Active Inertia and the Dutch Healthcare System: A Parallel to Football???

In my Strategy and Leadership elective during my MBA, I learned about the four hallmarks of Active Inertia, as written by Donald Sull of London Business School. I originally applied these ideas to something close to my heart—Manchester United—and the struggles they faced under manager and club legend, Olé Gunnar Solskjaer (refer to original article: link below).

But recently, I’ve found myself thinking about that same concept in a very different arena: the Dutch healthcare system. And more specifically, how it’s experienced today by the people within it, the people who support it, and the people who are trying to make sense of it—like expats, newcomers, and global-minded professionals.

There’s no shortage of mudslinging when it comes to the system—from international observers calling it “too relaxed,” to locals insisting “this is how we do it here.” But is it really just a matter of differing expectations? Or is something deeper at play here, something that can explain the growing disconnect between how the Dutch healthcare system is intended to work and how it is experienced by those who enter it from the outside?

Let’s first set the stage. The Dutch healthcare model is rightly respected for its emphasis on prevention, self-regulation, and thoughtful use of resources. It centers the general practitioner (huisarts) as the gatekeeper to the rest of the system, and discourages unnecessary testing, referrals, and interventions. For many Dutch people, it works—and has worked well for decades. The system is lean, structured, and remarkably cost-effective.

But cracks begin to show when the context changes. In recent years, the Netherlands has become more international, more mobile, more complex. People come in with different reference points for healthcare—some are used to being able to self-refer to specialists, others expect fast diagnostics, while others simply want to be heard without needing to prove they’re sick enough. And when the system doesn’t seem to meet them where they are, friction arises. The result? Frustration, mistrust, and sometimes, an unspoken standoff between “how it should be” and “how it actually feels.”

Which brings me back to Sull’s concept of Active Inertia—the idea that companies (and I would argue, systems) often fail not because they do nothing, but because they respond to disruption by doing exactly what made them successful in the first place… only more intensely.

Let’s unpack the four hallmarks of Active Inertia through the lens of Dutch healthcare:

1. Strategic Frames Become Blinders

Strategic frames are those mental models that help leaders make decisions and prioritize actions. But when they become fixed, they limit vision. In the Dutch system, there’s a strong frame around efficiency, minimalism, and evidence-based care. These principles are good. But they can become blinders when they prevent providers from recognizing that some patients aren’t just asking for antibiotics—they’re asking to feel seen, reassured, and included. It’s not a rejection of science—it’s a plea for humanity.

2. Processes Become Routines

Processes help systems scale. But when those processes become rigid rituals rather than adaptive tools, they lose their usefulness. In Dutch healthcare, triage protocols, GP gatekeeping, and referral requirements were all built for a purpose. But ask any expat who’s been told to wait two weeks for a consult about a worsening issue—and you’ll see how those same processes can feel like barriers, not support. What started as a way to avoid overuse is now being perceived as under-care.

3. Relationships Become Shackles

Strong provider-patient relationships are the bedrock of good care. But when the expectation is that trust must be earned over multiple visits before one’s symptoms are taken seriously, it creates an unspoken disadvantage for newcomers. Expats who haven’t built that relational capital are often left feeling dismissed or judged. And meanwhile, providers who stick to familiar methods and colleagues may miss out on new ideas or external expertise that could help them better serve an evolving population.

4. Values Become Dogma

This is the most emotional—and perhaps the most revealing—of the four. Dutch healthcare is built on values like independence, restraint, and personal responsibility. These values work. But they can become dogmatic when they’re applied without nuance. When the default response becomes “come back if it gets worse,” or “we don’t refer for that,” the message to patients can feel more like a wall than a welcome. For those raised in systems where reassurance, rapidity, and responsiveness are expected, this approach can seem cold—even if it’s clinically sound.

So what now?

I’m not suggesting that the Dutch system is broken. Far from it. Like Olé when he first came in after Mourinho’s meltdown, the Dutch system has accomplished a lot, especially post-COVID. But what I am saying is that the environment has changed—and with it, the needs of the people using the system. And if the system continues to double down on what it knows without reflecting on what it’s missing, then it risks losing not just patient satisfaction—but the very trust that holds the system together.

In my opinion, one of two things needs to happen.

First, the system could benefit from outside eyes. In business, when a company struggles to adapt, it often brings in consultants—not to tear everything down, but to spot what’s being overlooked from within. For Dutch healthcare, this could mean cultural consultants, healthcare anthropologists, or even trained expats who can help interpret the experience gap and make the system more responsive without compromising its core values.

Second, there’s room to build new bridges. Patient navigators, multilingual platforms, and even small adjustments in GP training could go a long way. Sometimes a simple shift in tone or timing can make the difference between a patient who walks away frustrated, and one who walks away feeling respected.

On a final note—just like I will always be a United fan, I continue to respect and admire the Dutch healthcare model. But admiration doesn’t mean silence. It means wanting it to succeed for everyone it serves. And that includes those of us who didn’t grow up in it, but still need to trust it when we—or our families—fall sick.

Reference:
Sull, D.N. (1999), Why good companies go bad [HBR OnPoint Enhanced Edition], Harvard Business Review, 77(4), 42–50.

RJ Pesigan is the founder and owner of Cornerstone Health, created to address the multifaceted healthcare needs of expats in the Netherlands. Trained in Internal Medicine and Sport & Exercise Medicine, RJ has worked in both resource-limited and advanced clinical environments—from busy hospital wards treating critically ill patients to performance-focused sports clinics guiding athletes to peak health. Through Cornerstone Health, RJ leverages clinical expertise and real-world expat insight to help families and professionals navigate the Dutch healthcare system with confidence, clarity, and peace of mind.

Original Article: https://www.linkedin.com/pulse/kicking-against-active-inertia-ramon-julian-pesigan/?trackingId=ZDoFuQ57TNCok90srv94BA%3D%3D