Workplace innovation at Vivent: the neighborhood nurse in a new guise

2011– Vivent is providing care in residential and nursing homes as well as ‘care at home’ in ‘s-Hertogenbosch, the Netherlands and in six surrounding municipalities. In 2009 Vivent launched a project to bring the fragmented care back to a neighborhood-based approach with a Vivent Contact. This person is the face for clients in a specific neighborhood. The district nurse in a new guise. Yvonne Zonnenberg started nine years ago as a regional manager. After a major merger she stayed and started working as a manager of major projects. “Neighborhood Care had my interest already, so I was very pleased with the request from the organization to take the lead in this project" as she says.

Workplace innovation
The impetus in 2009 was the result from the independent client consultation and employee consultation. All this took place in a dynamic fast changing environment within healthcare, care for long-term care demanding people and supportive care in the housekeeping. In recent decades a lot effort has been put in task sharing to make healthcare more efficient. Thus there were many different people with different tasks visiting the clients. “In order to make it more clear for the client and thus to increase client satisfaction, we decided to do things differently and to appoint one Vivent Contact for each client," said Yvonne Zonnenberg. This contact is the fixed face for the clients in the area. He or she knows the community and its agencies and knows how to refer and mediate. The contact fulfills a control function in the care process. With this organizational concept the responsibility for the care was layed with the team. Yvonne says: “The idea arose because employees were faced with dissatisfied customers who indicated this. They have identified themselves with the clients and decided to provide the care differently."

A pilot project started  in collaboration with staff. This pilot ran from January 2010 to July 2010. In four districts, they started with the care at neighborhood level with one Vivent Contact. “We actually go back to how it used to be", says Yvonne Zonnenberg. A major difference is the new technology. “Nurses walk around with a PDA to make appointments and plan the work". Vivent wants to minimize the administrative side, but certain things need to be done to process the declarations. “Eventually we need our money". The pilot has led to very positive results, both for the customer and for the employee.
Four project teams started to work in the pilot and executed and tested the feasibility and affordability of the concept of ‘Neighborhood Care’. Twice a week during the pilot the project team monitored the practical experiences from the premise that the concept of Neighborhood Care had to be performed in a uniform and consistent manner. In short, they looked at the experiences of clients and staff in the pilot, but also to the organizational aspects that are important to ultimately take a decision whether a possible rollout of the concept over the whole organization Vivent would be feasible and affordable. 

Results pilot
The evaluation that Vivent has conducted shows that clients are positive about the reduced number of employees that come to help them. Also they are very satisfied with the contact person who is more available and accessible for questions, complaints, practical support and as liaison to Vivent. And clients more often have a conversation about how they assess the care they receive. They are positive about the Vivent Contact. In 90% of the cases the Contact responds correctly to questions, suggestions or complaints. The overall judgment of clients has therefore increased to an average of 8.47.
Furthermore, the employees in an evaluation indicated that they experience greater autonomy and a greater influence on their work schedule. As a result, they think that they can better meet the demands of the clients. It is also important that the productivity in the pilot period has increased and fewer hours are spent on roster planning.
The results of the pilot were very positive.

Implementation Vivent wide
Because the pilot had such good results, it was decided to implement this way of operating in the entire Vivent organization. This had quite some doing. “In the pilot enthusiast colleagues joined and fought hard for a change", says Yvonne. “It was to be expected that the implementation would evoke resistance and that was the case." The initiators of the four pilot regions have become change agents during the implementation process. This was convincingly for the organization. Yvonne also noticed that you have to deal with traditional decor and hierarchical control in such a large implementation project. She noticed that this kind of changes need time.
For this project Yvonne had much inspiration from the development in Buurtzorg, with the big difference that at Vivent things had to be changed from an existing organization and this is really more difficult according to her. The Foundation Vivent is still working to realize this change. Also Vivent-wide, there are high expectations for the new way of working. Currently Vivent reduces the number of different employees who visit clients, organizational wide. “We expect that, as in the pilot, the dissatisfaction about the number of people that visits the client will decrease and that customer satisfaction will increase." Also the accessibility of the Contact for clients will increase. “By better care and higher client satisfaction Vivent will become a more attractive employer," says Yvonne Zonnenberg. Another advantage of this way of working is that employees experience more control by increased impact on the planning of their own work. Moreover, there is more control room to respond to changes in demand / desires of the client. The expectation is that the satisfaction of the employees about their work will continue to improve.

Future developments require the further development of this innovation.
Indeed, the government cuts on the statutory compensation for long-term care, while more people will require assistance in the future. The expectation is that the responsibility for care will shift to municipalities. This will mean that health care costs will be covered by the Social Support Act (WMO). Care will have more similarities and overlap with wellbeing. Networks of volunteers and professionals will emerge in neighborhoods and do the caring. Delivering care at neighborhood level is very close to these developments. In short: Vivent is on the right track.