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What can improvers learn from Buurtzorg’s self-managed model?

Q members were amongst many at a recent AQuA event looking to learn about the increasingly influential Dutch care model – Buurtzorg – and its gradual emergence in the UK. Buurtzorg has 10,000 staff, no managers and an administrative back-office of only 50. Health Foundation Improvement Fellow Bryan Jones shares his experience of the day.

Few European care models have attracted as much interest on this side of the English Channel as the Dutch Buurtzorg district nursing model. Since getting underway in 2007, Buurtzorg, or ‘neighbourhood care’ to give it its English translation, has had a meteoric rise. It has gone from one team of four people a decade ago to 850 teams and over 10,000 caregivers across the Netherlands today.

Participants share their questions about the Buurtzorg model

What makes Buurtzorg unusual is that each team (of no more than a dozen) are wholly responsible for how the care of their patients is planned, delivered and
co-ordinated. Teams organise themselves, take decisions collaboratively and aren’t governed through a traditional hierarchical management structure. Regional coaches are available to support and guide teams, but it is up to the teams to manage and appraise themselves and resolve any issues that arise.

The driving ethos behind the Buurtzorg model is to give each team the scope to really get to know their patients and what matters to them so that they can build up a complete picture of their medical and personal care needs. Each team handles between 50 and 60 patients and 60% of professionals’ time is spent directly with patients. Moreover, the emphasis is firmly on supporting and enabling patients to manage their own care as far as possible and to focus on what they can do, rather than on what they can’t do.

Emphasis is firmly on supporting and enabling patients to manage their own care as far as possible and to focus on what they can do, rather than on what they can’t do

The impact of Buurtzorg has been impressive. Satisfaction levels among patients and those delivering care are exceptionally high. Home care costs are significantly lower than those of equivalent Dutch providers. Patient costs are reported to be 40% lower than other home care organisations and Buurtzorg’s overhead costs stand at around 8% compared to a competitor average of around 25%. Buurtzorg has been named as the best employer in the Netherlands in four of the last six years.

What has been key to Buurtzorg’s success is a bespoke IT system that has been developed in partnership with caregivers. It operates like Facebook and is geared towards sharing information and knowledge rather than the reporting of management information. Much has also been made of Buurtzorg’s slimmed down bureaucracy: only around 50 people work in its back office which handles salary and financial administration and contracting for the organisation.

Buurtzorg is not without its critics or issues. One recent study, while acknowledging all the benefits described above, found that the overall cost of patient care – taking into account acute costs as well as home care costs – is around average for Dutch home care providers. Nonetheless, for UK health and social care providers looking for an integrated, person-centred and cost-efficient way of meeting the needs of people with multiple conditions, the attractions of Buurtzorg are immediately obvious. What is less clear is how the Buurtzorg model could be applied to a UK context.

To explore this question further the Advancing Quality Alliance (AQuA) organised an event earlier this month in Manchester for 150 people from NHS organisations, local authorities and other public bodies in North West England. Much of the discussion focused on how to foster the type of autonomous, non-hierarchical, collaborative working that personifies the Buurtzorg approach. Creating a permissive environment in which teams at the front-line have the confidence and skills to take full responsibility for planning and delivering patient care would, it was felt, require a major, system-wide shift in attitudes: one that would be challenging to achieve. People can’t and shouldn’t simply be told to implement the Buurtzorg model. In addition, the split in England between personal care and nursing care was seen to present an important practical obstacle to the implementation of Buurtzorg.

Nevertheless, many participants saw echoes of the Buurtzorg approach in their own work, particularly in its focus on embedding self-management and multi-disciplinary working. It suggests that aspects of the Buurtzorg model are already finding their way into the English health and social care landscape.

The adoption of Buurtzorg principles looks set to accelerate in the years ahead as more organisations look to replicate elements of the model. The Health Foundation has recently given funding, for example, through our Innovating for Improvement programme, to a project in Hampshire that is looking to integrate primary, community and social care services within an extended primary care team. The project, which is led by Southern Health NHS Foundation Trust, will incorporate learning from Buurtzorg. Elsewhere, Tower Hamlets has been conducting a Buurtzorg pilot and the principles behind the model are being tested in Scotland. No doubt other organisations and systems around the UK are doing the same.

To support this work, there is now a wide range of resources on which pilot sites can call, many of them tailored to the needs of a UK audience. Events such as the one held by AQuA will also help to bring together and foster networks of like-minded practitioners and commissioners who are interested in exploring the applicability of the Buurtzorg principles to the UK.


Periscope live-streamed sessions:

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