The passion for the profession and the desire to improve the lives of people in need are what drive nurses. Jos de Blok, the founder of Buurtzorg (which means "neighborhood care" in Dutch), understood this well. In 2008, he completely disrupted the medical system in the Netherlands by founding, along with a team of 12 self-managed nurses, what now accounts for 80% of the payroll in the home care market in the Netherlands (approximately 15,000 people) and inspires many organizations in more than 24 countries, including France...
Buurtzorg's philosophy is based on simplification: simplifying procedures, rules, and communication to focus on the core business, which is providing care to clients, and stop wasting time on unnecessary tasks.
The approximately 1000 Buurtzorg nursing teams are entirely self-managed and handle the entire process of medical care: they manage, among other things, the search for new clients, scheduling their appointments, providing care to individuals, and even hiring their own staff. Fifty people work from the headquarters to support the nurses in their self-management and administrative processes.
Twenty-one regional coaches are also there to guide teams in self-management development and help them resolve internal issues and conflicts that may require third-party intervention. They act as a cross-link between teams (a kind of memory to support and inspire them with solutions from teams that have faced similar problems) and as a mirror (asking relevant questions to redirect the team to its choices and operation). Each coach follows between 45 and 50 teams, forcing both parties to focus on essential questions and maintain strong autonomy. New teams are formed every week, and each team can apply to be assigned to a neighborhood, i.e., an intervention area, in which it will operate. Madelon, a nurse we interviewed, says, "Once a team is formed, it finds its way on its own." At Buurtzorg, the goal is for each team to be unique and to stand on its own.
How do these teams organize themselves on a daily basis and internally?
Quite simply, actually: teams work by area and are responsible for the clientele in that area. In terms of care, nurses together distribute the clients for the day. But their roles and tasks go beyond their core business. Buurtzorg has predefined the different roles necessary for the proper functioning and well-being of a team, which the nurses distribute by mutual agreement. These roles rotate over the life of the team and the nurses' preferences (teams generally rotate roles twice a year). There are seven predefined roles explained and developed in the manual that all Buurtzorg nurses receive, "Self-management, how it does work" by Astrid Vermeer and Ben Wenting:
- The Main Role: This is the position for which all Buurtzorg members were initially hired: doing what they love, their nursing work, and contributing professionally to the team and Buurtzorg.
- The Team Player: Ensures collective dynamics based on the "one for all, all for one" principle. Encourages communication within the team, always in line with set goals and overall organization.
- The Housekeeper: Organizes all technical logistics but also the functionality of the "offices." Regularly informs the team about expenses and budgets.
- The Informer: Monitors the team's productivity, publishing reports on the work done and value production.
- The Developer: Manages collaboration within and between all teams. Gains information about the experiences and expertise of other teams and informs their team to enhance skills and organization.
- The Planner: Plans the team's work time, ensuring it aligns with client expectations. Keeps the entire team informed about future schedules and possible changes. All decisions are made with the team, taking into account the expectations and needs of the nurses.
- The Mentor: Takes care of new entrants and acts as a personal coach for each team member: works on emotions after a heavy loss, resolves internal conflicts, develops Buurtzorg's entrepreneurial spirit. This role is usually filled by a more experienced individual.
As a rule, a team consists of a maximum of 12 people; in reality, team members, with their skills and affinities, know when the team should split or not. Madelon explains that some teams are much more productive with 6 members than with 12. The team structure is quite fixed because it provides a framework for nurses. Teams meet every two weeks, mainly to discuss the overall situation, address specific cases, and solve any problems encountered.
To ensure teams are cohesive, recruitment in such a decentralized organization is crucial and entirely in the hands of the nursing teams. Recruitment often occurs through informal exchanges between the Buurtzorg team with a vacancy and external nurses. After the standard exchange of cover letters and resumes to verify qualifications, two nurses volunteer to conduct the interview, which has no predefined structure. The two nurses then report the interview to the other team members, and they decide together on the person's integration into the team. Two months are then allocated for any disengagement by the new recruit.
The Buurtzorg Web, a true backbone of their cross-functionality
Where the model is truly strong is in networking these teams and promoting a strong sense of belonging to a common mission. Indeed, Buurtzorg's network of 1000 teams is much more than the sum of the teams: they are all connected through the work of regional coaches, but also through their internal network, the Buurtzorg Web. Communication between nurses facilitated by this network is the key to their cross-functionality: it allows them to share experiences, develop new skills, or even communicate and create new communities.
This enormous collaborative IT infrastructure promotes knowledge exchange, customer focus, and alignment of values. This platform has several objectives:
- Mutual assistance: If a nurse encounters a problem she cannot solve alone, she asks the question on the network and receives answers from her 10,000 colleagues. This is the true strength of the network, fostering an open and constructive discussion among nurses and allowing them to share best practices.
- Sharing the experience and work of teams: Through Team Inside, which provides an overview of each team's time spent with each client, team organization, etc. This sharing of experience allows each team to draw ideas from their counterparts to improve. A goldmine that few companies can boast of!
- Communication: Communication on the platform is open and uninhibited. Everyone, including Jos de Blok, freely asks questions and regularly questions best practices to adopt or difficult cases to manage. This taboo-free communication enhances the nurses' sense of belonging to Buurtzorg. Jos de Blok also regularly posts messages to inform his employees of the main changes and innovations in the company. He also asks many questions to gather the teams' opinions.
- Training: An e-learning space is available to develop new talents but also to discover more about self-management.
The Buurtzorg Web was quickly adopted by the nursing teams as a communication but also management tool. This network also includes a team-to-team messaging system widely used by nurses. It's not surprising that it was quickly embraced by the teams who shaped the Buurtzorg Web as it was being built.
A model that works and continues to expand
Buurtzorg is a spectacular success, one of the most beautiful examples of a large-scale managerless company!
Today, no less than two-thirds of the country's nurses work at Buurtzorg. The financial and medical results of the organization surpass all indicators, with a 30% reduction in emergency admissions and an average 40% reduction in time devoted to care for each patient compared to other home care organizations. However, nurses take the time to have coffee and talk with their patients, their families, and their neighbors to strengthen the support around them and improve their recovery. Patients heal faster and become independent more quickly.
And the time spent actually caring for their patients, as opposed to selling products or doing reporting, has a significant impact on the nurses: 60% fewer sick leaves and 30% less turnover than in traditional healthcare organizations (figures reported by Frédéric Laloux in 2015).
