The €29 Billion Question — LinkedIn Live #5
Elsbeth Van Lienden and Nienke van Bezooijen on sick leave, KPIs, and the architecture producing the illness.
Sick leave in Dutch organisations sits at an average of 5.4%. An estimated €29 billion per year in cost to the country. And those figures do not count the people still showing up but no longer present. Silent quitting. Mental absence.
Most organisations respond the same way — a new KPI, a wellbeing week, a professional to pressure people back into their hours. It rarely works. Because the KPI targets the symptom. The system that produced the illness stays untouched.
The standard response
The playbook is familiar. Set a new target: from 5.4% down to 3.1%. Roll out a wellbeing programme. Train managers on how to respond when someone reports ill. Bring in the arbeidsdeskundige to pressure the person back into their hours.
None of these are wrong. Manager training helps. Wellbeing weeks bring attention. But none of them address the design underneath. And so people keep dropping out — different people, same pattern.
The architecture producing it
Elsbeth reframes the question. Instead of what can we do about sick leave? — ask what is the architecture producing it?
Responsibility without authority. People are asked to own outcomes without the authority to shape them. The gap between the two quietly widens until someone falls out. It rarely looks like a system failure. It looks like a personal one.
Constant transformation as ambient threat. Reorganisations, restructures, and now AI — each round of change carries the same subtext: your role may not exist next quarter. Uncertainty stops being situational and becomes structural. Structural uncertainty becomes chronic illness.
AI and the two responses. Some organisations use AI to reduce headcount. Others invest in people so they can work differently alongside it. Same technology. Two very different architectures. The sick leave numbers of both look different within eighteen months.
It's not just looking at the symptom. It's asking what kind of system is even creating the opportunity for that sick leave to arise.
Discomfort. Dis-ease. Disease.
Nienke names something most organisations miss: illness is the end of a line, not the beginning. Long before the sick note, there are earlier signals — discomfort, then dis-ease. Both are the body and the organisation asking for something to be seen.
Most organisations wait for the disease before they respond. By then, the person is already gone from the room. Sometimes they come back. Often they do not.
Discomfort is a signal. Dis-ease is a signal. Disease is the signal ignored too long.
The organisational equivalent: engagement scores drifting downward, meetings getting heavier, decisions taking longer. These are the discomfort signals. When leaders respond only at the disease stage — sick leave, resignation, burnout — the intervention cost is a multiple of what earlier attention would have required.
Quantum leadership — safe conversations before intervention
In a soul-led architecture, prevention is not a programme. It is a quality of conversation that is possible in the organisation.
When someone reports ill, the first conversation is not about their hours. It is about their signal. When someone is about to drift out, the environment is safe enough for them to name it before they leave. This does not happen because a policy says so. It happens because the leadership is present enough for it to happen.
The CFO reframe
Most CFOs look at sick leave as a cost line. Elsbeth invites a different question: what is the return on investment on prevention?
In most organisations, the answer is: we do not know, because it has never been measured. The wellbeing initiatives are booked as HR expense, not investment. Their impact on retention, output, and psychological safety is not tracked back to euros.
Once the question is asked seriously — once prevention is treated as investment with measurable ROI — the case for architectural work stops being a soft argument and becomes a financial one.
If I were CFO of a larger company, I would take a much closer look at what is the return on investment in decisions around sick leave and the prevention of it.
The MRI analogy
Elsbeth's closing image: you do not walk into a doctor's office and accept surgery because the doctor glanced at you. You want the MRI first. You want to see what is actually going on before the intervention.
Organisations rarely afford themselves that. The KPI is the glance. The wellbeing week is the surgery. The MRI — the architectural diagnosis — is what The Indigo Elephant is designed to provide. Both the seen and the unseen. The KPIs and the undercurrent. The structure and the signals it is producing.
Five questions for your organisation
Not to answer immediately. To sit with long enough for the honest answer to surface.
One. Where do people have responsibility without matching authority?
Two. What is the actual ROI on your current wellbeing initiatives?
Three. Where is uncertainty structural rather than situational in your organisation?
Four. When someone reports ill, is the first conversation about their hours or about their signal?
Five. If you removed the sick leave KPI, what architectural question would surface underneath?
Continue the conversation
Frequently Asked
What is the average sick leave rate in Dutch organisations?+
Around 5.4% on average, with an estimated total annual cost to the Netherlands of €29 billion. These figures do not count silent quitting or mental absence — people who are still showing up but no longer present.
Why do wellbeing programmes rarely reduce sick leave sustainably?+
Because they target the symptom, not the architecture producing it. A wellbeing week does not resolve the gap between responsibility and authority, the structural uncertainty of constant transformation, or the leadership style creating the conditions for illness. When those stay untouched, the pattern returns.
What does 'the architecture producing the illness' actually mean?+
It refers to the design underneath daily work: how decisions are made, where authority sits, how uncertainty is handled, what the actual (versus stated) priorities of the organisation are. These design choices — usually invisible to those inside the system — produce predictable patterns of illness and disengagement.
How is this different from a standard HR consultancy approach?+
Standard HR work operates on the layer of policy, training, and programme design. The Indigo Elephant works one layer deeper — on the architectural design and the undercurrent that produce or prevent illness in the first place. Both are needed. One without the other is incomplete.
What is the Organisational Architecture Assessment?+
A structured reading of where your organisation is on the scale from controlled to intelligent — across leadership, human intelligence, communication, ownership, and the energetic undercurrent. It combines interviews, existing reports, and an energetic reading. The output is a clear map and the most intelligent next move.
How can I stay updated on future LinkedIn Live episodes?+
Follow The Indigo Elephant on LinkedIn — episodes go live every Thursday. Recordings are published here after each session, together with a written companion article like this one.
See you next Thursday for LinkedIn Live #6.
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