Or perhaps her name is De Smet. Or Jansen. Or something else entirely. The name hardly matters anymore. What matters is how familiar her story feels.
She has a GP. A specialist. A nurse who visits her at home. A hospital record. A medication list. Discharge papers that seem to exist somewhere between organisations. Most of all, she carries a story she has learned to tell clearly, because she has had to tell it over and over again.
Each time she enters care, she begins again, because the way the system is organised today does not recognise her as one continuous human being across all of her care. The handovers, the transitions, the gaps between providers are not accidental. They are structural. They exist because care unfolds across lives and contexts, while the structures supporting it are still organised around institutions and responsibilities.
Thomas Dubois has told Mrs Smith’s story many times; on stage, in conversations with healthcare leaders, among colleagues and peers across the sector. Her story is not exceptional. In fact, everyone knows her.
As a healtchare expert and strategic advisor, Thomas has worked across different industries and care settings, and that systems-level perspective shows in how he frames the problem. He does not use Mrs Smith’s story to evoke sympathy.
He uses it as a mirror, held up to a care landscape that has normalised fragmentation to the point where it no longer even looks strange.
When a GP spends half of a fifteen-minute consultation reconstructing information that already exists elsewhere, that is not a minor inefficiency; it is time that could have been care. When a nurse arrives with incomplete discharge information, she compensates with experience and intuition, increasing risk. When a specialist treats a condition without visibility of what came before or what follows next, quality quietly erodes.
But fragmentation does not only affect professionals or organisations.
For Mrs Smith, at 83, this is not a conceptual debate. It is exhaustion. The mental strain of remembering details. The emotional labour of re-explaining the same story. The cognitive load of navigating portals, letters, codes and multiple professionals, often while hearing, energy or confidence are fading.
What if her support network is limited? What if language, health literacy, or digital skills are a barrier?
Official assessments of the Belgian healthcare landscape consistently point to continuity of care, especially informational and organisational continuity across providers, as a persistent weakness. Despite strong coverage and high-quality care at individual touchpoints, coordination between those touchpoints remains uneven.
The building blocks exist. The architecture does not.
Ask any caregiver today what the real problem is, and they will rarely mention a lack of commitment. They will talk about a lack of breathing room, for themselves and for the people they care for.
“This pressure is not accidental. It is the result of several forces converging at once.”
People live longer. Chronic conditions are becoming more prevalent, and multimorbidity is increasingly the norm rather than the exception. In Belgium, a substantial and growing share of the population already lives with one or more chronic illnesses, a trend that intensifies sharply with age.
Care demand, therefore, rises not just in volume, but in complexity. At the same time, the available workforce struggles to keep pace. What often remains underexposed is that the volume and complexity of care journeys increasingly exceed human coordination capacity. The current care model keeps going because people compensate, not because it is designed to work that way.
The system is screaming, but into a void.
It would be wrong, very wrong, to say that healthcare has stood still. On the contrary.
Digital records are widespread. Current standards and platforms aim to improve how information travels across care settings. Progress is real. But here is the uncomfortable truth: technology has not removed the bottleneck, because the bottleneck was never purely technical.
The tools exist. What has not existed at scale is shared ownership of the journey, shared workflows, shared accountability, and shared priorities that ensure information flows the way people do.
“Innovation has often improved individual organisations, not the connections between them. We modernised components of care without redesigning how those components work together.”
Care journeys rarely fail at expertise. They fail at handovers, where responsibility, information and context move from one actor to another. The result is a care landscape with pockets of brilliance, but little coherence.
Discussions about healthcare reform quickly drift into familiar territory.
All of that is true. Fragmented governance has even been identified as a structural inefficiency in itself. At the same time, financial pressure is becoming structural. Without a course correction, Belgium’s sickness and disability system is heading towards approximately €1.8 billion in annual structural pressure by the end of this decade, a reality that does not disappear by postponing decisions.
But here is the harder truth: Waiting for perfect policy conditions is a convenient way to postpone responsibility. That is what Thomas cuts through when he reframes the issue.
“Financing won’t change tomorrow, and governance won’t simplify overnight. If we wait for that, nothing will move.”
Change in healthcare is difficult precisely because it is old, layered and deeply institutionalised. There is no reset button. But there is room, today, for actors willing to collaborate beyond their own boundaries, align around shared outcomes and treat data as shared infrastructure rather than organisational leverage.
Mrs Smith will be 84 next year.
Her care will become more complex, not less. Her story will grow longer. The number of professionals involved will increase. The need for continuity will only intensify. Her story is not an exception. It is a preview.
The question is not whether the care landscape can keep adding tools. The question is whether it is willing to remember people as wholes, not fragments.
And whether we are finally ready to organise healthcare the way life actually happens, rather than the way organisational charts are drawn.