That experience changed my thinking. Clients must be part of the process. Nothing about them without them. They belong in the problem analysis, and in finding and implementing solutions. People often argue that involving clients brings too much emotion and makes consensus impossible. My point is: if you leave them out, the solutions won’t work.
Another objection is that there are too many parties involved, so the municipality should just take the lead. That doesn’t work either. I became convinced that everyone — including clients — must sit down together. Emotions will surface, of course, but that also opens up space to explore where they come from. I’m a strong advocate of having the whole system in the room: bringing everyone together to discuss the case, not only the professionals but also the leaders of their organizations.
To make that happen, you need someone with authority to convene the group. In this case, I had that authority from the mayor — I could speak on his behalf. If parties failed to cooperate, they could expect a call from the mayor the next day.”
Professionals designing their own solutions
“A while later, I became CEO of the Amsterdam Youth Protection Agency (BJAA). Again, we faced a wicked problem. The Executive Board and Supervisory Board were in a crisis of trust. Employee representation was in turmoil. And more crucially, there were long waiting lists for children in need, high sickness absence, financial troubles, and staff who no longer saw how their efforts contributed to the organization’s goals. Quite a mess. Where do you even begin?
I drew on my earlier experience. We started with a pilot group of 15 frontline professionals — the Head Group — who were given three months off their regular duties to examine the work. Their task: identify which activities were ‘waste’ and which created real value: ‘value work’.
After a few weeks, my two fellow directors and I visited their project room. The walls were covered with large sheets of paper, most of them marked red. Seventy per cent of the work was red — waste — and only thirty per cent green: value work. The group looked depressed; they’d discovered why their jobs made them so unhappy. Most of what they did served no useful purpose.
The Head Group then redesigned the workflow. One good example was the ‘contact journals’ staff had to complete after every client interaction — because the Protocol said so. When they went looking for this Protocol, they never found it. So that task was abolished.
The concept of value work became the foundation for a new family-centred approach. Once we had a few successful cases, the group felt they had found a new routine — what later became known as the Generic Family-Oriented Approach, focused on mobilising families’ own strengths and networks. Its principles were:
- treat the family, not just the child;
- all family members should be present at meetings;
- if the father works during the day, meet after 5pm;
- all relevant organizations contribute;
- obstacles are escalated to higher management or the board;
- leadership support is essential, so staff can act with ‘extended authority’ across organizational boundaries.”
Rolling in, not rolling out
“We wanted to roll out this new method across the organization, so all employees could adopt it. We organised a big meeting with about 600 staff. I asked the Head Group’s team leader to explain the new approach. But the response was hostile: ‘That won’t work!’ people shouted. That’s when I realised this wasn’t the way.
It would only succeed if everyone went through the same learning curve as the Head Group. That’s how the phrase ‘rolling in’ was born. People have to experience it themselves — to roll into it — before they can see the value of a new way of working.
We set up our own academy to support that learning process. In the end, it was a major success: the number of court-ordered interventions and out-of-home placements was halved, and we saved tens of millions in unnecessary youth care costs.”
Innovation creates new obstacles elsewhere
“Still, two things troubled me. First, the method didn’t spread nationwide — the classic ‘not invented here’ effect. We collaborated a lot with the Dutch province of Zeeland, training their people through our academy at cost price. Yet some thought we were trying to take them over. Our enthusiasm was misread as arrogance.
Second, other subsystems didn’t change with us. We’d finally managed to motivate resistant families to seek help, only for them to end up on a waiting list for six months. Or the municipality would ask, ‘Why are you 10% more expensive than similar organizations?’ Because we invested heavily in staff training, certification, intervision and supervision. They forgot we were saving the system €30 million.
By working with the city, local teams could handle more cases themselves — which meant the ones that still came to us were far more complex. The workload grew heavier. If you then insist the number of cases per worker stays the same, you risk staff burnout. Every innovation creates new bottlenecks elsewhere in the system.”
Scaling success
“That issue — how hard it is to scale up success across a whole sector — stayed with me in my next role as Secretary-General at the Ministry of Health, Welfare and Sport (VWS).
I used to receive letters and emails from parents of severely disabled children. I invited two couples to my office, along with the Deputy Director-General for Long-Term Care, the head of the Care Assessment Centre (which determines care needs) and the regional Care Office director (which approves and pays for care).
The parents explained that twice a year they had to fill out an 80-page form to prove their child was still severely disabled. You could see the shame on the managers’ faces. Nobody gets out of bed thinking, ‘How can I make life harder for these parents?’ — and yet we do.
I suggested letting the parents propose a solution themselves. They said: complete the full assessment once, and then every few years only update what’s changed — children grow, need heavier equipment, more support. That idea made sense. Three months later, the minister sent a letter to Parliament adopting it in full.
This grew into the national movement ‘Wij zien je Wel’ (We Do see you), a network organization where parents and policymakers work together on improvements. One innovation was the introduction of a co-pilot role — a family supporter who looks after the whole family, not just the child.”
Missing funding models block scaling
“Another example was remote care through video consultation. In the Achterhoek region, there was a pilot for chronic conditions like COPD (lung disease that constrains the absorption of oxygen), heart failure and diabetes. Two hundred patients no longer had to visit hospital; they took their own measurements and discussed them via video calls with a specialist nurse or doctor. Within months, unnecessary hospital visits and COPD crises dropped by 60%.
I met the healthcare manager who led the pilot and asked about scaling. He said: “Scaling up will cost us money. There’s no funding model for it. The home-care organization bears the costs, but the savings go to the health insurer. Yet the model could easily cover all 4,000 similar patients in the region”.
I proposed a working visit — me as Secretary-General — and asked him to invite all key parties: home-care provider, hospital, GPs and insurers. During the session, an older patient shared his experience, a nurse presented the workflow and outcomes, and someone from finance showed the cost–benefit analysis — down to visitors’ parking fees.
I asked how we could scale it to all 4,000 patients. The hospital director foresaw revenue losses from fewer treatments; insurers were reluctant to bear the transition costs or compensate the hospital. After that meeting, we developed a ‘shared savings’ model: over several years, costs and savings would be distributed gradually, with annual financial monitoring.”
