Saving more lives with less money

Roger Rennenberg is not aiming for a spectacular new treatment that makes the headlines. However, ambition is not lacking because by focusing on improving the quality and safety of healthcare, he wants to save more lives with less money. With his inaugural speech titled "Healthcare of the highest quality and safety, at what cost?" on May 12th, internist and vascular physician Roger Rennenberg assumed the chair of "promotion of quality and safety in healthcare." His inauguration address can be watched  here.

Although medical breakthroughs often receive a lot of attention, they usually only help a small group of patients and cost a lot of money. Money that Roger Rennenberg prefers to spend on the work floor. "The quality and safety of healthcare in the Netherlands are already at a high level, but the progress that has been made in recent decades is stagnating. To make a difference now, we need to invest in the way healthcare providers with different professional backgrounds collaborate with each other. And in doing so, we can learn a lot from what is already going very well," he argues.


Learning from what goes well

To make healthcare safer, the focus tends to be on what goes wrong, and then plans are made to prevent it from happening again. At the same time, as a doctor, Renneberg observes many complex situations where things actually go well. "For example, when someone ends up in the emergency room after a serious accident. Sometimes, in retrospect, I realize that we it really was a close call. Then I wonder how that is possible - why did everything go well there? That's where we can learn, that's what we need to disseminate."

Therefore, Rennenberg focuses his research on complex situations in which it is still possible to deliver safe and quality care. As an example, he mentions the COVID period at the ICU. "Those were very difficult circumstances, no one had expertise in the field of COVID and there were major shortages of supplies and personnel. Many of the nurses who stepped in had never worked in an ICU before. And yet, despite the high demand, the team was able to continue providing necessary care. They were capable of an exceptional performance."

In the case of COVID, he discovered that it was mainly related to communication and collaboration. "The hierarchy disappeared because nobody was an expert, COVID was new to everyone. Doctors, nurses, and other healthcare providers faced the same problem and had to solve it together." Rennenberg wants to identify the positive elements of such exceptional performances and apply them in other areas of the hospital to improve the overall quality of care.

Team performances

Rennenberg states that improved team performance will greatly enhance safety, and therefore healthcare providers need to better understand each other's knowledge and skills. There is now much more focus on interprofessional collaboration and communication skills in the training of physicians, where Rennenberg plays a role as the director of the medical education program. "The doctor is no longer the one who says, 'This is how we do it,' and expects everyone to obey. The doctor is part of the team and must actively collaborate and understand what others in the team have learned and what their ideas are," he adds.

Psychological safety also plays an important role: every team member should feel free to voice their observations. Rennenberg explains, "Does the nurse dare to say to the doctor who is busy with a surgery, 'Hey doctor, there's still a bit of blood leaking here - is that normal or should we do something about it now?' And how does the doctor respond? How you interact with each other in such a situation will likely determine whether someone will share their concerns or feelings next time, and it has an impact on the quality and safety we can deliver."

His focus on learning from what goes well does not mean that he doesn't want to learn from mistakes. On the contrary, he advocates for more openness about incidents and encourages a positive approach towards people who report that something went wrong. As an educator, he sets a good example in this regard. "When I'm in the emergency department with the resident doctors, things occasionally go wrong, or something happens where you think afterwards, 'I should have noticed that.' I then discuss it as openly as possible with the resident doctors. On the one hand, to learn from it, but also to show that I'm not infallible myself."

Total effect

Plans to improve safety sometimes come with unforeseen adverse consequences in other areas, notes Rennenberg. For instance, he contributed to a study on a safe way to prevent kidney function decline when using contrast agents in X-ray examinations, which led to a change in international guidelines. The research group demonstrated that the existing safety protocol at that time actually resulted in complications and the benefits did not outweigh the costs.

He does not want to fall into that trap with his ideas for improving interprofessional collaboration. "When you talk to people about improving collaboration, everyone thinks it's a good idea. But before we start implementing various measures to promote interprofessional collaborations in the workplace, I want to conduct thorough research to assess the total effect of such changes on healthcare. I hope that in five years, we will have research results showing that investing in team performance does not lead to adverse effects in other areas."

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