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April 22, 2015

How to make the step-change

This month, new legislation came into force designed to enable people who have additional care and support needs to remain longer in their homes and communities. Health and social care partnerships are to work with a range of others, including the third sector, to deliver the kind services that people want to see. But whether the creation of new monolithic structures can deliver the sort of highly bespoke services that individuals really need is another matter.  There is however, another way. It called the Buurtzog way.



Jos de Blok: The Beginning – Neighborhood Care the Way It Was Meant To Be

In 2006, a few community nurses with a vision started a new concept in the Netherlands:  Buurtzorg, which in English means “Neighborhood Care.”  Prior to this, community care was fragmented and the system of paying for activities by the hour resulted in many different tasks delivered by lower-educated caregivers.  Patients were forced to deal with multiple caregivers doing individual tasks, while higher-educated nurses grew increasingly frustrated, unable to properly carry out their work.

Having been a community nurse and managing director, I saw a need to develop a new model based on old principles of primary health care:  skilled nurses working together in a team of no more than 12, in a neighborhood of 10,000 people, caring for all kinds of patients.  These teams would be responsible for the patients and have the autonomy to deliver the best possible care. This would be an organization without management and with low overhead costs so the money could be spent on the patients and their nurses, and so higher quality could be delivered at a lower cost, all supported by an innovative IT system.

What started as a team of 4 nurses in 2006, has grown to 580 teams of 6,500 nurses in 2013.  Each team created their own network with support from General Practitioners and is supported by a single “back office” of 30 people.  As a non-profit, Buurtzorg has grown to serve 50,000 patients without a single complaint and with revenue of more than € 180 million euro.

External research has shown outcomes from the Buurtzorg model have been consistently better than every other homecare organization.  In 2009, Nivel, the Netherlands Institute for Health Services Research, found Buurtzorg had the highest satisfaction rates among patients anywhere in the country. In 2010, Ernst & Young found the average costs per client were 40% less than other homecare organizations, indicating a potential national savings of € 2 billion euro per year!


This drew the attention and support of the Prime Minister, the Dutch Health Ministry, patient organizations and others.  Many politicians supported the model as a best practice and used it as an example in reaching agreements.  The greatest honor, though, came from our nurses in 2011 and 2012, when Buurtzorg received the national Employer of the Year Award, as determined by employee surveys.