Erasmus MC staff playfully fitter during night shifts

January 28

‘Thanks to the KoersKaart, a dialogue is created that you don't normally get quickly.’

A care innovation does not always have to be technologically advanced. It can also be a social innovation. A good example of this is the KoersKaart Fit in de Nacht, a 'serious game' that ensures that Erasmus MC employees can work their night shifts fitter and more vital.

Some 5,000 Erasmus MC employees work night shifts. Because this is difficult for many employees, the hospital wants to help them as much as possible. For example, special sleeping pods and night goggles were purchased and extra attention was paid to nutrition prior to and during night shifts. Erasmus MC was also looking for a good way to get employees to think for themselves about questions such as "How do you stay fit during your night shift" and "How do you keep working with pleasure?” The ultimate goal was to allow employees to stay fit through the night, but also to keep them longer as night shift workers.

Collaboration The Course

In order to take this social innovation further, Sonja Smits (work and organisation expert at Erasmus MC) went in search of a suitable partner. In the end - partly thanks to support from Zorginnovaties010 - she ended up with the company De Koers, which helps (large) groups to put complex themes on the map in a playful and structured manner. De Koers does this for corporates and various ministries with a self-developed, scientifically based methodology. The common thread: participants discover together the route from the current situation to the desired situation.

Interesting issue

‘We immediately found the issue that Sonja came up with interesting,' says Hendrik-Jan Martens, one of the founders of De Koers. ‘Not only because Erasmus MC is a great organisation to work with, but especially because night work involves very specific challenges. The nurses are fighting their biological clock, but at the same time they have to perform at their best. After all, patients expect the quality of care at three o'clock in the morning to be the same as at three o'clock in the afternoon. What's more, it's important for both employees and Erasmus MC to be able to keep up this work for years to come.’


In order to gain a good understanding of the theme, De Koers engaged in a first session with some fifteen stakeholders. Policymakers and employees from various departments within Erasmus MC, as well as employees from TNO (semi-government and science) and RET (24-hour organisation with night shift workers) were involved. ‘We always work on the basis of co-creation,' says Martens. ‘That's the only way to highlight the theme from all sides and to understand the context well. This way, we first make the current situation transparent. While talking, a group comes to the desired situation: the ideal picture. In order to get from A to B, a route is needed. That is where our expertise comes into play'.

Serious game

This is how the KoersKaart Fit in the Night was developed. A so-called 'serious game' in the form of a poster (and/or web app), with questions and assignments that night workers in groups of four to eight people deal with. In the first half of the game they get to know each other and the theme. They discuss whether they are a morning or an evening person, what effects the night shift has on themselves, the home situation and the quality of work, among other things, and think about what a perfect night shift looks like. In the second half, they translate this into concrete experiments and action points, which they rank on the basis of impact and urgency.


Martens: 'It's not a real game, because it has no winners and losers. But because of the different question blocks, the time limit and the different roles everyone has, it is experienced as a game. Above all, it's about creating a dialogue between employees that you wouldn't otherwise be able to initiate so quickly. Of course, people always have ideas about how things can be done differently or better. But thanks to this Race Card, people become really aware of the route and we activate people to take concrete steps together and share knowledge. That's how it becomes our own.’

Rich data

The employees participate anonymously. All input is digitally recorded and can be viewed by managers. ‘It provides valuable input for Erasmus MC’, says Martens. ‘Matters are discussed that do not quickly come up for discussion during performance reviews. You won't get this back if you have all employees fill in a questionnaire. That's why the data Erasmus MC receives is so rich.

Quantitatively, because, thanks to our methodology, we receive broadly the same input from all 5,000 employees. But above all, qualitatively, because employees have already discussed with each other and have noted down well-considered information. The organisation can translate this "collective intelligence" directly into policy. If, for example, 3,000 employees say they like to work with night glasses, Erasmus can do something with that'.


The KoersKaart Fit in de Nacht is currently being used for the first time in several departments of the Sophia Children's Hospital and will be rolled out further afterwards. De Koers and Erasmus MC have a (mutual) licensing partnership. Martens: 'De Koers brings in the methodology, Erasmus the knowledge. Once we have the first results, knowledge will be released that we can use to further develop this programme or to zoom in on certain themes. In addition, together we can take this solution further to other organisations that work at night. Not only within the healthcare sector, but also, for example, at the RET and companies in the chemical industry.’

The KoersKaart Fit in de Nacht was realised in part thanks to Zorginnovaties010, a programme of the municipality of Rotterdam in collaboration with Erasmus MC. The new website of Zorginnovaties010 will be officially launched during the third edition of the LSH010 Hybrid Breakfast on Thursday 10 December 2020. The theme is 'How to finance your healthcare innovation? Click here for more information, the programme and to register! In the run-up to the LSH010 Breakfast, inspiring articles about the 3D Baby Scanner and Scolioscope will also be published.