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Experiment Ruwaard: Thinking, acting and organizing differently!


Susanne Smits ,

Robuust, NL
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Bart Bakker,

Gemeente Oss, NL
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Jord Neuteboom,

Viatore, NL
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Franca van Rosmalen,

Robuust, NL
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Lonneke Hoop,

Robuust, NL
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Sandra de Loos

Robuust, NL
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Introduction: In Ruwaard, a community in the municipality of Oss (the Netherlands) several organizations collaborate to realize their dream for a more sustainable  future: “Ruwaard is a vital community where residents sustain their lives with  a better (positive) health at lower costs”. 

Objectives: The residents and the service providing organizations  aim at five strategic objectives:

-  Better health and experienced quality of life for individual residents

-  Lower social costs for the community

- Better and well  integrated services for healthcare, social services and housing

- More collaborative participation and collective responsibility by residents

- Better supporting systems (that accelerate all of the above)

Targeted population: There are approximately 13.000 residents living in Ruwaard. These residents  have a generally lower social economic status, significantly more lifestyle related diseases, a lower mental health and the total amount of 75-year old persons is significantly higher than elsewhere in Oss

Highlights: To reach these objectives several behavioral changes are realized in collaboration with residents and  the different participating organizations. Residents are active participants and initiators  in these changes. Bottom line in this radical approach: residents, professionals, managers and executives have to think, act and organize differently. This also requires  new protocols, structures and cultural changes in the social domain and primary care of Ruwaard.

A resident and his question for help are the center of the new routine in the care providing process. During a multidisciplinary meeting this question for help is analyzed by asking the three main questions that are answered by the resident: ‘what matters to me’, ‘what can I do myself’, ‘what form of support do I need from others ’. The answers to these questions lead to solutions and activities  that are resident driven  and owned. These three main questions are also used to identify necessary changes in well-being and precautionary measures for the resident and to establish a new integrated care ecosystem.

In more than 150 individual cases the working principles of this Ruwaard method were used. The outcomes are:

a much higher rate of wellbeing (self-rated and self reported by residents)

substantial savings by using the three questions in delivering (social) care support

improved collaboration between professionals from different organizations

Transferability: Most of the involved organizations are working in larger areas and want to introduce this method and working principles in these other areas. First examples are available.

Conclusions: The new approach in Ruwaard has a deep impact on the Ruwaard community, on the residents’ own effectiveness, the working method by professionals and attitude of care organizations.

As a result of the preliminary outcomes the municipality of Oss made the  total social care budget available for this community in Ruwaard for this new cross-organizational working method. In this new context the participating organizations are accountable for (social) care outcomes in this community. Ruwaard develops towards an interesting experimental working place to prevent unnecessary health care, cutting down borders between fragmented health care organizations and dismantle systems with too many restrictions. 

How to Cite: Smits S, Bakker B, Neuteboom J, van Rosmalen F, Hoop L, de Loos S. Experiment Ruwaard: Thinking, acting and organizing differently!. International Journal of Integrated Care. 2018;18(s2):28. DOI:
Published on 23 Oct 2018.


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