The Netherlands Ep. 2: Buurtzorg: Redefining Nursing With Self-Managing Teams
One of the biggest global challenges in healthcare at the moment is the workforce crisis. Workforce shortages are not related to the number of people that get trained for healthcare professionals but the working conditions that they need to operate under. What’s the alternative?
Buurtzorg was established in 2006 in the Netherlands, as a counterweight or as an anti-establishment organization that opposed the capitalistic approach towards nursing, where every caring act is measured in minutes, and the success of services is measured in outputs, not outcomes. In Buurtzorg, nurses take time to talk to their patients, meet the family and establish communities in which people take after each other. Instead of a hierarchical structure, the organization comprises of self-managing teams - each with 12 members, that take care of roughly 50 patients.
Buurtzorg has approximately 17% of the home care market in the Netherlands but has expanded globally and today supports over 950 teams, and 15,000 nurses in 24 countries.
Because the teams are self-managing, the actual back office headcount is small - around 50 people.
Similarly, as clinicians go to medicine with the mission to cure people and save a life, so do many nurses enter the nursing profession because of their affinity to work and care for people. Hence the hierarchy, bureaucracy, workforce shortages, and consequently suboptimal care, are pushing nurses outside the profession.
According to Intely Health: 57% of new nursing graduates left the bedside within 2 years of practice prior to the Covid Pandemic. 55% of nurses are thinking of changing their profession.
Buurtzorg provides care in the home setting, which is different compared to the hospital. The key thing for nurses within Buurtzorg is that they get to know their patients very well, and focus on their well-being, not how many services they provided. In the end, that’s visible in treatment outcomes. “People often talk about giving autonomy. I don't think you can give autonomy, you can take it away. It's a bit like freedom. You can disrupt it quite easy, but to restore it is very difficult. And I think that is one of the main focuses organizations should have where, not how do I control my employees, but how do make them feel trusted,” says Thijs de Blok about the self-managing approach.
Buurtzorg International usually starts operating in new markets due to local interest groups that come across the organisation. Thinking of the lessons learned in different countries, Thijs says the world could learn from Cuba. “From a financial resource point of view Cuba has very little at the moment. But 25% of the people have a bachelor's degree or higher in healthcare.
So you have a really good environment where people immediately understand certain topics, for example, what prevention means in your own environment. And people talk openly about these things. Whereas in the Netherlands, you often see that a general practitioner doesn't want to live in his neighborhood where he is working or in the village but goes and live in the next village or next neighborhood because he or she is scared that he will run into clients in the supermarket and they may ask him a question.
And in Cuba it's the opposite. Health is a communal problem and to contribute towards better outcomes, everybody is involved, so the entire networks around someone that needs help are amazing to see. I think it would be a very good example for the entire world to look a bit more at what this means, not only from a financial point of view but also from a social point of view.
And quite honestly, I'm quite jealous that with little financial means, they are doing so much better than we are still doing in the Netherlands with this.”
As explained in the book Reinventing organizations by Frederic Lalaloux, a 2009 Ernst & Young study found that Buurtzorg requires, on average, close to 405 fewer hours of care per client, patients heal faster, and have shorter hospitalizations. The savings for the Dutch social security system were estimated to be close to 2 billion Euros annually.