For Care Managers

Buurtzorg is the Dutch word for “neighbourhood care.” It’s an old concept which was generated in 1986, a Community Nursing Review led by Julia Cumberlege, who suggested the establishment of neighbourhood nursing services in each and every district. Buurtzorg reminds us of the significance of working with and in neighbourhoods, where eloquent relationships are at the sentiment of all that we do.

Those relationships which bring happiness and delight to the clients and the workforce are the things which Buurtzorg reminds of. Through their involvement with Buurtzorg staff, elder people had the idea that their rehabilitation would be helped with an inducement – something to train for. The staff presented a rollator walking-frame race in the park, which has been repeated and brought to the Olympic stadium. This was one of the reasons why Buurtzorg has been rated as the best employer in the Netherlands.

In order to comprehend the model, it is important to understand and know about Jos de Blok – Founder of Buurtzorg. He started adult life studying economics but realised it wasn’t it for him.

However, he figured that nursing was something that lifted his soul, especially Community Nursing. He felt content in being able to provide care that facilitated people at their most vulnerable and empowered them to return to wellbeing. He saw the influence on the healthcare of the imposition of bureaucracy and the breaking up of the care process. The stated purpose of those changes was to improve quality and cost-efficiency, but Blok noted the contradictory effect those changes had. Quality diminished, cost amplified and workers were pushed to do more and more to reduce the expenses.

The nurse’s role and influence reduced too. The sense of fulfilment in the nurse’s role plunged. Even when he had reached high-ranking positions in traditional care services, Blok decided to set up an alternate approach: working with a group of like-minded people, he visualised, researched and developed a model. After two years of planning, he managed to launch Buurtzorg, with 4 nurses.

Buurtzorg now has over 9,500 nurses in 800 teams supported by 45 backroom staff, 15 trainers and a custom-built IT system. This is a network, not a hierarchy and there are coaches to enable, not managers to manage. Sick leaves are hardly ever used, satisfaction is extraordinary, feedback is exhilarated so complaints are dealt with timely, transparency is the norm; hence, all of this resulted in a transformational change. Trust, flexibility and self-sufficiency are the pillars of the success of Buurtzorg model, set in the environment of humanistic, person-centred care. The approach is relational, not transactional and offers 24-hour care.

Buurtzorg is essentially about an integrated model of care, not structures. It’s about the encouragement of human connections and all-inclusive care. Buurtzorg is based on faith and emphasizes transparency and straightforwardness. The model simplifies bureaucracy for care teams but most importantly also for the patient, especially those who no longer have people coming to them.

The main features of Buurtzorg’s philosophy, which is shifting the community of care by taking a patient-centred approach. It runs on ideals of community-building, it recognizes and respects each individual’s professional know-how, it concentrates on the needs of the clients, each and every employee shares in the responsibility, it integrates reflection, sharing, and discussions to continuously rethink practices for development and employees work with an open mind and self-motivation to build faith with their clients.

Their chief motivation is to serve their clients, not to clear their to-do lists. Also, the employees are more independent in their tasks and the decisions they make. Their principal aim is to serve the client in the best possible way in order to provide them with the satisfaction and care they need. They integrate their three-dimensional focuses on prevention, caring and curing, and achieving vigorous economic outcomes.

The concentration on networks rather than hierarchy emancipates up the skills and the personal accountability of the team members. The answer cannot be found within the hierarchy as it lies within them. Where difficulties exist, coaches are brought on rather than managers. Coaching comes from the confidence in people’s own capability to find answers, but also provides them with data and tests to permit people to work in their own comfort zone. There are fewer meetings; instead, people are encouraged to get out and associate with people. Buurtzorg model supports leadership qualities at all levels and develops all of the team, not just those at the top level.

Buurtzorg model has occasioned in a decrease in hospital admission rates alongside a great level of satisfaction with the care provided. These accomplishments did not happen overnight. Buurtzorg was built up slowly, focussing on people and associations, listening to people and building facilities and support around an individual. This needs a great commitment from politicians, service leaders and the public. Moving from controlling the environment to trust requires the ability to stay with the process of transition. The Buurtzorg model would suggest that the results make this very worthwhile but that it can’t be done halfway as it needs commitment and faith at all levels.

A collective and persuasive understanding of the need for change is a significant component to change and seek a new model. In Blok’s own words, ‘people know the current way is finished.

The new way of working is keeping everyone content, both patients and nurses. The Buurtzorg model needs to be both, simple and easily measurable. The new way of working – Buurtzorg model - can be clearly described and understood by everyone involved and also there is uniformity in how that’s done; to conclude, simplicity is the key to success for the Buurtzorg model.

The new way of working and the necessity for a change becomes a portion of the shared awareness. The experience of Buurtzorg proposes that once it is started, it builds its own momentum.

Accomplishment and understanding and know-how gained through the experience nourish the sense of “rightness” of the Buurtzorg model, and the collective benefits for all the parties are so influential that they tell their own story. ‘If you have the possibility of doing much better work that costs less, why would you not do it?’ as Blok himself says it.

Modification from a focus on policy to one of professional practice. The present system of concentrating on process has a tendency to detach nurses and others from their professional knowledge and constitution or experience, so by shifting the focus back to the professional practice, it releases the teams’ full potential to work for the best outcomes and to provide the best services.

The nurses should stand behind the patient and not the organisation. Nurses can be durable and resilient advocates for the people they work with – their colleagues and teammates - and offer support and attention and care to the new way of working which empowers nurses to be an influential lever for people in the system.

Buurtzorg model advises to find and recruit the encouraged stakeholders, have such people involved who appreciate as well as understand the need for change and they can manage to keep it small and practical in order to ensure simplicity. Get the people who see the answers to lead it. And finally, have open discussions and dialogues that get the change to actually happen.

The Buurtzorg Model is all about caring for each other with mutuality at the core. Initial thoughts and reflections are around the true person-centred nature of Buurtzorg and have emphasized how, with the good community connections, with proactive and preventive care and highly enthused and motivated professionals, people are convinced to self-manage their conditions, knowing that support is available to them if and when it is required by them. The Buurtzorg model of self-managed teams, with faith in extremely trained professionals to deliver care and fix issues at a local level, was also of significant interest.

An evaluation by consulting a big 4 firm, KPMG in 2012 found that although the care might be expensive per hour than under a traditional approach, it was of greater quality and very much appreciated by those in receipt of these care and services. Crucially, only half as much care was usually required.

“What I see in a lot of countries is that systems are increasingly complicated and frustrations are becoming worse and worse,” says de Blok. “I want to show that it’s easy to change.'’

“I’m not interested in money,” de Blok says. “I see so many people searching for a new way of doing things in all the places I visit. It’s all about creating something different from the bottom up.'’

To conclude, the Buurtzorg model offers a rich seam of learning, a ray of hope in the face of the present system under massive pressure and a perceptible way of working that is simple and absolutely person-focused instead of an organisation focused and it is also cost-effective too. Suppliers of care are being given an opportunity to lead this work and to be courageous and determined enough to put people at the centre.