Buurtzorg's Healthcare Revolution: 14,000 Employees, 0 Managers, Sky-High Engagement
One of the most amazing organizations on our Bucket List is Buurtzorg. The fully self-managed home-care organization in The Netherlands has grown to 14,000 employees in only 10 years time. Client satisfaction is highest in their segment while employee satisfaction is through the roof. To better understand this unique organization, we visited Buurtzorg, joined one of their teams and interviewed founder (and humble revolutionary) Jos de Blok.
In 2006, Jos de Blok started Buurtzorg with a team of 4 nurses. After being a nurse himself for years at a traditional home-care organization, Jos felt their way of working got in the way of delivering proper healthcare due to too much bureaucracy and too little autonomy.
Today Buurtzorg employs over 14,000 nurses and care workers working in teams no bigger than 12. The circa 1000 teams are supported by no more than 50 administrators, 18 coaches, and 0 managers.
We decide to first visit one of Buurtzorg's local nursing teams and arrive at a small office to meet up with nurses Nel and Patricia. It becomes directly clear to us that everything at Buurtzorg is focused around functionality. The small office isn’t even a bit fancy, nor does it look like an inspiring place to work in. But this doesn't seem to bother them an inch. We quickly learn that Buurtzorg's nurses are not motivated by a fancy office but are rather driven by a deeper kind of motivation. A motivation based on high levels of purpose, autonomy and mastery.
The motivation and passion of the nurses is hard to miss once they proudly start to explain how they run their own neighborhood. Having worked for other more traditional Dutch health care organizations before, the way of working of Buurtzorg has set them free. Nel: "We feel more liberated, appreciated, and fully in control of how we can provide the best possible healthcare to our clients. Instead of having to work with lots of frustrating bureaucracy, we can now do what we love to do: delivering care to clients”.
Network of teams
At Buurtzorg, the circa 1000 teams are completely self-organised and they therefore take care of the entire health care process. Among many other things they take on new clients, plan their own the work, delivering care to their clients and they even hire new nurses for the team. There is, however, still a small headquarters of about 50 people to support the nurses.
But this headquarters has only one single function according to Jos: “The headquarters takes care of the inevitable bureaucracy, so the nurses won’t be bothered with it. Think about charging for the health care, making the official financial statements and making sure that our nurses getting paid.” Besides this back office there are also 18 coaches around to support the teams with problems they cannot solve themselves (i.e. conflict resolution).
New teams are still joining Buurtzorg on a regular basis. New teams can apply to run their own neighborhood. Once they start, they mostly rely on their own. Jos: “We noticed that the teams we supported the most, took the longest time to be up and running. This is how we learned to let go and let the teams find their own way.”
Buurtzorg's network of 1000 teams is more than just a sum of the parts. To be able to use this network the best they can Buurtzorg has established an important and supportive IT infrastructure to allow and promote knowledge sharing, client focus, and constant alignment. Here are a few tangible examples of how Buurtzorg is leveraging the power of technology:
- If a nurse encounters a specific care issue that he or she is not familiar with, they post their questions on the intranet and often receives an answer from one or more of their 14.000 colleagues within a few hours.
- A comprehensive overview of the percentage of hours spent with clients is shared on the intranet and used to gain insights into the client focus of the various teams.
- The intranet is used as an easy means of communication between founder Jos de Blok and the others in the organization. By writing a blog post, he can easily and instantly inform all his colleagues (or get their advice) on important topics.
Common sense leadership
There is no doubt that technology plays an important role for Buurtzorg's success. But we believe something else plays an even more important role. This is the (almost comical) common sense leadership style of Jos de Blok. When asked the question “How do you motivate your people?”, he once responded: “I don’t. I think doing that is too patronizing”. On the followup question “What is the dot on the horizon that excites you and your teams?” he answered “That dot doesn’t exist. I don’t feel anything for that stuff, that dot.”
But this is not all, here are some more hilarious quotes to give you a better understanding of De Blok's unique philosophy:
- "I think strategy just gets in the way of us doing our job."
- "In my time here, I have never written a policy document."
- "For us, our work is all about building relationships with clients, without all that strategical baloney around it."
We experienced a similar common sense attitude during our conversation with him. Sometimes, Jos simplifies to such an extent that (even we!) felt we were overthinking and over-complicating things. After our conversation, we sent him some additional questions that were asked on our online community. We got some beautifully simple and honest answers from him:
- Q: "How much is technology influencing changes on your practice and on the way the organization generates revenues?" Answer: "No idea."
- Q: "How does the organization sense and make the decision to respond to those changes & opportunities?". Answer: "By constantly listening!"
Whether you call it downplaying or oversimplifying, for Buurtzorg it works. When we asked him about his most important role as a leader of Buurtzorg, he simply answered “I'm here to keep the principles alive”. This includes communicating the vision, leading by example, and being in service of the organization and its purpose.
Buurtzorg's success does not go unnoticed and the organization has been researched extensively over the last years. This research clearly shows that their client satisfaction is through the roof and their employee satisfaction is proven to be the highest among any Dutch organization consisting of more than 1000 employees.
In addition, the costs of the healthcare Buurtzorg provide is lower than those of any other Dutch home-care provider. While Buurtzorg nurses spend more time with their clients they keep the costs lower due to their limited overhead costs which are only a third (!) of those of the competitors. Why? Well, because they have for example no call center, no HR, no planning, and no marketing department.
Another myth busted
A common critique on Buurtzorg (and some other pioneering workplaces) is the fact that they started with a new organisation and therefore didn't have to transform an existing one. Common criticism: "Buurtzorg had no history and no legacy, but a clean sheet to start with. That's easy. But it will never be possible to transform an existing organization into this."
Last year, once again Jos de Blok and Buurtzorg proved them wrong. They even surprised the most skeptical people when they took over more than 2,000 employees from a Dutch home-care provider in crisis. After the employees worked their last day in a traditional, hierarchical organization on Friday, they started their Monday in a fully self-managed organization. While chaos was expected, the transformation went surprisingly smooth. Jos: “We experienced some minor difficulties, but now, one year later, everything runs very smoothly and we have amazing results.”
Buurtzorg goes viral
It’s not surprising that more and more countries want to copy “The Buurtzorg formula”. At this moment, Buurtzorg is supporting the expansion of their approach in countries like the UK, Sweden, Japan, China, Taiwan, South Korea and the US. By doing this, Buurtzorg is not just changing the way healthcare is organized in Holland, but it has started a worldwide revolution when it comes to delivering high quality home-care.
The success story of Buurtzorg continues and is taking the world by storm. Hopefully this revolution will move beyond just health care, because we believe that a similar approach to education and business has the power to unleash huge amount of untapped potential in the workplace and will liberate people from the demotivating and frustrating management practices that we have built up over the last decades.
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If we could tag one apocalyptic rider for adaptive organizations, it would be "traditional performance management." It is old-fashioned performance management that keeps us in a world of humans as resources, as command-and-control takers, with rigid top-down planning, and solid prevention of curious and exploratively-minded cooperation. Its logic is plan – do – check – act.