Jos de Blok: Buurtzorg – could it work in England?

So in Holland we decided that home care should be ten different products and we got paid per hour for these projects. So what happened was that the costs in ten years doubled because of things which were delivered which were, in my opinion, not necessary; are you there to solve a problem or are you there to sell products, that’s...  And I think in a community you need to work together and you need to focus on, in my opinion, what a patient, a client, can learn themselves again; how can you empower them, how can you yourself make yourself not needed anymore.

So informal networks focusing on the client work together as a team. My opinion is if you focus on neighbourhoods of 5,000 to 10,000 people you know all the networks and you can use the volunteers, you can support the informal networks, and then you can also work in a very positive way and a very constructive way together with GPs, physiotherapists, the pharmacists and so on and you know everybody in person.

Based on this idea, my idea was that creating management layers would be not very productive, so we said these teams can easily work to organise all the work themselves if they are supported by a good idea. We started with one team in 2007 and at the moment we have 850 teams and we have 10,000 workers, mostly nurses.  At the back office we have just 45 people taking care of all the back office activities and we have 18 coaches, and the coaches are only supporting when it’s necessary so the teams decide when they are using a coach, for example, when there are some conflicts in the team.  The team should not be bigger than 12 persons because when you make teams bigger you get more coordination problems and some of the team members will behave like a leader or a manager and that’s what we need to avoid.

We need to be financially sustainable. The teams need to be 60% available so they know that 60% of their time should be spent on patients. The rest of that time they can spend on the networks, they can train volunteers, they can have meetings with GPs and so on.  They decide themselves on how to spend the rest of their time.  And there are yearly annual appraisal and plans.  Our slogan on the cars – we have a lot of cars that the nurses are driving in – is we want just to deliver the best possible care at home, and when these nurses are doing that what you see as the result is that we are delivering the best possible care.

The last few months we had the inspection doing an audit and four of the five teams they were doing the audit they said we had the highest score ever. The perception of some people is that it’s chaos, self-organising, how can it be disciplined, but there is much more discipline in a self-organised team than in a hierarchic organisation, is my conclusion, and this was also the conclusion of the inspection.  We’ve been the best employer for four years, in one year we were just second, and this year we expect it again.  Because they are their own employers, in a sense, so they’re hiring their own colleagues so when they don’t hire the right colleagues they are doing something wrong and they’re responsible, not me.

When we started we wanted to show that quality goes up and costs go down when you’re doing the right things, and what we saw... We did two researches with KPMG, Ernst & Young, the results were that there were 40% lower costs because we are delivering less hours.  In an article in the daily newspaper it was seen as something negative that you deliver less hours but, in my opinion, it’s very positive because the clients are very satisfied about it.  So they’re not waiting for hours, they’re waiting for solutions, in my opinion.  And the overhead costs are around 8% where the average in Holland are 25%.  So reducing the costs and the overheads give you the opportunity to work the higher educated people and to spend more time off of the total income and patients.

We influenced the payment system. The payment system now went back from ten products to one tariff.  So it took ten years but at the end our minister decided that this would lead to more focus on outcome.  We also supported other organisations, so we don’t see them as competitors, we see them as colleagues, and now we see that 80% of the Dutch care providers we have a collaboration.  At the moment we are innovating in youth care, we are having teams to be doing mental care, be doing maternity care, and we have now a big part with 4,000 people who are doing domestic care.  We also have a lot of experience in other countries now.  We started in Sweden and the US, we have a franchise collaboration in Japan, we started in China, Korea, and it’s funny to see that in all these countries the problems are quite the same.  What I try to do is to build a network where nurses and care workers can just ask each other when they want some information about how are things going in other countries.  And this is what I wanted to share and I hope we have a fruitful discussion.