Making healthcare healthy
A change of course is needed if we are to keep healthcare in the Netherlands accessible. The South Limburg Regional Plan, presented in late 2023, focuses on cooperation between dozens of parties and organisations. Researchers Daan Westra and Svenja Cremer explain the contribution that Maastricht University is making through its Academic Collaborative Centres.
The demand for healthcare is increasing, costs are spiralling and staff shortages are acute. With time running out, strategic memos and ambitious plans abound to turn the cumbersome tanker that is the healthcare system around.
“We need to organise healthcare completely differently,” says Daan Westra, assistant professor at the Department of Health Services Research and an affiliate of the Academic Collaborative Centre for Sustainable Care. “We have to transition from medicalisation to prevention, focusing on wellbeing, vitality, positivity and living a good life. This requires us to look at a person’s needs holistically and emphasise self-reliance and staying healthy, rather than treating them from a single perspective. It calls for care providers and care recipients to change the way they think and act. It means making space for social and technological innovations, daring to let go of bureaucracy. And above all, working together.”
Change mission
At the national level, the Integral Care Agreement (IZA) and the Healthy and Active Living Agreement (GALA) offer a range of possible solutions. In line with these guidelines, South Limburg is coming up with its own plan. “There are more people with chronic diseases here, life expectancy is shorter and the demand for care is greater. This has to do with physical and social factors,” Westra explains. “We want to know exactly what’s going on. Why are people here, on average, unhealthier? How can we motivate them to do more prevention themselves? And how can the healthcare system contribute to the required changes? Our plan will fit in within the national frameworks of IZA and GALA, but with tailored solutions for this region.”
Living labs
Insurers, hospitals, healthcare institutions, municipalities, doctors and interest groups are all working together on the South Limburg Regional Plan. The plan dovetails with the Knowledge and Innovation Agenda for the Southeast Netherlands, in which UM’s Academic Collaborative Centres play an important role. “They have a long tradition in the region as living labs,” says Svenja Cremer in a recently opened wing of a residential care centre of Envida in the Amby district. Cremer is a postdoctoral researcher in the same department as Westra and an affiliate of the Academic Collaborative Centre on Care for Older People in Limburg.
“You can sit at your computer or the drawing board and come up with wonderful plans,” she says, “but it’s about how those plans translate into practice. How does healthcare actually function, what do the caregivers and care recipients think of it, do they want things to change or not? The collaborative centres bring together doctors, nurses, caregivers, therapists, designers, organisational experts, finance people and, of course, the users themselves in an integrated way to try to figure out the best forms of housing and care.”
Daan Westra is assistant professor of Healthcare Management at the Department of Health Services Research and unit leader of the Academic Collaborative Centre for Sustainable Care. He is involved in regional initiatives to transform healthcare in Limburg through measures such as improving cooperation between different parties.

Key
Everyday practice, Cremer says, is the key to the much-needed transition. “We develop and test joint innovations in the living labs. Professionals discuss treatments and options with patients. In nursing homes, we learn how to make people’s last years of life meaningful and happy—which is not the same as always doling out medication and treatment, medicalising everything.”
The Regional Plan depends on cooperation and participation, says Westra, who received a Veni grant in 2022 to map the formation of networks in healthcare. “Collaboration always sounds great, but every organisation has its own goals and ambitions, its own background and culture. They need to look beyond walls and across borders. There’s bureaucracy, there’s money involved, there are monitoring bodies. Healthcare is so broad. You can only arrange it properly and keep it affordable and accessible if parties work together. In the coming years, the Regional Plan will have to put this approach into practice and prove that it can work.”
Rethinking and adapting
The collaborative centres on Sustainable Care and Care for Older People work closely with each other and with other centres at the Faculty of Health, Medicine and Life Sciences. “We conduct research in professional practice,” Cremer says. “My PhD focused on everyday activities in nursing homes. The guiding principle was what people can and want to do themselves. Getting dressed, choosing their own clothes, making their own sandwiches, making their own way to the dining table instead of being pushed in a wheelchair. Things that seem small, but which are very real and different from the usual protocols. Visiting the zoo, taking a walk, doing activities, having social contact, listening—all these things contribute to a healthier life.
“The next step is to translate our findings to employees, team leaders and management. That way, we can begin transitioning to a new form of healthcare. It requires rethinking things, adapting. But it also makes healthcare more appealing to work in, because there’s more room for personal input and creativity. This is just one step in a very broad package of measures to make healthcare healthy.”
Text: Jos Cortenraad
Photography: Paul van der Veer
Svenja Cremer is a postdoctoral researcher at the Department of Health Services Research and an affiliate of the Academic Collaborative Centre on Care for Older People. In her PhD research, she was commissioned by the professional association V&VN to develop guidelines focused on care in Activities of Daily Living (ADL). Cremer teaches on the Bachelor of Health Sciences and coaches students in the Master of Health Policy Innovation and Management.

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