juncture of the times, the transformation that we have initiated in healthcare.’
More power for nurses
The UMCs, says Lahuis, have increasingly shifted to providing ‘third-line care’ in recent years. ‘We treat patients with diseases that are less common or that require specific knowledge. Or if the interplay of diseases in a patient is complex and concentration of knowledge is required.’ Many standard treatments have been moved to the peripheral hospitals, with which they collaborate.
And what was considered complicated care not long ago is no longer so. ‘Where in the past oncological treatments took place almost exclusively in academic hospitals, patients now even receive immunotherapy at home. You were in hospital for a week for a new hip, which is now being done in day treatment.’
With the renovation, Radboudumc is also tackling the organization of the hospital. The biggest change is that soon the UMC will no longer be managed per department, but in eleven centers. In all these centers a doctor, a business administrator and a nurse form the management. Lahuis: ‘We want to bring in all perspectives and in this way also anchor the voice of the nurses more firmly on all kinds of levels. This is also incredibly important for nurses; it also shows that they have career prospects in the hospital.’
Ultimately, says Lahuis, all these developments can be described with one word: sustainability. So: the new building is the most sustainable hospital building in Western Europe, with solar panels on the roof and heat-cold storage in the basement, and also, if you want to find meat in the canteens, you have to look hard; it’s there, but it’s behind the vegetarian sausage rolls. Radboudumc staff will not fly if a conference or working visit is less than 700 kilometers away.
And even: alcohol has been completely banned from the hospital, right up to the Christmas drinks, ‘because we have to lead by example, and alcohol is a major health problem, just talk to our gastroenterologists. No, that’s not patronizing. We are patronized all day long in the outside world and nudgedbut in the direction of unhealthy food and drink.’
From sugar tax to Tata Steel
Sustainability is ‘the paradigm shift that we stand for as an academic hospital and as a country’, says Lahuis. From care to health. “Covid was a slap in the face. Who turned out to be the most vulnerable? The overweight people, the people from the lower socio-economic classes. At the same time, the IPCC report on the climate was released, showing that climate change is having disastrous effects on people’s health. As a knowledge institute, it gives us an enormous responsibility to raise red flags when policy goes in the wrong direction. Look, we can talk endlessly with the government and with health insurers about enough money and people for healthcare. But if we don’t do anything about nitrogen, don’t make healthy food VAT-free, don’t introduce a sugar tax, we continue to drive too fast, just let Tata exist in IJmuiden, what are we doing here? Then the patients will continue to be brought in here, and we will be carrying water to the sea.”
It leads to ‘social shifting’, says Lahuis. It is precisely the most vulnerable who are presented with the largest health bill. The Nijmegen neurologist Bas Bloem, for example, has shown that Parkinson’s disease occurs more often in people who have been in contact with long-term pesticide use. Lahuis: ‘We should definitely make a point of that. So that is the result of years of government policy in the field of chemicals, it is not the case that this has only been known for a year.’
The role of Radboudumc is therefore no longer just treating patients, is Lahuis’ conviction. ‘If someone comes in here with overweight or with Parkinson’s, we will of course treat them. But we also need to increase our knowledge of where that obesity, where that Parkinson’s comes from. And it is our moral duty to inform citizens and policymakers of the results. And to point out to them that things have to change with our agriculture, with our food.’
Breaking through systems
This sustainability also applies to the systems on which the healthcare organization is built. They get hopelessly stuck, Lahuis notices every day. Example: doctors in Nijmegen have the Fit for surgery research programme, in which patients are prepared physically and mentally for an operation. Twenty surgical procedures are being studied for the effect. With a better condition and a few pounds less, the risk of complications in the operating room decreases; patients recover faster, die less often, spend less time in a hospital bed. Benefit for the patient and for the healthcare budget.
‘Everyone is very enthusiastic’, says Lahuis, ‘the health insurers, the Zorginstituut, the Dutch Healthcare Authority. But the health insurers are not yet able to process this in their systems. If we finally agree, we are still waiting for each other. We must have guts and courage to break through our systems, otherwise essential, sustainable innovations will not get off the ground.’
It should be a lesson, says Lahuis. In any decision of any ministry, the first questions should be: is this sustainable? And do we thus promote health for the inhabitants of the Netherlands? ‘If the answer is ‘no’, society will not become more beautiful, but the dichotomy will increase. A recipe for unrest, that is an old sociological fact.’