Founder of "Keep things small - innovation in the health care sector is too massive"

2 June 2016

The online accommodation booking website is often mentioned within the health care sector as an example of innovation. The company revolutionized the hotel sector, growing from a one-man company to an international success story with 12,000 employees. Geert-Jan Bruinsma, the founder of, was my roommate once upon a time. I visited him in Amsterdam to find out what lessons the health care sector could learn from this giant of innovation.

Geert-Jan was graduating university in Enschede in the Netherlands when the World Wide Web was just coming into prominence. He was immediately fascinated by the new medium's technological possibilities, but at the time he didn't have much company. "A few people realized that the World Wide Web could provide solutions to everyday problems, but the vast majority assumed it was just a passing fad," he remembers.

Of course he was part of the first group. He quickly got the idea that the new technology could be used to make booking a hotel room much simpler than it was at the time.

"I'd like to reserve a hotel room, please..."

"That's how we started, by developing a solution to this common problem." Back then, in 1996, making reservations in a hotel was a nightmare, especially if you had to book a room in a foreign country. First you had to find out what the country code and telephone number were (and this was often a roundabout process) and then you had to do your best to communicate with the hotel receptionist and hope that nothing got lost in translation. Some readers will no doubt be able to remember doing this.

And that was a problem for both the travelers and the hotel owners. "It was a ridiculously complicated affair. I realized that the internet might pose a solution," Geert-Jan explains. "So that's how we started, by developing a solution to this common problem."

Using new technology to solve problems

This idea of using new technology to solve a problem would prove to be a recurring theme as grew. It is also a recurring theme in my conversation with Geert-Jan, because he soon starts talking about startups. "I really enjoy seeing the entrepreneurialism, but the audacity I see in a lot of starters is amazing. Too often they are only interested in getting as many people as possible to use their technology without wanting to solve a genuine problem."

He believes that innovation starts the other way around. "People experience a problem that so far has been unsolvable, but thanks to a new technology it's suddenly possible to solve it. If you do that incredibly well, users will follow your solution automatically."

Innovation in health care

"Innovation in health care is not a goal in and of itself." According to Geert-Jan's idea, innovation in health care should therefore not be seen as a goal in and of itself. "But in the health care sector, there are a lot of issues that create problems for people. To name just one example, I know a lot of people who are dealing with a chronic disease and for whom it is a serious difficulty to constantly have to get to the hospital."

The truly successful innovators examine these kinds of situations in detail and realize that they can use modern technology to create a genuine solution to the problem. Or sometimes they have to develop the technology. But often they can make a great deal of progress just by looking at existing technology and applying it in a clever way.

Small steps has chosen to progress and innovate in small steps. "We have 1000 developers in Amsterdam, and about 950 of them have no idea what they'll be working on next month. And more than half of them have no idea what they'll be working on next week. That's how small our steps are."

"The secret is in keeping innovations manageable." The secret is in keeping innovations manageable. has dozens of small teams, each of which is responsible for something else. All of a given team's energy, focus, and capacity is spent on optimizing that one detail, whether that's speeding up the booking process, getting better insight into reviews, or anything else. They are constantly improving their innovation, one step at a time.

Geert-Jan thinks that this is also how innovations in health care should work. "Keep things small. The health care sector is much too massive. Even a hospital or in-home care organization is too big. You have to think on the level of the user. A practical problem experienced by an individual patient, doctor, or nurse can be solved through innovation."

Tips for health care managers

Geert-Jan has three tips for health care organizations that want to work with innovations like eHealth.

1. Start from the problem, not from the technology.

"Despite all the temptations and promises of technology, the digitization movement is actually not about technology itself. If you want an innovation to be successful, you have to think from the point of view of the user. What problem are you solving? How can you use your technology to create a better user experience?"

2. Divide the issue into smaller pieces.

Whenever Geert-Jan reads about eHealth, he sees ideas that he considers far too large to be practical: wiki portals, patient files, and digitizing the entire hospital. His second tip is to keep things small.

"Start in a single department in a hospital and keep it manageable. From there you can grow step by step. And after each step, monitor whether things are still working. Only then should you move to the following step. If an idea isn't working, don't be afraid to stop using it! At, a lot of our ideas never make it to the consumer. That's part of the process."

3. Embrace scarcity, as it stimulates creativity.

This tip is rather unexpected. It's incredibly difficult to find talented programmers, so is constantly dealing with too little capacity. Even though this is frustrating at times, it improves focus. The limited capacity means that innovators are constantly having to decide what has top priority at any given moment, so that they can focus all their efforts on that.

"And you only want to work on the most important issues," says Geert-Jan. "Having limited budgets or labor makes you creative and goal-oriented." He believes that this applies to the health care sector, too. "In the rapidly changing landscape of technology, among all the millions of apps out there, there is no room for mediocrity. Don't waste time reinventing the wheel - make smart use of the things that are already there."

The biggest surprise: the human touch

"Our technology is given added value precisely because we combine it with real people." As the conversation comes to a close, we come around to the topic of how technology and humans cooperate. I talk about my vision of a "Blended Care" model - the combination of physical and virtual care.

Geert-Jan's eyes light up. "You know, maybe the most important department in is our call center. When I was just starting out, I thought that technology would make people obsolete, but the opposite is true. Our technology is given added value precisely because we combine it with real people."

Innovating is hard work

Even though I've known Geert-Jan for many years, I'm grateful that he was willing to take the time to share his experiences with me. As we pass the giant logo on the way to the elevator, I ask him if he had known beforehand that his ideas would create such drastic changes to the world of travel. He starts to laugh, and answers, "Luckily the word 'disruption' never came up when I was starting. I honestly did not have any plans to become the biggest player in the world. I simply went to work with an outstanding team, and we worked really hard for many years to solve a problem that people were facing."

I get in the elevator at the end of an enjoyable morning. Don't think too far ahead, focus absolutely on your user, enjoy what you are doing, and keep both feet on the ground. That's the best recipe for success I know!