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St. Bernold’s Hospital:Building on Compassionate
Human Care
,St. Bernold’s Hospital: Building on Compassionate Human Care
Introduction
Director Mayra Westman looked towards the nurses’ hall adjacent to her office at St.
Bernold’s Hospital in Apeldoorn (hereafter St. Bernold’s), the Netherlands. The clock
on the wall beyond the counter showed it was just past six in the morning, but the
abundant May sunlight was already illuminating the place. Director Westman had no
time to lose before the board meeting started at eight. She closed the door and sat
down to review St. Bernold’s 2021 annual report one last time. The previous year had
been tough. The hospital had been hit hard by Covid-19 and was lagging in its regular
care. The takeover of St. Eustachius’ Hospital in Zwolle (hereafter St. Eustachius’) that
began in 2019 was still in progress. The explosive workload had taken a toll on
employees at all levels, with absenteeism higher than ever, mainly due to illness and
fatigue. The hospital had been forced to hire extra staff to be able to cope and it had
received less income from outpatient visits. Although they had managed to end the
year with a positive €4.5 million, Westman’s resilience and leadership had been tested
in an unprecedented way.
In early 2022, St. Bernold’s stood larger than before, serving the people in the central
Dutch provinces of Gelderland and Overijssel with dedicated care while maintaining
a healthy 15th position in Newsweek’s ranking of best Dutch hospitals. However, the
hospital badly needed to regain its footing in elective care and stabilise its financial
standing after two difficult years. How could St. Bernold’s best approach these
challenges to be able to thrive in an increasingly competitive healthcare market and
be suitable for what the future held?
Healthcare and the Dutch Hospital Sector
The healthcare sector in the Netherlands had expanded consistently over the years,
with the government spending more than €100 billion on health in 2020 (Appendix
1), equivalent to 11% of the country’s gross domestic product (GDP). Approximately
one million people were employed in the sector (Appendix 2), roughly encompassing
21,000 medical specialists, 20,000 general practitioners, 69 hospitals and 35,000
hospital beds throughout the country.
This teaching case was written by Paula Arellano Geoffroy under the supervision of Dr. Martina Buljac, Dr.
Sandra Sülz and Dr. Jeroen van Wijngaarden at the Erasmus School of Health Policy & Management
(ESHPM). We like to thank Tao Yue at the Rotterdam School of Management (RSM)’s Case Development
Centre for her input.
This case is based on desk research. It is written to provide material for class discussion rather than to
illustrate either effective or ineffective handling of a management situation. The names and some quotes
have been fictionalised to maintain the privacy of the people and institutions involved, and to better serve
the case discussion.
Copyright © 2022 RSM Case Development Centre, Erasmus University. No part of this publication may
be copied, stored, transmitted, reproduced or distributed in any form or medium whatsoever without the
permission of the copyright owner. Please address all correspondence to cdc@rsm.nl.
2
, St. Bernold’s Hospital: Building on Compassionate Human Care
The Dutch hospital market had become increasingly concentrated over the last 40
years. 1 Since 1960, roughly 135 hospital mergers had taken place (Exhibit 1), 30
hospitals had exited the market, and only one general hospital and a few treatment
centres had entered. Successive government policies seeking to increase hospital
quality and efficiency had brought about this structural change. Nonetheless, over the
last decade, public critique of hospital mergers had appeared, causing a policy shift
towards incentivising competition. As pressure from competitors, health insurers and
municipalities increased, healthcare executives had become inclined towards mergers
to strengthen their market positions and bargaining power.
Exhibit 1. Dutch Hospital Mergers per Decade
Source: https://repub.eur.nl/pub/108851
As a way to compete and differentiate themselves, hospitals tended to organise their
work in centres focused on specific patient groups (e.g. hospitals for the elderly),
offering multidisciplinary care to patients who often had comorbidity (multiple
illnesses at the same time). Insurance companies also assumed larger roles, financing
those groups of patients instead of hospital activities. Even though life expectancy in
the country was high (Appendix 3), forecasts predicted a rise in both the demand for
and costs of care due to demographic changes2 such as population increase (up to
18.4 million by 2060), aging (26% of the population would be over 65 years old by
2040), and chronic disease (55% of the population was likely to be diagnosed with a
chronic disease by 2040). The main trends3 for the future of healthcare predicted
customised therapies for specific patient populations, data analytics and artificial
intelligence for predictive medicine, and telemedicine for virtual monitoring and
treatment programmes. Therefore, technological innovation and digital health
implementations were considered essential for healthcare providers in the near future.
St. Bernold’s Hospital in Apeldoorn
The hospital was founded in 1976 as a result of the merger of three hospitals in the
province of Gelderland. After a decade of renovations, a new regional hospital was
officially inaugurated in Apeldoorn in 1988. Named after St. Bernold of Utrecht, a
medieval bishop and reformist who helped reduce episcopal powers over monastic
3
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