Introduction & Background

The Dutch community nursing provider Buurtzorg Nederland has attracted widespread interest for its deployment of self-led nursing teams and in turn having improved outcomes alongside being more cost effective.  Rather than relying on different types of personnel to provide individual services, this holistic approach expects nurses to deliver the full range of nursing, medical and support services to clients.

The Buurtzorg (meaning neighbourhood care) model consists of self-led teams up to 12 staff, embedded in the community who provide co-ordinated 24/7 care for geographical catchment areas of 10,000 people, usually 60-80 clients.  The composition of the teams in terms of speciality and practice level varies according to need in each area.

Buurtzorg provides excellent person centred care due to its approach putting patient self-management at the heart of its operation and due to its community links to lever local community assets as appropriate.

The results have shown:

• Higher levels of patient satisfaction
• Reductions in the costs of care provision
• Development of self-directed structures for nurses and improved job satisfaction

The KPMG study in January 2015 found that Buurtzorg ranked amongst the best home care agencies in the Netherlands on measure of patient reported experiences.  In summary the KPMG study concluded that Buurtzorg’s highly satisfied, self-managing teams of nurses provide low-cost home care that is both efficient (fewer hours per patient) and of high quality ( as measured by patient satisfaction) but at a total cost including nursing home, physician and hospital costs – that is about average for Dutch home-care providers.

However, ultimately the future importance of Buurtzorg may lie in the recognition of the value of its key components.  These include the colocation of health professionals in neighbourhoods or community settings and the provision of comprehensive and co-ordinated care.  Most importantly, however is the use of self-led teams – with their potential to bring joy to work, autonomous work teams may offer and antidote to the growing problem of burnout among health professionals [1]

There are currently a number of Buurtzorg programmes across the UK – Scotland, West Suffolk, Guys & Thomas’s FT and Tower Hamlets. AQuA has been working alongside Public World to test Buurtzorg amongst the AQuA membership.

Evaluation Proposal

Over the past year, AQuA has been working with Public World, a specialist provider to recruit and support up to 3 teams across the North West to develop and test 3 self-led neighbourhood teams by December 2018, who will become the pioneers for the adoption of self-led neighbourhood care in the North West. These teams are moving at pace and want to evaluate their work.

The aim for the evaluation is to augment the work to date which has supported teams to:

• Deepen  an understanding of Buurtzorg principles and practice by exploring the Buurtzorg model, which included spending time with nursing teams in the Netherlands.
• Develop and test the governance, IT and HR implications/challenges of this type of approach across 3 different systems to allow for  self-led teams to be recruited by December 2018.
• Recruit up to 3  self-led teams across  different systems by December 2018
• Establish a plan for  further promotion and roll out building on the learning from the 3 pioneer teams to spread this beyond December 2018.
• Establish a process to share the learning and experiences of the pioneer sites in adopting Buurtzorg models into English health and care contexts.
• Ensure social care, patients, commissioners and relevant local stakeholders are fully involved with the development process.
• Share best practice throughout the life of the programme and be responsible for sharing the evidence and learning achieved throughout the programme.

The majority of teams are now at the implementation stage and could benefit from support to deliver a number of the previous aims by formally evaluating their work for others to learn from.  The key areas that have been identified by the teams themselves for evaluation are:

• Evaluation of the governance and ‘heatshield’ issues ( HR, IT, Supplies, estates) associated with embedding self-led teams into an established paternalistic, risk adverse system
• Evaluation of patient outcomes and improvements in self-care
• Evaluation on the impact to staff – indications about retention, role fulfilment and joy at work
• Changes to organisational culture and risk
• Lessons for future teams

The plan would be to retrospectively evaluate learning and development to date and then focus on the benefits, successes and challenges of teams on the ground working in this new innovative way.

NB. We are still awaiting a final cost from evaluators for this piece of work.

[1] Gray, Sarnak, Burgers, Home Care by Self Governing Nursing Teams: The Netherlands’ Buurtzorg Model, The Commonwealth Fund, May 2015

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