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The Slingeland Hospital in Doetinchem and Streekziekenhuis Koningin Beatrix (SKB) in Winterswijk decided to merge back in 2017. There were good reasons for this, but poor communication caused staff, the public and local politicians to rise up in protest.

At the end of 2019, the bomb exploded: trust was gone and support for the merger disappeared like snow before the sun. Jeltje Schraverus found herself at the head of both hospitals in the heat of the dispute. She had to restore the peace and quickly came to the conclusion that there was only one solution: to undo the merger. An interview with a seasoned administrator.


Healthcare

Format afbeeldingen Insights

Eind 2019 barstte de bom: het vertrouwen was weg en de steun voor de fusie verdween als sneeuw voor de zon. Jeltje Schraverus kwam in het heetst van de strijd aan het hoofd van de beide ziekenhuizen te staan. Zij moest de rust terugbrengen en kwam al snel tot de conclusie dat daar maar één oplossing voor was: de fusie terugdraaien. Een interview met een doorwinterde bestuurder.

Exceptionally poor communication

Mergers frequently do not succeed, no matter how promising they seem. How could this merger fail so badly, was it purely down to poor communication? "I think it has to do with expectations. The merger started with the agreement: we will let both hospitals exist as they are. But they failed to clearly define what that means, a fully functional hospital.

Slingeland needed and still needs a new building and during the planning stage, people realised that it might be useful if, for example, obstetrics, intensive care and acute healthcare were concentrated in the new hospital next to the A18 motorway. That was a rational decision that involved all those who needed to be involved. But when that came to light, things exploded in Winterswijk, because it was written down on paper that the SKB would remain a fully functioning hospital. After that, they no longer trusted anyone and the communication was exceptionally poor."

"You have to take a bit more time to think about the consequences of a merger like that, and discuss those consequences with each other before you go down that whole route, so that you can be sure that you are not caught off guard at the end."

Discuss the consequences

How could this merger have been successful? "I think that you have to consider things a bit more before making promises and setting them down on paper. And once you put something down on paper, you have to keep to it. You have to take a bit more time to think about the consequences of a merger like that, and discuss those consequences with each other before you go down that whole route, so that you can be sure that you are not caught off guard at the end.
There was also a surprise at the end here. Because suddenly it would no longer be a fully functioning hospital. I can understand the emotion, because something was promised and that was not kept. There have been a few attempts in the past to have the SKB merge with another hospital and all those attempts had failed. So you could have figured out that this was going to be a sensitive issue."

"Those people have grown to dislike each other so much that even if you rationally think that this cooperation should proceed, the emotions get in the way of the chance of success."

Complete disassembly

In July 2020, you were appointed interim chair of the Executive Board. What assignment were you given? "Before me, there had been an administrator there who was ousted by the medical staff after only five weeks because he was trying with all his might to save the merger. I said from the start, I am neutral, I have no opinion on this. I then spoke to everyone for three weeks and established that the merger was an impossible undertaking.

These people have grown to dislike each other so much that, even if you rationally think that this cooperation should go ahead, emotions get in the way of any chance of success. So I went back to the Supervisory Board and said: I have come to the conclusion that this can't be done and that is what I plan to let be known. That is what I did, posting a vlog in both hospitals, in which I announced that I was going to start with a demerger. And that this should be a fact by the end of 2020.

In the SKB, they were cheering when we disbanded, but in the Slingeland there was real grief, because they were pinning their hopes on the new building for their hospital. On 1 January, the demerger was a fact and I was appointed Director of the Slingeland.

The SKB also got a new director. Boer & Croon selected both of the new supervisory boards. Both hospitals were completely disentangled from that date."

FINISHING THE CONFLICT

Of course there was a rationale for pursuing a merger, which means there were underlying issues. Do those still need to be resolved? "It was chiefly because the SKB is a relatively small hospital, with a turnover of less than 100 million. Then you get bogged down by the numbers that you need to be able to continue doing certain types of surgery, for example. They will not be able to achieve those numbers now. But whether they do it with Slingeland or, as is now the case, with the Twente Medical Centre, if you can solve things by doing that, then that’s something too. Whether it is a long-lasting solution remains to be seen. The Slingeland has a turnover of 200 million euros, it does have a right to exist, but it will be very difficult to keep the SKB afloat in these times. On top of that, Winterswijk receives what is known as an availability grant of 2.5 million euros. This once originated at the very tips of the Netherlands: Vlissingen, Den Helder, Winterswijk, where you actually have too few inhabitants to be able to keep the emergency department open, but where it has to be done because the distances are too great. Everyone needs to be able to get to an emergency department within 45 minutes."

"The moment the Slingeland Hospital manages to complete its new building next to the A18 motorway, the SKB's availability grant will be withdrawn, because the Slingeland Hospital will then be accessible to everyone in the border region within 45 minutes. That's when the problems start. €2.5 million is a lot of money compared to €100 million. They really have to make some choices now. I will stay on for a few more years and then I will make way for a new board. That has to do with the new building for the Slingeland. We are now drawing up a plan to finance this new building to the tune of around €175 million. The initial budget was almost EUR 300 million, but that was far too generous. We are going to build for a quarter less than that. This is also possible in this day and age, because a lot of care has been moved to the primary healthcare sector or can be dealt with through appointments over the phone."

"Everyone is finally finished with the conflict. Don't forget, we also had corona in the middle of it all. So people are ready for something positive and prefer to look ahead into the future."

Jeltje Schraverus

Jeltje Schraverus (1956) werkt al vele jaren in de gezondheidszorg. Zij startte in de verpleging en studeerde daarna bedrijfseconomie en psychologie. Ook heeft zij de master of health administration gevolgd. Haar werk kenmerkt zich in het begeleiden en leidinggeven aan veranderingen in de zorg, zowel als adviseur (o.a. bij PwC) als bestuurder (o.a. Flevoziekenhuis, Waterlandziekenhuis). De laatste jaren is zij zich meer gaan richten op het interim besturen, wat vaak een combinatie is van de vaardigheden leidinggeven en projectmatig handelen. Zij is inmiddels bekend met alle onderdelen in de zorg. Van gehandicaptenzorg tot en met ziekenhuiszorg!


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