Onion Framework – When Dutch Health Realised Productivity Wasn’t About Seeing More Patients

It was just after 8:00 in the morning when Marianne, a community nurse in a small Dutch town, knocked on the door of an elderly gentleman recovering from hip surgery. He lived alone, and on paper his care plan looked comprehensive. A physiotherapist visited twice a week. A social worker checked in periodically. Meals arrived each afternoon. One nurse helped him dress each morning; another came later to manage his medication.

Every provider on the roster was doing exactly what they'd been asked to do. Every visit was scheduled, documented, measured. And yet, weeks . . .

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