10 Questions About Buurtzorg's Self-Management Model - Answered
For the past weeks, I’ve analyzed dozens of Q&A sessions with Buurtzorg team members. Here are the 10 biggest questions that came up—and the blunt, unpolished answers from the people who live it.
1. No managers? How do you stop things from going off the rails?
"We start with trust. We believe professionals don’t need managers telling them what to do. Nurses know their patients better than we do."
This isn’t some kumbaya nonsense about “believing in people.” It’s a strategy.
- Hire competent adults.
- Give them clear responsibilities.
- Let them own their work.
That’s not chaos. That’s alignment.
2. How do you prevent teams from just doing whatever they want?
"We work within a simple but clear framework: Happy staff, happy clients, happy finances."
Think of it like sports. No one tells the players exactly how to pass, shoot, or move. But there are rules, a scoreboard, and a shared goal. That’s the difference between structure and micromanagement.
3. What happens when there’s conflict? Who breaks the tie?
"Conflicts happen, just like in any organization. But rather than relying on a manager to resolve them, we encourage teams to have open discussions. If needed, a coach can step in, but the final decisions always rest with the team."
Here’s what Buurtzorg figured out:
- People don’t need a boss to fix their problems.
- They need conversations.
- If all else fails, a coach can help—but not as a referee, just a facilitator.
No backroom politics. No running to HR. Just grown-ups figuring it out.
4. Who makes the big decisions?
"We use our internal communication platform to discuss major decisions. When people are involved, they’re more committed to making it work."
Let’s be real: At most companies, big decisions are made in closed rooms by people who never touch the work. That’s dumb.
Buurtzorg flips that:
- Decisions are transparent—anyone can weigh in.
- Teams own execution—no buy-in theater.
- No "strategic alignment" meetings—just action.
5. No KPIs? How do you measure performance?
"Quality is built into our model. Teams track their own performance using real-time data: client satisfaction, financial health, employee well-being."
Most companies collect vanity metrics that don’t matter. Buurtzorg tracks:
✔ Patient outcomes (not PowerPoint slides)
✔ Financial sustainability (not budget politics)
✔ Employee satisfaction (not corporate “values” posters)
That’s how you get real results.
6. How does this scale? Isn’t self-management only for small teams?
"Scaling is easy when you stick to the basics. Each team operates as a small, independent unit."
Most companies scale by adding layers of bureaucracy. Buurtzorg scales by replicating autonomy.
- Each team runs itself.
- Teams learn from each other.
- No central control, just support.
7. No promotions? How do people grow?
"Growth at Buurtzorg isn’t about climbing a ladder—it’s about deepening expertise."
Your title means nothing if you don’t get better at what you do. At Buurtzorg:
- No pointless promotions.
- No fake “Senior Associate” titles.
- Just becoming the best at what you do.
If you need a fancy job title to feel important, you don’t need a promotion—you need therapy.
8. No individual bonuses? How does pay work?
"We follow national collective agreements, so salaries are standardized. There's no negotiation or individual bonuses—it’s about fairness and transparency."
Translation: Everyone gets paid fairly. No secret deals. No pay gaps. No games.
The result?
- Less internal politics.
- More team collaboration.
- No salary-driven ego battles.
If you want a big bonus, go work on Wall Street.
9. Has Buurtzorg faced resistance from traditional institutions?
"Insurance companies initially resisted us. They didn’t understand how we could operate without management. But over time, our results spoke for themselves."
Translation: Legacy institutions freaked out. Then they saw:
✔ Lower costs.
✔ Better patient outcomes.
✔ Higher nurse retention.
Now? Buurtzorg thrives. Bureaucrats make excuses.
10. Can this work outside the Netherlands?
"Yes, but with adaptations. We’ve helped organizations in Japan, the UK, Taiwan, and the US implement self-managing teams."
Culture matters. But care is universal.
- Taiwan figured it out.
- Norway figured it out.
- Brazil figured it out.
Self-management isn’t a Dutch thing. It’s a competence thing.
Final Thought: This Works. If You Let It.
Buurtzorg is proof that self-management isn’t a utopian fantasy—it’s just smart business. The hard part? Letting go of control.
If you want to see this in action, check out our Corporate Rebels Masterclass, where we break down case studies like Buurtzorg and others who are rewriting the rules of work.
