Too many underprivileged people fall by the wayside – their care needs are so complex that an individual approach is essential. But not from a single care provider – cooperation among several parties working towards a solution and not being afraid to break rules is what is needed. Five years ago, this realization led to the foundation in Rotterdam of the Münchhausen Movement. Joost Vos has researched this society and he will be awarded a PhD by the University of Groningen on 30 September.
The emphasis in health care is steadily shifting towards market mechanisms, resulting in a strong focus on efficiency and an organization’s own interests. Vos: ‘Most professionals want to do what is really necessary, but at the same time they feel that there’s often not enough room for that.’ The Münchhausen Movement comprises a number of parties that have agreed to ‘not say no’ to each other. Starting from that attitude they create new small-scale facilities. ‘If suitable help still turns out to be impossible, the parties must be brave enough to put aside the formal systems and do what is necessary in that specific case.’
The original idea behind the Münchhausen Movement was to search for structural measures to improve the dovetailing of care provision. However, it was not long before the conclusion was drawn that this was not working. The complete range of care offered by social institutions is so complex that it is impossible to force dovetailing through regulations. Vos: ‘There are so many exceptions. You’re always dealing with tailored solutions.’ This in his opinion is also at the heart of what the Münchhausen Movement stands for: ‘Care providers have to look beyond the borders of their individual responsibility.’
According to Vos, the greatest strength of the movement is that it sets an example. ‘During the meetings, held six times a year, stories are told of heartbreaking situations that have been resolved through this type of cooperation. This helps people realize that they can make a difference and that offering help to individuals is extremely important. This encourages people to join the movement, from the top of the organization right down to the professionals on the workfloor.’
The Münchhausen Movement is in favour of cooperation chains, although in this case it may not be so much a chain of work processes as a chain of stories. Vos: ‘I hope that this way of thinking will be adopted at many other places. This is the only way to convince the field of the efficacy of these kinds of ideas, which will in turn result in the necessary funding and legislation.’
For the time being, the extra time and energy that care providers have to invest in harrowing situations is not funded. Nor are the extra steps that are needed, Vos realizes. ‘That space has to be created, though. The determined drive towards organizations that do exactly – and only – what they have been contracted for is too short-sighted. Organizations must be given the opportunity, where necessary, to have that little bit of extra room to manoeuvre. And that includes financially.’
If the Münchhausen Movement wants to succeed nationally, too, then it’s important that the emphasis on the small scale remains. ‘That is extremely important. We’re dealing here with individual, specific small groups of people who are being marginalized. That has to be tackled at neighbourhood or town level.’ If the scale is any larger, the cooperation chains quickly become too complex, Rotterdam’s experience shows. The key is small-scale cooperation. ‘If we want to change the care process, however, this type of thinking will have to permeate the entire field.’ That’s the only way to achieve consensus for new norms and patterns for cooperation. It is nice to see that the initiative has in the meantime been adopted in a number of other cities.
Joost Vos (Hilversum, 1960), studied Pharmacy in Utrecht. He will be awarded a PhD by the Faculty of Economics and Business at the University of Groningen. His supervisors are Prof. C.T.B. Ahaus (professor of quality management at the University of Groningen) and Prof. J.B. Rijsman (professor of social psychology at Tilburg University). His thesis is entitled ‘De Münchhausenbeweging: Beweging voor Ketensamenwerking’ [The Münchhausen Movement: Moving towards Cooperation Chains]. Vos works as a Managing Consultant for TNO Management Consultants in Apeldoorn.
Information: Joost Vos, tel. 06-515 918 94, e-mail: vos tmc.tno.nl
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