Buurtzorg

Buurtzorg
Home care at its best

Question # 1
What is the purpose of Buurtzorg?

Buurtzorg’s purpose is to help people live meaningful,
autonomous lives.
Cf. http://www.leadershipandchangemagazine.com/reinventing-organizations-a-case-study/
Cf. http://www.reinventingorganizationswiki.com/Evolutionary_Purpose

3 Buurtzorg goals:
1. Maintain or regain patients’ independence.
2. Train patients and families in self-care.
3. Create networks of neighborhood resources.
Cf. https://www.commonwealthfund.org/publications/case-study/2015/may/home-care-self-governing-nursing-teams-netherlands-buurtzorg-model

Buurtzorg is an innovative approach in the Netherlands which
was set up to deliver home care to all kinds of patients.
Cf. http://journal.aarpinternational.org/a/b/2013/06/Buurtzorg-Nederland-Nurses-Leading-the-Way

Question # 2
How good is Buurtzorg?

How good is Buurtzorg compared with other home care organizations?
Cf. https://www.goodreads.com/review/show/3397074094 page 16.

Compared with traditional nursing organizations in the Netherlands,
people who use http://www.buurtzorgnederland.com/
1. get healthy / cured faster,
2. require half the amount of care,
3. experience 1/3 fewer emergency hospital admissions,
4. have shorter average stays when they are hospitalized.
5. are less likely to go into nursing homes.
Cf. http://www.commonwealthfund.org/publications/case-studies/2015/may/home-care-nursing-teams-netherlands
Cf. http://dealbook.nytimes.com/2014/09/19/putting-soul-back-into-business/

Ernst & Young estimated that the Netherlands would save nearly
EURO 2 billion a year if all home care organizations achieved results
like http://www.buurtzorgnederland.com/.
Cf. http://www.australianageingagenda.com.au/2014/07/30/dutch-model-offers-alternative-approach-home-care/

Cost comparison

Question # 3
What do nurses do to help people?

5 examples of home-care services nurses do:
1. Assess patients’ needs.
2. Develop and implement care plans.
3. Provide care services.
4. Schedule medical visits as needed.
5. Generate documentation needed to facilitate continuous care and billing.

To ensure financial sustainability, Buurtzorg nurse teams must spend
at least 62% of their time on billable patient care.
Cf. https://hbswk.hbs.edu/item/this-company-lets-employees-take-charge-buurtzorg?s=03

At the heart of the Buurtzorg nurse-led model is self management.
It is about empowering patients and making the most of their existing
capabilities, resources and environment.
Cf. http://www.australianageingagenda.com.au/2014/07/30/dutch-model-offers-alternative-approach-home-care/

A nurse may start working with a client by having a cup of coffee
with him or her to find out what the elderly person
1. can still do herself / himself, and
2. can no longer do / needs help with.
Cf. http://livestream.com/accounts/5587887/events/6186028/videos/135388718

Nurses continuously educate themselves to be able to do many
different tasks for a client during one visit. This is
efficient and it improves the social interaction, because only a few
care professionals need to visit each client.
The average patient visit lasts 25 minutes.
Cf. http://www.business-improvement.eu/lead_change/Buurtzorg_autonomous_teams.php

When there is a problem, each nurse corrects things himself / herself.

Question # 4
How does a nurse team work?

3-4 nurses on a team care for 1 patient. This allows for
consistency and closer patient relationships while also
ensuring round-the-clock coverage.
Nurses independently decide what the patient most urgently
needs, buy medical supplies, and adjust care plans.

A team of nurses has responsibility for a defined geographic
area, typically encompassing around 10,000 Dutch residents.
Each team takes responsibility for all aspects of care for 50 – 60 patients.

Each team of nurses:
 finds people who need care.
 schedules who will serve which people.
 recruits new team members.
 manages finances.
 constantly improves the quality and efficiency of care.
Cf. https://www.goodreads.com/review/show/3397074094 Page 16.

During a meeting in a team of nurses,
1. each nurse suggests ideas on what to do and change.
2. each nurses votes on which ideas to try out.
When there are no fundamental objections against trying out and idea,
the idea will be tried out to find out how well it works.
Cf. http://www.enliveningedge.org/features/jos-de-blok-founder-buurtzorg-speaks-journey

Each team has several administrative roles – including
 housekeeper,
 reporter,
 vitality manager,
 team player,
 planner, and
 mentor.
Nurses rotate through administrative roles.

Question # 5
How do nurses get better?

Nurses are encouraged to build expertise in
areas that most interest them.

Nurses, who work via the Buurtzorg network, learn by trying out
ideas.
They don't expect perfection. However, they believe that by not
being afraid of failing, better ideas and experiments emerge.

Each nurse decides herself / himself
1. what he or she needs to learn,
2. which person – internal or external - is the best person to help
him or her get better.
Cf. http://www.reinventingorganizationswiki.com/Training_and_Coaching

If a nurse team has a and feels unable to resolve it without
help, the team can, if they wish, seek help from a coach.
The role of the coach is to support teams without stepping in to
directly manage their problems. Nurses have the freedom to
use of not to use the advice of a coach.

Coaches coach nurses about
 how to listen actively,
 how to make decisions,
 how to solve conflicts, and
 how to coach each other.
Cf. http://www.leadershipandchangemagazine.com/reinventing-organizations-a-case-study/
Cf. http://www.strategy-business.com/article/00344

Question # 7
How is Buurtzorg organized?

There are no layers of management in the Buurtzorg network of health
professionals. The foundation of Buurtzorg are small self managed teams
of health professionals.
Cf. https://www.youtube.com/clip/UgkxOyMuWrLIMOSOyus-0fyRl6aYAacT06p9

11,000 nurses and 4,000 domestic helpers work for Buurtzorg.
They are organized into 1,200 self-managing teams.

Buurtzorg’s administrative personnel include
 52 regional and head office coaches.
 50 back office staff - mostly IT professionals.
 2 senior directors - including Jos de Blok, Buurtzorg’s founder.

Each team comprises maximum 12 nurses.

If a team grows larger than 12, it splits into two teams.
Teams that fall below 6 nurses merge.

There is no HR department in the Buurtzorg
network of nurses.
Cf. http://www.australianageingagenda.com.au/2014/07/30/dutch-model-offers-alternative-approach-home-care

The Buurtzorg management approach called “integrating simplification”
works. It is characterized by a simple, flat organizational structure
through which a wide range of services, facilitated by information
technology, can be provided.

Question # 8
What digital platforms
do nurses use?

Teams use an IT system called BuurtzorgWeb, through which they
 share patient notes,
 distribute knowledge,
 collaborate on problems that extend beyond a single neighborhood team,
 access the Omaha System, a standardized taxonomy to classify patient
care and outcomes.
BuurtzorgWeb serves as the main way nurses communicate and share best
practices. For the Buurtzorg network of health professionals, this
technology replaces middle managers.

Nurses use an IT system for
 online scheduling,
 documentation of nursing assessments and services,
 billing.

Question # 9
How do nurses innovate?

Cf. https://www.nbforum.com/newsroom/blog/innovation/innovation-with-jos-de-blok/
If a nurse has an idea, she or he shares the idea with anyone he
or she thinks it is interesting to share the idea with. People listen
to the idea and encourage the person to test it / try it out to find
out if it can lead to a purpose and useful innovation.
If most people, who learn about the idea, think that it’s a good
idea, a strategy is made, so that many people can experiment with
the idea. If everyone still thinks that it’s a good idea, then the idea
is implemented.

Buurtzorg leader Jos de Blok writes a blog.
Decisions are made when it is obvious that ideas / experiences
that people share on the blog go in a certain direction.
Cf. https://youtu.be/BeOrNjwHw58 from minute 5.

Question for you:
What ideas do you have to improve home care
in the country you live in?

Sources of inspiration
http://www.australianageingagenda.com.au/2014/07/30/dutch-model-offers-alternative-approach-home-care/
http://www.business-improvement.eu/lead_change/Buurtzorg_autonomous_teams.php
https://www.commonwealthfund.org/publications/case-study/2015/may/home-care-self-governing-nursing-teams-netherlands-buurtzorg-model
http://www.commonwealthfund.org/publications/case-studies/2015/may/home-care-nursing-teams-netherlands
http://dealbook.nytimes.com/2014/09/19/putting-soul-back-into-business/
http://www.enliveningedge.org/features/jos-de-blok-founder-buurtzorg-speaks-journey
https://www.goodreads.com/review/show/3397074094
https://www.goodreads.com/review/show/4034017789
https://hbswk.hbs.edu/item/this-company-lets-employees-take-charge-buurtzorg?s=03
http://journal.aarpinternational.org/a/b/2013/06/Buurtzorg-Nederland-Nurses-Leading-the-Way
http://www.leadershipandchangemagazine.com/reinventing-organizations-a-case-study/
http://livestream.com/accounts/5587887/events/6186028/videos/135388718
https://www.nbforum.com/newsroom/blog/innovation/innovation-with-jos-de-blok/
http://www.reinventingorganizationswiki.com/Evolutionary_Purpose
http://www.reinventingorganizationswiki.com/Training_and_Coaching
http://www.strategy-business.com/article/00344
https://youtu.be/BeOrNjwHw58
https://www.youtube.com/clip/UgkxOyMuWrLIMOSOyus-0fyRl6aYAacT06p9

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