About 2018-02-21T11:02:42+00:00

Wicked problems

We think healthcare is transforming. That’s great. However, healthcare has a hard time doing so.

Demands are on the rise, but services increasingly fail because of understaffing and over-spending, despite a world-wide average increase of national expenditures. Also, innovations’ return-on-investments (like e-health) are often disenchanting and implementing comprehensive change (like: value based healthcare, Triple/Quadruple aim or integrated care) often meets with change management issues, relating historic boundaries between old professional silos and turfs.


How to deal with disruptive (technological) change? How can professionals adapt effectively to shifting roles and responsibilities? What are effective 21st Century healthcare workforce skills and knowledge and how should we invest in those? And how should we deal with healthcare’s ancient, hierarchical and unwritten rules that are hard to change? How can we transform our regions into efficient networks of complex adaptive systems, with multi-disciplinary teams working based on a patient-centred culture of continuous improvement? How can we facilitate SUSTAINABLE transformation?

Send in the change management experts? We think not.

Expert opinion indicates that answers are harboured in the soft factors within organizational change, interdisciplinary collaboration and behaviour of people. Moreover, latest research indicate so called ‘socio-technological’ issues a last barricade for healthcare innovation.

And here’s where DIRMI comes in.


A new focus

Expert opinions indicate that many answers to the above questions are harboured in soft factors within organizational change, interdisciplinary collaboration and behaviour of people. Latest research tells us that the ‘socio-technological’ issues are the last barricade for healthcare innovation. This growing body of scientific evidence and field experience tells us to focus on the epicentre of healthcare transformation: the men and women creating it together. At a daily basis, these are the people who endure the impact of disruptive changes. And collectively they are holding the key to sustainable transformation. Facilitating them in transforming, during ‘opening-hours’, requires adequate expertise and best practises in institutional change, group dynamics, leadership avant-la-lettre and new forms of governance in healthcare.

Healthcare and medicine are probably the oldest trades in the World, but urgently need a hand in adapting to the Information Age. – Anonymous


We believe investing in human factor elements of interprofessional practise, (medical) leadership and collaborative governance can contribute to up to 10-15% increase of effectiveness in healthcare’s processes and successful implementation of innovation.

We also believe that such investments will significantly help create an agile 21stCentury healthcare workforce, highly capable in performing in and across novel networks of technology-enabled integrated care settings.

The way forward, in our opinion, is to learn more about how to change or improve ‘old’ ways of communicating, interacting and engaging between people and across teams and organizations. Go beyond redesign of processes, and dare to enter the relatively new but contested territories of professional identity reform and deeply enshrined organizational cultural change. Along ‘evidence based’ approaches, naturally. Since these terrains might seem new, they are sturdy scientific domains holding much promise for solving our wicked problems.

We believe that by synthesizing experience and endurance of scientists, field experts, entrepreneurs, managers, administrators, clients/patients and many others, we can learn how to better cross boundaries that often keep healthcare from transforming the way it should.

So, that’s why DIRMI.

Some background

Some time ago

We have learned a lot from our early work in change management, (medical) leadership and team work. With contours of the current DIRMI Institute gradually emerging, about half a decade ago, we contemplated about ‘DIRMI’ as the acronym for ‘Dutch Institute for Research and education on Medical leadership and Interprofessional practise’. We have come to the conclusion that what is needed, is more than change management, leadership and teamwork. Much more.


Fear for change

Adequate sharing of information comprises use of sophisticated information systems, as well as effective collaboration between people. We also know that about 80% of collaboration is based on communication, which is predominantly influenced by nonverbal communication. And this is where things start to be complex.

Research and experiences unequivocally proof that people often find it hard to speak up or to receive feedback. Also, due to similar underlying emotions (e.g. fear), most people dislike change – in particular the disruptive kind. Research also brought us to the understanding that, bluntly put, significant amounts of people die, due to preventable adverse event caused by human factors. Yes, there is a correlation.

Factors hampering effective communication or change are often strongly related to individual attitudes and behaviour, as well as organizational culture. Concepts like ‘just culture’, ‘safety climate’, ‘patient centred care’, cannot do without a culture of psychological safety and trust. Consequently, establishing such climates is highly beneficial to safety, to innovative ideas and … transformative activities.

Dirmi … what?

Like most important things: it starts small. Transformation starts with the individual. In particularly when things get difficult it is a challenge to speak your mind, be open, provide or receive feedback. To collaborate towards sustainable change. Or vice versa, to effectively listen to others as well as to ourselves. This makes or brakes quality and innovation.

However vague all this might sound: at DIRMI we know of lots of science that shows the significance. It’s the soft part, that is the hard part. We think that creating or maintaining a culture of continuous improvement starts with ‘dirmi’ – Italian for: ‘please tell me’.

Roots & foundation

DIRMI was founded in 2014 and officially launched in 2018, with support of partners, including the University of Twente, the Netherlands.

The DIRMI vision is based on extensive (action) research work and field experience of healthcare transformation experts, in particularly those contributing to Projects featuring on this website.

Part of the DIRMI work is rooted in the PhD projects and prior work of Wouter A. Keijser MD, who is research associate at the Faculty of Behavioural, Management and Social sciences (Chaired by Prof Dr. Celeste Wilderom), University of Twente and healthcare transformation coaching expert at Wacomed BV, Utrecht the Netherlands, and HIM SL, Barcelona, Spain.

DIRMI’s lifecycle

We believe that healthcare transformation will take significant time. However, in some years from now, the way things-are-done in healthcare will have changed. Moreover, we foresee that the ‘way’ people and institutions in and near healthcare will be able to continuously change and adapt. At that time, DIRMI will cease to exist.