We all know it: healthcare is knee-deep in shit.

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But what’s the problem behind the problem? And what does the solution look like? In our quarterly column series ‘Operation New Welfare,’ Dytter founder André reflects sharply on healthcare and the state of affairs surrounding the revolution that our platform is unleashing.

We’ve all heard it on the news: the healthcare branch is panicking. The number of salaried healthcare providers who switched to self-employment increased by more than 56,000 in the past five years. Still, healthcare costs are rising, and a look towards the future teaches us that they might even double by 2040. “Staff shortages!” people claim. Or “Self-employment in healthcare? Let’s #cancel!” But that’s just too easy. So what is the real problem?

At Dytter, we perform market research and talk to countless people that work in healthcare. From that research, it becomes apparent that healthcare providers have too little say in when and where they work.

Even more so, they tend to go over their own limits as a result of peer pressure – “Aww, are you really unable to go to Mrs. Clark for two extra hours? It’s so busy!” Many healthcare professionals work in healthcare because they have a big heart and they, well, care. If you put these carers under too much pressure, they will oblige to go to Mrs. Clark, even when they don’t have any energy left: neglecting their own needs in order to care for others.

They accept the unhealthy work pressure. The inconvenient work schedule. The traveling distances that don’t match up with where they prefer to work.

About healthcare, some might say “healthcare with love.” But that love is rarely aimed towards the healthcare provider. Instead of love, there is continuous pressure that everything has to go even faster, even more efficient. More clients, in less time. But that’s not what makes caregivers feel good – and clients even less. That’s not why they chose to work in healthcare. They feel rushed, their lives dictated by inconvenient works schedules, and tired in their work.

Thus, it’s not crazy that more and more healthcare providers choose the self-employment route. Not for the money, which is often what they’re accused of, but for flexibility and freedom. For being able to maintain their boundaries. For the energy that they can spend on other important people in their lives – hello partner and kids.

"There are whole armies of loving people who are willing to provide good care, either salaried, freelance, or as volunteers. So when are we going to start utilizing that?"

André, the founder and creator of Dytter

Then the side of healthcare organizations. What is the problem behind the problem there? They have agreements with health insurers, which state that they have to help a certain number of clients. But if a part of their personnel disappears to work freelance and another part decides to work less – averaging from 29 to 25 hours a week in the Randstad – then how can you achieve that without the costs skyrocketing?

Not only the costs of hiring people externally and having them settle into the work routine, but also sharing information between salaried healthcare providers and externally hired freelancers is costing more and more time and money. And thus it costs the clients more time and money too.

The result? Clients receive less attention and the bank is breaking. Panic all around. That’s the moment when healthcare organizations start to experiment with more and more ways of organizing, planning, and working. They hire expensive consultants. But is there any real change? No. Investments still don’t translate into more efficient care, but rather break the bank even more. Many people in healthcare are tired of this – it’s not uncommon to see a sick-leave percentage of 18% during some periods.

But then what is the solution?

Well, winning back the lost hours. Those 25 hours a week need to go back to 30. When that happens, there are more hands at the side of the bed – which is the only thing that counts. How to achieve that? Simple. By listening to all those caregivers that have switched from working salaried to being self-employed. So: good employership. A say for caregivers in where and when they work. Appreciation for what they do, day in, day out. And having them participate in thinking about ways to enable the freedom of choice that they crave.

That’s how you treat caregivers in a way that removes the reason to go freelance, and shows that working 30 hours a week is feasible. Without going over limits.

Another solution for healthcare organizations: allow hybrid working. Allow your healthcare providers to work partly as salaried workers, and partly in self-employment. For example, 24 hours salaried, and a couple hours freelance at another healthcare organization. That way we increase healthcare capacity and cater to the needs of providers in terms of flexibility. And we take away the urge to completely leave the field due to being unable to combine their work life with their private life.

Umbrella organization De Rotterdamse Zorg is already experimenting with this – we have to, is what they’re thinking. A good thought, if you ask me. Because why wouldn’t we divide all the salaried, self-employed, and voluntary caregivers in a smarter way in order to solve the shortage?

There is one big But. The system must cooperate. Because as long as the Tax and Customs administration doesn’t make it possible to work in self-employment as well as working salaried hours, solutions like this are impossible. As long as the tax authorities make it impossible for the countless volunteers in the care sector to receive a small, tax-free compensation for their much appreciated work, we are actively maintaining staff shortages.

Conclusion: healthcare organizations can seize opportunities by listening more closely to their caregivers. It is the ministries’ task to come up with a joint plan to make smarter use of the various available sources, from salaried care providers to freelance professionals and volunteers. And the tax authorities? They can do what they’re good at: enabling these plans by raising fair and targeted taxes – and not by doing so where that’s inconvenient.

There are whole armies of loving people who are willing to provide good care, either salaried, freelance, or as volunteers. So when are we going to start utilizing that?

Stay tuned for the revolution.
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