‘In comparison with Lean, Accezz focusses on getting to the heart of an organisation, not least by addressing employee behaviour.’

Chair of the Board Tineke Hirschler, regularly helps out with nursing duties to understand the day-to-day issues within departments.



“To use a medical analogy, some professionals make a diagnosis and say that there is therapy available, but then don’t provide it. Accezz is different. It carries out thorough research, presents a diagnosis, offers an effective therapy and then implements it,” says Chair of the Board Tineke Hirschler, who regularly helps out with nursing duties to understand the day-to-day issues within departments. She continues, “C2 is a clinical care unit for oncological and vascular surgery and gastrointestinal and liver diseases. For a long time, there had been lingering dissatisfaction with the excessive workload. Employees were willing but not able to change the situation.”

Manager of Clinical Care Mieke Berends says, “Due to the work pressure experienced by staff at C2, we were continually asked for additional employees, but there was already a large budget overrun.” It did not help matters that C2 had seen many department heads come and go. That was until 2009, when Anne-Marie Mulch started at C2 as operational manager. In the beginning, it was not easy for Mulch. She says, “There were many informal leaders in the team. I also noticed that the use of more staff certainly did not lead to a decrease in work pressure. Why was that? It was not unwillingness. Perhaps it was our way of working.”

After a Lean programme (note: Lean is a continuous improvement methodology), Deventer Hospital approached Accezz International. “In comparison with Lean, Accezz focusses on getting to the heart of an organisation, not least by addressing employee behaviour. This is particularly important if changed working methods are to be permanently embedded. Accezz provides a good basis for Lean and is an important addition,” according to Tineke Hirschler. Bringing in Accezz was not a difficult decision. “Accezz offers a free diagnosis. It also gives a 100 per cent financial guarantee for the implementation process because it is convinced that results will be delivered. As we had nothing to lose with this approach, we decided to wait and see what Accezz would come up with,” says Hirschler.

Before C2 implemented a new working method, based on the analysis by Accezz, everyone was invited to think about the issues that needed to be addressed. “It only works when everyone’s voice is heard,” says Anne-Marie Mulch. And Mieke Berends agrees. She says that implementation will not work unless the manager, in this case Anne-Marie, is willing to allow herself to be vulnerable: “Working with Accezz is intense and personal. Anne-Marie was immediately committed, but, in the initial phase of the change process, there was quite a bit of resistance.” Why then did Anne-Marie still want to do it? She says, “It’s incredible how fast we were able to effect a fundamental change in behaviour. Within 12 weeks of starting the change process, just as the new structure was implemented (which was developed in consultation with the employees), people could immediately see that it worked!” But wait. Let’s go back a step: what is working exactly and how did this come about.

Accezz International developed a customised planning and monitoring tool for C2. Staff themselves provided input for the time management estimate: it was the only way a realistic assessment could be made between activities performed in the department and the hours spent on them. “C2 is an intense, hectic department. Complex patient care in C2 includes specific wound care and vacuum therapy, which take more time compared with activities in other departments,” says Mulch. The planning tool allows us to predict peaks and troughs, even in a somewhat unpredictable department like C2. The analysis by Accezz resulted in a substantial reduction in work hours but, at the same time, made more time available for quality work. A paradox? Mulch continues, “This is certainly what we thought at the start. This conclusion led to commotion shortly after the analysis. However, staff soon found that, by working smarter, more hours were available for personal development, training and patients. There is now quality time available for washing hair, walking with a patient or having a good conversation about the impact of a disease.”

A solution was found within 12 weeks for a structural problem that had lasted years. “Of course, there are sometimes hectic days when more patients arrive than were expected and things don’t go according to plan. But that’s part of our job. The management system we now have at least makes it clear where the time went. As a result, there is more understanding, individuals can take direct action and there are almost no complaints,” says Mulch.

But all good things come to an end, or do they? Accezz has left and life at C2 continues. How can Deventer Hospital secure the route it has taken? Mulch concludes, “It will be secured because the approach was developed by the employees themselves. The method already had broad support, lingering concerns have been expressed and resolved under professional guidance and the positive outcomes are experienced by every employee in the department.” Senior nurses now know exactly what their role is and pursue the same policy together with Mulch, even though Accezz has departed. Mulch adds, “Of course, the first day after Accezz left, there were nurses who reverted to their old behaviour, but we have made them acutely aware and it has not happened since.”

C2 is today a more peaceful department and has a professional team that possesses a greater level of awareness. There is also better transfer of information and improved communications. Mulch’s work now gives her even greater satisfaction: “For a long time at C2, we failed to break with the old habits. Work pressure is a mindset compounded by the ever-present perception of a shortage of time. Workload, on the other hand, is measurable and fact based. But we have achieved much more than simply reducing the feeling of pressure. It perhaps sounds like a cliché, but C2 has proven that you really are stronger when you pull together!”




Tineke Hirschler – Board of directors

‘It’s incredible how fast we were able to effect a fundamental change in behaviour.’