Buurtzorg: A Revolutionary Approach to Community Healthcare

This blog post is part of 50+ case studies of self-managing organizations we created for the 2024 inaugural ZeroDX awards. These organizations embody the principles of RenDanHeYi in their work structures:

• Zero Distance to customer: Decision what to build is based on insights from the marketplace

• Autonomy: Small teams with full decision-making autonomy enable speed in execution

• Shared Rewards: Everyone in the micro-enterprise participates in its financial success.

Introducing Buurtzorg

Founded in 2006 by Jos de Blok, Buurtzorg is a Netherlands-based home-care organization that has become a game-changer in the healthcare industry. With over 10,000 nurses providing care to more than 80,000 patients annually, Buurtzorg (meaning "neighborhood care" in Dutch) is renowned for its revolutionary approach to healthcare.

At its core, Buurtzorg is driven by principles such as:

• Humanity above bureaucracy
• Simplicity above complexity
• Practical over hypothetical

Its mission is clear: to help individuals lead healthier, more autonomous lives by providing high-quality, personalized care in the comfort of their own homes.

Organizational Structure

Buurtzorg operates with a highly decentralized, horizontal organizational structure.

Unlike traditional healthcare organizations that rely on hierarchical management, Buurtzorg consists of about 900 self-managed teams of up to 10-12 nurses each. These teams are fully autonomous, handling everything from patient care to administrative tasks and team management. There are no managers; instead, teams use a system of peer support and coaching to guide their work.

Buurtzorg employs a group of about 20 coaches, each working with 40-50 nurse teams to support them in difficult times, and transitions. The role of the coaches is to safeguard the Buurtzorg framework, which relies on 4 principles for self-managed teams:

• Solution-focused communication
• Solution-focused meetings
• Team decisions made with consensus
• Dividing and rotating roles and tasks beyond the core nurse workload.

This setup minimizes bureaucracy, fosters a culture of trust, and enhances employee autonomy—key elements of self-managed organizations.

Zero Distance to Customers

Buurtzorg's model emphasizes customer centricity. Nurses are granted significant autonomy to make on-the-spot decisions that best meet the needs of their patients.

This level of empowerment ensures that care is highly personalized and responsive. Nurses develop care plans in collaboration with patients and their families, ensuring that care is tailored to individual needs and circumstances.

By eliminating layers of management, Buurtzorg ensures that nurses are directly accountable to their patients, maintaining "zero distance" between caregivers and clients. This approach not only enhances patient satisfaction but also improves outcomes, as care is more consistent and holistic.

The impact of this model of patient-centric care is not only client satisfaction ratings (30% higher than ratings of comparable organizations) but also the effectiveness of care as required hours of care per patient is between 50% and 67% lower according to analysis of the company data and the larger healthcare system in the Netherlands.

Internal Culture and Employee Engagement

Buurtzorg's internal culture is built on principles of autonomy, trust, and professional development.

The organization offers a supportive environment where nurses are encouraged to continuously develop their skills and share knowledge with their peers.

Buurtzorg's success is shared with its employees through a model that emphasizes aligned interests; while there is no formal employee ownership, the empowerment and satisfaction derived from their roles provide intrinsic rewards. Regular feedback and open communication channels ensure that all team members feel valued and heard, contributing to levels of job satisfaction and retention considerably higher than those of comparable organizations.

To preserve autonomy, there is no monitoring of the work of the nursing teams. Instead, a set of performance metrics is monitored. The most important among these is the productivity threshold, which is set at 62%. No fewer than 62% of the teams' hours should be spent on patient care. This is the minimum percentage of billable hours necessary to run a profitable team.

Although Buurtzorg has a nonprofit status and cannot make profits and allow for profit-sharing mechanisms, it has found another way to enable aligned interest also financially. The salaries of nurses are up to 30% higher compared to similar positions elsewhere in the Netherlands. Besides, 2% of the revenue is reserved for unforeseen costs, and in case there is an unused surplus, it is divided as follows: half goes to innovation projects and the other half goes to a bonus pool shared among all employees.

This approach fosters a high level of engagement and retention among employees, setting Buurtzorg apart as a leader in progressive workplace culture.

Conclusion

Buurtzorg stands as a beacon of innovation in healthcare, demonstrating the power of self-management, patient-centric care, and progressive organizational structures. By prioritizing trust, autonomy, and simplicity, Buurtzorg has not only transformed community healthcare but has also set a global standard for what’s possible when humanity leads the way in caregiving.

For organizations exploring self-managed models or seeking inspiration for a people-first approach, Buurtzorg offers a proven roadmap for sustainable success.