“Critical Examination of Ambulance Care Groningen’s Quality Improvement Efforts by Dutch Healthcare Authorities”

At Ambulance care Groningen, the problems are not only in the diseased manners and unsafe working atmosphere; there is also structural underperformance. National standards for arrival times have not been met for years, duty rosters do not match the care needs of patients and colleagues at smaller ambulance posts have so little to do that this may have consequences for their skills as care providers.

This is what the so-called ‘change team’ of Ambulance Care Groningen, a group of managers and employees, writes in a report that should be the first step towards a much more professional organization.

Earlier this year, research agency Het Zuiderlicht already concluded – following reports in Newspaper of the North – that there is widespread transgressive behavior in the organization. This takes the form of intimidation, sexist remarks, foul language and, as a result, an unsafe working atmosphere. There is also a gap between the ambulance stations in the province and the head office on Gothenburgweg, known among colleagues as the Ice Palace and the Pentagon.

Worse and worse

Until now, less attention has been paid to the performance of Ambulancezorg Groningen, which carries out around 60,000 trips annually. Where the performance standard is to be on site within 15 minutes in 95 percent of emergency journeys, the organization is succeeding less and less, up to 91 percent this year. In addition, the planning is not well organized. Between 5 and 7 pm on weekdays and at the weekend around noon, there are often too few ambulances available in the province to meet the demand for care, while there is often an overcapacity of vehicles and personnel at night. Sickness absence in the organization has risen to over 10 percent this spring, while other ambulance organizations are around 6 percent.

This has not led to incidents with patients or worsened care so far, emphasizes interim director Jack Thiadens. “The picture we have brought up is not a good picture at all. As an interim director, I am used to quite a bit, but this change task is definitely of a considerable size,” says Thiadens. The report mentions a neglected organization. “I apologized to all employees for this, because we did not facilitate them enough in their work.”

Drop down to the lowest level

Ambulance care Groningen has been under ‘stimulating supervision’ by the Health and Youth Care Inspectorate for several months now. Every two weeks, Thiadens and the medical managers update three inspectors. A next step would be stricter supervision, after which the Inspectorate can intervene. In addition, the organization is also in the crosshairs of the Dutch Healthcare Authority (NZa), which assesses the quality of Ambulance care Groningen with ‘category B’. There is a risk of falling to the lowest level, category C, the change team writes in the report.

In addition to the NZa and the Inspectorate, health insurers Achmea and Menzis have also been sitting at the table with Ambulance care Groningen more often than usual since lort. They have pledged support for the change process. The ambition is high: within three years the change team wants to be a leader in the Netherlands in the top 10 of well-performing ambulance organizations.

In any case, improving the duty rosters is being looked into. The organization is currently violating the Working Hours Act and is acting in violation of the Collective Labor Agreement in some areas. Employees of the ambulance stations in Leens and Uithuizen now drive an ambulance on average around 15 percent of their working hours, due to a lack of calls. The rest of the time they are on hold. Employees at posts in the city are around 50 percent. One of the solutions is to have ‘Leens’ and ‘Uithuizen’ also run at busier locations, so that ambulance staff can continue to perform enough medical procedures. Unfairly distributed shifts are a major divisive issue among staff and are one of the causes of high absenteeism.

Short shrift of transgressive behaviour

In addition, the change team wants to make short work of transgressive behaviour. There will be training for a professional work attitude and a better approach culture and sanctions will be imposed. The reporting process for undesirable behavior must be improved and victims must be intensively supervised and protected. In addition, Thiadens wants Ambulance Care Groningen to seek more connection with initiatives that it previously did not want to participate in, such as the pilot recumbent care transport in which Friesland and Drenthe do participate.

,,We should not only look ahead”, says team manager Paula van Oudheusden, who chaired the sounding board group. ,, There is a lot of sadness in people, because they did not feel heard and seen for years. So repair work is definitely needed.” All in all, it will be a process of at least two years to get Groningen Ambulance Care where it needs to be, says Thiadens. “But that’s worth it. Because this is a crucial organization for healthcare in our region. A public service we should be able to count on. I see the pride in our work in our people and patients are very satisfied with us. But something is wrong. It can and should be much better. That is also the opportunity that the necessary change process now offers us.”