A Nurses Revolution

Why did you get involved in home care?

J. D. B. : In the Netherlands, home care was being ruled by the laws of the market and obsessed with productivity. Having worked as a nurse for several years, I had witnessed first-hand the slow deterioration of our working condi­tions. All the services were organized around huge call centers. With each call, a different nurse was assigned to a patient. I told myself that home care’s first priority should not be profitabi­lity. Better to deliver quality care and to focus on prevention, so that even­tually people wouldn’t need this sort of help. I opted for an entirely horizontal organization, which is more beneficial to the employees. Buurtzorg is the fruit of this reflection.


How does Buurtzorg work?

J. D. B. : Our not-for-profit company delivers self-management based health services in many neighbourhoods of the Netherlands, as well as in other countries. A group of at most twelve nurses is assigned to each neighbou­rhood where Buurtzorg is implanted. They decide everything: care, planning, recruiting, financial management. It is an entirely horizontal organization without a managerial structure: the only role of our headquarters is to pro­vide the necessary expertise.


How do you explain its rapid success?

J. D. B. : When our first group of nurses was formed back in 2007, I wasn’t expecting this. Ten years later, we have 14,000 nurses in 950 teams throughout the Netherlands! Several studies have shown that the care provi­ded by Buurtzorg is of better quality and less costly than that of its competitors. During the same period, the number of hours spent with the patients has decreased. They appreciate being able to talk directly to a person instead of going through a call center. By emphasizing professional ethics, we have been able to attract the best talents. Doctors and hospitals recommend us. The nurses themselves are more satisfied, as they can do their work in peace while buil­ding a relationship with their patients.


Many think that a hierarchical organization and a sense of competitiveness are the key to efficient work. You seem to demonstrate the contrary.

J. D. B. : Market logic is precisely what has led to the rising cost and the decline in quality of home care in the Nether­lands. We want to fix the damage done and return to a public service philo­sophy. We are a private company, but we think like a public one. Many com­panies have followed in our footsteps. Buurtzorg is now considered the stan­dard for home care in the Netherlands.


Despite the success of Buurtzorg, do you meet any difficulties?

J. D. B. :  Of course, sometimes nurses will quit Buurtzorg because our method doesn’t suit them. But most of the time they integrate our working environment quite easily. Teams meet frequently, and employees have a say in the deci­sion-making process. Their input has a direct impact on their daily work. It doesn’t always go entirely smoothly, but the essential point is that everyone feels involved.


Can your model inspire other businesses beyond the social sector?

J. D. B. : Yes! Our model has already spread to over eighty countries.2 It was conceived with healthcare in mind, but it can be applied to many diffe­rent sectors, since the questions are always the same: which values should be upheld by our management sys­tem? How do we deal with complexity? How can we improve the quality of our work and our relationship with our customers? Most organizations are divided between those who make the decisions and those who are sup­posed to mindlessly execute them. I tend to think that organizations could be structured in a more horizontal way in order to come up with more sustai­nable answers to existing challenges. To come back to healthcare, what will we do in the future should we lack qualified workers because they don’t want to work like this any more? A lot of people are used to hierarchical decision-making, with big strategies coming from above. I think that on the contrary we should focus on our everyday practice. And we will conti­nue to spread our ideas and tp support those who are inspired by our action.


By Perrine Massy