BuurtzorgT: Revolutionizing Mental Health Care with Self-Managed Teams

Rewind eight years to when it all began with just an idea. Nico Moleman observed the rise of Dutch healthcare pioneer Buurtzorg, which revolutionized home care in the Netherlands by enabling patients to receive holistic care in their own homes. Employing over 15,000 nurses and health professionals who work independently in self-managed teams, Buurtzorg rose to global fame.

With a background in psychiatric care, Nico wondered if a similar concept could fill a gap in mental health care—bringing psychiatric care into people’s homes. This approach would offer a groundbreaking alternative to traditional options: outpatient care (weekly meetings with a psychologist) or hospital admission, both of which place heavy burdens on patients.

Nico reached out to Jos de Blok, Buurtzorg's founder, who quickly embraced the idea. The two clicked personally and professionally, sharing a positive view of humanity and a belief in the good intentions of people. Together, they decided to experiment: combining the principles of a decentralized, self-managed organization with a systemic therapeutic approach to mental healthcare. For both, it was essential that self-steering, local teams run the organization, freely deciding what is best for each patient.

In the early days, the pioneering journey lacked a set direction. “We did not make a plan,” Nico recalls. “We simply started.” The co-founders built an organization based on simplicity over complexity and trust over control. They believed this would foster camaraderie and connection among employees rather than the alienation often seen in large organizations. And so, the inspiring journey began.

Self-steering in practice

Today, BuurtzorgT’s pioneering ideas are in full bloom. At the heart of the organization are its regional teams—tight-knit groups of 7-8 professionals, including psychiatrists, social-psychiatric nurses, therapists, and other mental health experts. Rooted in their local neighborhoods, these teams provide rapid, direct care in patients' homes. Patients are treated by several practitioners from one team, avoiding one-to-one dependency while enabling learning among team members.

What sets BuurtzorgT apart is its treatment approach: teams and patients co-create the treatment plan. Therapy can take the form of a nature walk or a musical session, tailored to the patient's needs. The organization’s structure gives caretakers the freedom to act on their ideas immediately. “If you think of something, you can carry it out yourself,” one caretaker says.

Furthermore, therapy integrates the patient’s support system. Family and friends play a vital role in recovery, contributing to lasting treatment effects.

With freedom comes responsibility. In a non-hierarchical setup, teams take ownership of all aspects of their work, from vacation planning to crisis interventions. This includes tasks outside their expertise, such as organizing consultations or writing job descriptions. Roles are distributed to ensure tasks align with individual skills. Financial accountability also rests with the teams, supported by regional expert coaches when challenges arise.

BuurtzorgT’s model is highly effective. It eliminates the need for costly treatment facilities and significantly reduces waiting times. Surveys indicate exceptional care quality, and the organization has become a magnet for employees, with waitlists for new hires. Employee satisfaction sets records among Dutch healthcare organizations.

Journey to steward-ownership

By 2019, five years after its foundation, BuurtzorgT had grown to 180 employees across 34 teams. The concept was successful, and the organizational setup was stable and scalable, making BuurtzorgT a model for humane, effective mental healthcare.

However, two major challenges loomed:

1. Regulatory requirements in the Netherlands only allowed BuurtazorgT to invoice completed treatments or year-end totals, meaning BuurtzorgT had to pre-finance all the work delivered.
2. Nico and Jos, both nearing retirement, sought a succession plan and management buyout options that would preserve BuurtzorgT’s values and structure without selling the business to conventional investors and endangering its unique setup and values.

As the company urgently needed an external capital injection to finance its rapid growth, they faced a dilemma. “Taking on capital from investors would have been easy,” Nico recalls. “But we didn’t want to sell our soul.” Both founders had witnessed how external investors could undermine organizational values, turning healthcare entities into soulless, target-driven machines.

Through a mutual acquaintance, they connected with the Purpose Foundation and Purpose Evergreen Capital, where they learned about steward-ownership. The concept aligned seamlessly with their vision and self-managed setup. So, they decided to shift the company to steward-ownership and secure investment that supported this new structure.

Steward-ownership prioritizes purpose over profit by separating power from capital. Voting rights stay with individuals connected to the organization, while profits are reinvested or used for charitable purposes.

Purpose Evergreen Capital is an investment vehicle that provides patient, value-aligned capital to small and medium-sized enterprises in steward-ownership or transitioning to it. With a vision of helping businesses remain independent and true to their values, they became the perfect investment partner for BuurtzorgT.

Transitioning to steward-ownership

In the fall of 2019, the PEC and BuurtzorgT teams met in person to start collaborating and begin the due diligence process. When the process later moved online due to COVID lockdowns, it remained a deeply human-centered and constructive journey. Built on trust, fairness, and open communication, the agreements were more than formalities—they reflected shared values and a commitment to collaboration and respect.

During this process, BuurtzorgT found an ownership structure that fit the principles of steward-ownership while honoring the company’s culture and needs. After careful consideration, they adopted a golden share model, updating the company’s statutes to formally embed steward-ownership. In this model, the Swiss Purpose Foundation acts as the veto-shareholder, ensuring BuurtzorgT’s structure is protected for the future.

To finance the transition, Purpose Evergreen Capital (PEC) took over investor shares. These shares were designed as redeemable, meaning BuurtzorgT can buy them back later. Unlike traditional private equity, where buyback prices often skyrocket with external valuations, these shares have a fixed yearly dividend and a capped redemption price equal to their initial nominal value.

Importantly, PEC did not receive voting rights. Instead, it was granted comprehensive information rights, including financial forecasts, ESG metrics, and impact reports. 'I find the collaboration more inspirational than controlling,' Nico said. Regular communication, trust built during the process, and shared values allow PEC to offer useful guidance—such as during steward succession planning—while maintaining a strong and cooperative relationship.

BuurtzorgT’s transition to steward-ownership has, in many ways, become a beacon for others in the healthcare sector. It shows how purpose-driven, value-aligned governance can support both organizational success and positive societal impact.

For a deeper dive into BuurtzorgT’s journey to steward-ownership, including how stewards are appointed and how this model can transform the healthcare field, read the full case study on BuurtzorgT here.