Monday, 3 July 2017

Buurtzorg, a nurse work project with blue ocean strategy

10 years ago, the home care scenario for people with complex social and health needs in the Netherlands followed a bureaucratic scheme based on nursing work on one hand, social work on the other, in addition to the home support actions offered by companies, many of them from the cleaning service world. Jos de Blok, a community nurse, dissatisfied with this fragmented model, put an entrepreneur hat on, assembled a small group of nurses with whom he shared vision and discussed as much at large about a new model of care based on real needs of people. In an interview, Jos de Blok says, "What I wanted to show was that if you are a good nurse, you should know how to focus on the relationship and to build trust with patients in order to make them live with the maximum of independence possible. "

This is how Buurtzorg (which means home care in Dutch) was born, a small community nurse firm, in connection with family doctors, based on self-accountability of nurses, the autonomy of their work and obtaining the maximum possible involvement and independence of patients. Today, Buurtzorg is a non-profit company, which has more than 8,000 nurses, generates 8% of benefits that revert to the organization itself, has a 3% absenteeism rate (the Dutch average is 7%), and very high levels of user satisfaction. If you are interested, it’s highly recommended that you consult the case study "Home Care by Self-Governing Nursing Teams: The Netherlands' Buurtzorg Model" published by The Commonwealth Fund.

The Buurtzorg model

The model we’re used to, the one of home-based work for people with complex health and social needs is fragmented: each professional performs according to their competencies, often by following a global plan (although not always), and each company (or institution) evaluates the work of their professionals on the basis of workloads. Jos de Blok’s disruption consisted in thinking of a model in which teams of 10-12 nurses are responsible for all home services for 50-60 patients. The Buurtzorg nurses work with the maximum autonomy, they don’t have management controls, only control of results and instead of managers’ control they rely on coaches’ support.

Wagner model versus Buurtzorg model

Dr. Edward Wagner is an American family doctor who, tired of seeing how highly experienced doctors were lost in the labyrinth of fragmented medicine when they had a complex case of multi-chronic disease, developed an organizational model that, in an integrated way, should offer effective clinical processes to people who become more knowledgeable and more involved in the management of their own health (see the post: "Chronic Model: Wagnerian Keys"). What is the difference between the Wagner model and the Buurtzorg model? Very simple: the blue ocean strategy (see the post: "Complex Chronic Patients and Blue Ocean Strategy"). The Wagner model enlightens all professionals who wish to coordinate their actions better for the sake of the patients but sadly most of those who follow it have a hard time visualizing a blue ocean strategy beyond its realm of constrained by levels of care, institutional competencies and medical specialties. On the other hand, Jos de Blok not only designed a model of home care, but also generated a small business, started offering a service that everyone realized added value and suddenly he found himself sailing through a blue ocean.

Buurtzorg, from the most communitarian and more inclusive nurse speech, offers a blue ocean strategy. In short: less theory and more strategy.

Jordi Varela


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