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Kees van der Graaf was the R&D Director of SPITS Oosterwolde until 1 June 2020, and with 250 employees he was in charge of supplying medication pouches to over 200 pharmacies and healthcare facilities in the Netherlands. He was also co-owner of the pharmacy in Appelscha and Oosterwolde and established a healthcare centre where 15 health authorities provide daily care to the residents of Oosterwolde and the surrounding area. As co-owner and co-founder of one of the world’s largest packaging centres, he and Gerrit Baarda, founder and owner of ZiuZ Visual Intelligence, explain what motivated them and how the partnership between ZiuZ and SPITS Oosterwolde came to be.
G: “Kees, thank you for coming here today. Together, I want to reflect on how our partnership came to be, but first: what has the pharmacy trade and entrepreneurship taught you?”
K: “It taught me that Alpha is larger than Beta. I studied exact sciences – I am, after all, a pharmacist. I was interested to see: how can that white powder make someone happier, enable them to urinate better, make someone else get a good night’s sleep and another person’s infection go away. To everyone, it’s the same white powder. I found that so interesting. And then when I decided I wanted to be an entrepreneur – I didn’t really go into business because I wanted to be the biggest or the best – I wanted to do something good, so I also went to school to learn human and behavioural sciences. That actually taught be a lot more than exact sciences did. But if I had never gone to school to study pharmacology and started with business administration instead, I probably would never have had this opportunity. I am accepted in the field of healthcare because I am a pharmacist, so I can rely on that title.”
G: “You founded Spits Oosterwolde with Hage Verduyn in 2002. Why?”
K: “When we founded SPITS Oosterwolde, we wanted to do things more professionally, and on a larger scale. At the pharmacy in Oosterwolde, Farmatray was a major success. That is the concept of putting pills into compartments. We made a lot of those, and when you make large volumes of something, you also make a lot of mistakes. We made so many mistakes that it started working against us. We had to automate the process. We are pharmacists, we know the risks of medications and we know how to prepare medicine. So, we decided to produce our own medication pouches at our pharmacy in Appelscha. We did that for our own pharmacy and for other pharmacies we are acquainted with, because we wanted to keep the service in the first line of care. If we didn’t, it would go to major organisations and we would lose the ability to provide that service to the patient. And it exploded… We built a large space that we thought could house three packaging machines. Within a year after the first machine started working, we added the second machine and we had no space left. At first, we had no idea what else had to fit into that space! And then we started construction on a real SPITS factory in Oosterwolde.”
“We are pharmacists, we know the risks of medications and we know how to prepare medicine.”
G: “Shortly thereafter, we started the project collaboration between Spits and ZiuZ. I didn’t doubt our solution for a second. Never once did I think it would fail.”
Kees: “I never had those doubts either; I never thought the inspection machine wasn’t the best the world had to offer. We built a beautiful building in Oosterwolde where several packaging robots produced medication rolls for pharmacists’ patients. At the time, the medication pouches were all checked by hand, which I was very impressed by. But that was not tenable on the long term, and if you want to scale up, you have to do it properly and professionally. We didn’t want to compromise on quality.”
“From Twan (a pharmacist at Spits Oosterwolde), who you played volleyball with, we heard that you analysed images for the police. Then someone asked us if we could do the same with pills, and you initially didn’t say it was impossible.”
“I have a degree in pharmaceutical instrumental analysis, which intersects a lot with the ZiuZ technology, and I’m also an amateur photographer. I saw that love for photographic images in the work you were doing at ZiuZ. We thoroughly considered the camera and the darkroom. Because I wanted us to be able to determine the light quality, so we could get good, reproducible images. It’s the same concept we learned in pharmacology when we covered microbiology. You want to have a sterile product. So, your work has to be uncontaminated from the start, which means getting a picture with as little interference as possible from the beginning. That enables better error detection.”
“I never doubted that the inspection machine was the best the world had to offer”
G: “How do you see the future of pharmacists in the Netherlands?”
K: “The difference between now and when I started is that a pharmacist used to be financially strong and independent. Now, graduates want to be healthcare providers, but are likely to end up working for larger organisations. And honestly, those major parties’ primary focus is not on pharmaceutical care. In the Netherlands, too much has been bought by major companies and there aren’t many independent pharmacists anymore. Health insurance companies now have to manage things in healthcare, because the government can’t handle it. Right now, it’s just applause during corona times, after which everyone’s forgotten about it. Pharmacists were pleased with the attention they received sometimes, but do not see enough to realise that their whole means of existence is being hollowed out in the meantime. Many tasks are no longer carried out by pharmacists. They no longer prepare and check medication. They don’t supply ostomy products or diabetes testing materials. If it is up to the health insurance companies, pharmacists will have to take wound dressings and incontinence materials out of their product range entirely. Healthy people who work at a desk think in terms of: long live efficiency, healthcare is just a logistics issue. That loss leads to a 25% decrease in turnover. That increasingly limits individual pharmacies in their capacity to respond to and anticipate modern healthcare needs. And if we don’t react now, we will see that the distributing function of pharmacies will be scaled back more and more in the years to come. Patients realise far too late that their pharmacy care is disappearing, similar to the subpar quality of pills from Asia that is only now becoming clear.”
“Pharmacists want to provide care, but have to work hard to prevent their entire existence from being hollowed out”
G: “How do you see your personal future?”
K: “We are going to found Wolk Academy for pharmaceutical research and training. And we are working with another company to check artificial intelligence prescriptions. To filter out the risk-free prescriptions, allowing the pharmacist to focus on other prescriptions. But above all, I want to be the head of my organisation and grandfather to my grandchildren. That is my future.”
Kees van der Graaf, pharmacist and co-founder of Oosterwolde Healthcare Centre and SPITS Oosterwolde with the Frisian Business Award that ZiuZ won, and for which SPITS was a finalist in 2018.