CNU Summit 2015 - Buurtzorg: humanity above bureaucracy in a teal organization, Jos de blok

1. Jos de Blok
Buurtzorg: humanity above bureaucracy in a
teal organization

2. Buurtzorg – Quick Scan
• New organization and care delivery model
• Started in 2007 with 1 team/4 nurses
• Delivering Community Health Care
• working together with GP’s and others
• 2015: 9700 nurses in 850 ‘independent’ teams.
• 45 staff at the back office and 15 coaches
• 70.000 patients a year

3. Results dutch policy on homecare
2006
• Fragmentation of cure, care, prevention
• Standardization of care-activities/tasks
• Lower quality / higher costs: wrong incentives:
delivering much care against low cost is profitable
• Big capacity problems due to demographic
developments
• Clients confronted with many caregivers
• Information on costs per client/outcomes: none!

4. Start Buurtzorg 2007
Starting an organization and care delivery model
for community care with:
– independent teams of max 12 nurses
– Working in a neighborhood of 5000-10.000 p.
– who organize and are responsible for the
complete process:
• clients, nurses, planning, education and finance;
• and all kind off coordination activities!!!!
• Integrating nursing/medical and social care

5. CLIËNT
4. Formal networks
2. Informal networks
3. Buurtzorgteam
1. Selfmanagement client
Onionmodel Buurtzorg
Buurtzorg works inside-out:
empowering and adaptive,
networkcreating, supporting.
Vision: support indepence!

6. (Self)-Organisation
• Optimal autonomy and no hierarchy: TRUST
• Complexity reduction (also with the use of ICT)
• Max of 12 nurses a team, 40 à 50 clients
• Generalists: taking care for all type of patients
• 70% registered nurses/30% nurse assistents
• Their own education budget
• Informal networks are much more important than
formal organizational structures
• Training SIM: selfsteering and coaching

9. Different types of clients
• Chronically ill and functionally disabled clients
• Elderly clients with multiple pathology
• Clients in a terminal phase
• Clients with symptoms of dementia
• Clients who are released from the hospital and are
not yet fully recovered

10. Quality system
• Monitoring outcome instead of production: the
Omaha system
• Roles and activities
• Teamcompass
• High education level: 70% is RN (average 20%)
• And of course: clientsatisfaction!

11. Supporting the independent teams
• 45 people in 1 back office; 15 coaches,
managers 0!
• Taking care of inevitable bureaucracy, so the
nurses won’t be bothered with it!
– The care is charged.
– The employees are paid
– Making financial statements

12. ICT makes it possible! - Buurtzorgweb
Grip on the business
Position in the care-chain,
relationship whit other caregivers.
View on quality of care,
transparency
Shared values
Community
Instruments
Communitation
in the care chain
Production
Relationship
professional
and client

13. What we don’t do
• Management meetings
• Policy notes
• Strategic documents
• HR strategies
• Year plans

14. Buurtzorg in the whole country

15. New innovations
• Youth care
• Domestic/social care
• Mental care
• Pensions: rehabilitation
• Hospices
• Physiotherapy/OT

16. international
• Sweden
• USA
• Asia: China, Korea, Japan…......
• Czech Republic
• UK
• Etc

17. New theoretical model?
Frederic Laloux: reinventing organizations:
• Selfmanagement
• Wholeness
• Evolutionairy purpose
Sharda Nandram: Integrating simplification
• Needing principle
• Rethinking principle
• Common sense principle

19. Satisfied clients and employees
• Highest satisfaction rates of NL: 9,1
• Nurses appreciate:
– Working in small teams
– Working autonomous
– Independency
– Strong teamspirit
– User-friendly ICT
• Price for best employer 2011/2012/2014/2015

21. Cost Benefits for the Care!
• The home care would be 65% of the costs (Buurtzorgs
model leads to more prevention, a shorter period of care
and less spending on overhead)
• More satisfied employees and clients
• The government an all political parties are stimulating other
care organization to work like Buurtzorg.
• Other sectors are interested in the organization model

23. Thank you for your attention