Machiel van der Schaaf started at Martini Hospital six months ago. As Chief Information Officer (CIO) and IT Director, it's his mission to shape and form the digital transformation within the hospital. In this interview, Van der Schaaf tells us about his personal motives, the challenges for his hospital, and how he envisions the future of healthcare.

After years of working for the government, you started at Martini Hospital in September of 2020. What makes healthcare so appealing to you?

I have been socially involved my entire career. Healthcare is a unique sector where you are able to make a difference. It's also a field where you work with people and for people. Throughout my career I've noticed that those are the environments I am always looking for and where I feel most at home. Caroline, my wife, works in another hospital and we often discuss the digitalisation of healthcare. For years, I've been hearing that the digitalisation in healthcare can still be improved a lot. That was the perfect trigger for me to start contributing to the digitalisation of healthcare. 

As CIO, it is your responsibility to make sure all IT-related matters run smoothly, now and in the future. What has the highest priority?

The most important thing is that the IT foundation of the Martini hospital functions as it should. All staff should be able to do their job 24/7 unhindered and assisted by proper IT. There is a challenge in figuring out how to create the proper balance between continuity and development. My mission is to form and shape the digital transformation within the hospital. We have already accomplished several feats in that process, somewhat 'thanks' to COVID-19. We suddenly had to offer certain forms of healthcare digitally, because our patients were not able to come to the hospital. Now, our goal is to maintain what we've accomplished and to expand further on that. We want to implement all digital tools and conveniences in the hospital that we're already using every day in our own homes. That doesn't just happen by itself. There is still a lot of work to be done. 

How are you going to realise this?

On multiple levels: the IT support is up and it's running great. In that respect, I was pleasantly surprised when I arrived at Martini. The next step is to start the digital transformation and to broadly embed it. A beautiful opportunity arose there, because Martini was busy developing the new strategy for the next few years. This was the ideal opportunity for me to incorporate the digital strategy to the other strategy. That immediately gave us course and direction, but, especially, more focus and energy. That's what you need, because there is so much to do. If you're not careful, you will many projects half-finished. I have experienced with my previous employers that it's often better to focus on a few projects and outline and execute those projects really well. A widely supported strategy will aid us a lot in that process.

That requires leadership. How do you handle that, as a relative newcomer in the hospital?

That is a challenge, because getting to know colleagues and coordinating isn't easy under the current circumstances. For me, it always starts with cooperation. That is crucial, especially in a process such as the digital transformation. It isn't just an IT project you can undertake with only IT staff. Digital transformation requires you to work together when you tackle the hybrid forms of healthcare you want to implement. That has consequences for the organisation and the way you shape processes. For this, cooperation with the healthcare staff is very important. We don't just need to cooperate internally, but externally as well. We need to coordinate with healthcare facilities regionally. The rest of the region is also important when realising a digital strategy. It doesn't stop at the walls of our hospital, after all. That's how you make sure that the digital transformation is embedded properly and that it actually makes a difference. That does require leadership, courage, and entrepreneurship. You'll have to walk roads you have never walked together before. Luckily, there are a lot of people in our hospital willing to pull through on this.   

How important is the support of the board and the medical staff for the transformation?

That support is crucial. You need colleagues that back your plans. I spend a lot of attention and time on that. For example, we have organised sessions we can use to plan and shape the transformation together. Our IT staff has also visited all departments to ask for input for the strategy . They asked the care givers what comes to mind when they hear terms like 'digital first', for example. Those answers have been mapped extensively. That is how you create a good base. It's also important that the board participates in and supports the transformation. Personally, I often meet with our CMIO, who has an important role in the process. They need to explain to the medical staff what the possibilities are with the digitalisation of healthcare. Shaping and forming a digital transformation relies on teamwork. 

Besides cooperating internally, external cooperation becomes increasingly important in healthcare. What is your perspective on that as CIO?

We are no longer able to keep up with the tumultuous developments in IT by ourselves. The only real solution for that is through cooperation with other organisations. The first thing I think about for Martini Hospital is cooperation on a regional level, in the northern provinces of the Netherlands. We are already doing a lot in terms of cooperation here, but as far as I'm concerned we could expand on the existing cooperation. I also see a lot of amazing opportunities to cooperate on a national level, with the Santeon hospitals, in order to strengthen each other in the digital field. 

What else is needed to properly establish data exchange between healthcare facilities?

The ideal situation for me would be that, in a few years, we will be able to exchange all relevant information through national and international standards with all healthcare providers, both regionally and nationally. That has to be possible, because it became apparent that because of 'COVID-19' a lot more is possible that we thought before. New digital options have so much to bring to the table. One of the most important puzzles for the Martini Hospital, right now is to make the right choice from all portals and marketplaces where the supply and demand for healthcare information will meet. Such portals are springing up like mushrooms. What do you prioritise as a hospital? That's a diffuse and complex issue.

We're also thinking about how to shape the network healthcare of the future in the north of the Netherlands. Optimally, we would use network care paths, crossing the borders of healthcare facilities and the northern provinces, so we will be able to offer the proper care at the proper place with the proper information. We've started developing a network architecture in the northern provinces that will hopefully help us organise the data exchange more clearly and intelligently. Meanwhile, we have already realised a portal in Martini that has elevated the level of data exchange with general practitioners. We regard this portal as a great first step. We aim to add other healthcare providers to this portal in the future. Those developments will be made in the next few years and cooperation, again, is key in that process. 

Cooperation and data exchange also require a lot from an electronic health record...

That's right. Our EHR, HiX, is a very important source to make data exchange - both incoming and outgoing - possible. An open and interoperable EHR is essential for Martini in order to realise our ambitions in multidisciplinary cooperation. That cooperation can't start soon enough, if you ask me. The developments in that area aren't going fast enough. This is an appeal to ChipSoft to make this a project with high urgency. 

The patient's share in this is also increasing. Which role are you envisioning for IT in this?

I think that patients should be able to have high demands for the care providers and for the provision of information. That is something you already see in other sectors. Sadly, this is not yet commonplace in healthcare. If you look at the current systems and work processes, this does not yet meet the patients' needs. There is still a lot of work to be done. The national government is also setting higher requirements in the areas of personal health environments (PGO), accelerator programmes for data exchange between patient and professionals (VIPP), et cetera. A lot of progress is yet to be made there. If we also succeed in being able to offer the digital forms of healthcare in an approachable manner and in comprehensible language, we will have made some very amazing strides in this field. Involving the patient in that process is self-evident, I think.

How do you make sure that you maintain the proper balance between directing for the healthcare institution and directing for the patient at Martini?

That's an interesting question. A lot of areas require more and more from the people: municipalities are putting more responsibility on the citizens, banks on their customers, et cetera. I noticed that when I was working as CIO for the Leeuwarden municipality. I think we are also able to place some more responsibility with our patients. There is a limit there and that limit, however, is not one-size-fits-all. It will have to be customised. When looking for solutions, you will have to speak to patients through patient groups to hear what they would want. It's important to listen to their wishes and needs and take those wishes and needs into account during the development process. In other words: don't think about what the patients might want, but ask the patients what they want. You will then reach an optimum which might be different across different patient groups. 

Previously, you were active in several digital management roles, for example at the police department and the Leeuwarden municipality. Are there insights you've gained in those areas that you have brought with you to healthcare?

Absolutely! A movement has been going on for at least fifteen years in the police departments where they use intelligent data to catch more criminals. The focus is on the question: how do you use data to make the country safer? If we are able to make data work for us in healthcare, there are a lot of possibilities to make the healthcare facilities more efficient and effective. In Leeuwarden, I've learned how powerful cooperation between several parties really is and have taken that with me to the healthcare sector. Several ecosystems have been created there where the public, private businesses, knowledge institutions, and other parties will come together in different combinations in order to tackle social challenges. Those ecosystems are starting to reap the results in the municipal context. More often than not, these are multi-problems that have to be worked on together. That is no different in healthcare. As CIO and IT director at Martini Hospital, I think that our hospital has to play a more participating and proactive role in further shaping the cooperation and the ecosystem, so patients can reap the results.  

What else can be improved on in healthcare if you compare it to other sectors?

You can see that in other sectors a lot of administrative and repetitive tasks are done by robots. People in healthcare are often still mistrusting of that. Healthcare is a sector where human lives are at risk, so we'll have to have that discussion in a very precise and meticulous manner. However, such solutions will do healthcare providers enormous favours. Look at the financial sector, for example. They use robots with intelligent algorithms to limit financial risks. There are numerous examples like this. In Leeuwarden, we had a robot working for sanitation. That robot was searching for weak points preventively. This allowed us to perform maintenance before any problems would arise. There are also robots that can perform administrative tasks 24/7. That will clear a lot of hands of care workers that can then focus on providing care. Let's just embrace it and use robots to solve these types of issues. 

Where would you like Martini to be in 5 years, in terms of information provision?

That is hard to say. Nowadays, strategies you create will already be outdated in three years. At the same time, when I look at our ambitions and if our digital strategy is an appendix of that, it would be amazing if there were a hybrid form of healthcare - physical and virtual - that is commonplace. And that patients are really pleased about it and optimally involved in the further configuration of these virtual forms of healthcare. If we have realised the intelligent use of our patient data and the use of robots, as well as Artificial Intelligence that can actually support us in the healthcare process, I think we can be more than pleased on what we've achieved.

Do you dare to look further?

Yes [laughing], I do like a good vision for the future. Incidentally, I was watching Star Trek with my son recently. I saw a futuristic scanning device that instantly helped people recover. That is the direction we're heading eventually; patients will be scanned and, based on intelligent knowledge, lights will start to blink if anomalies are detected. The digitalisation of healthcare will not stop and it will only become a bigger factor. It will surely go a lot further than we can even imagine at this point!