Home sweet home and some other lessons

David Font

An article in the New England Journal of Medicine explains that the Department of Health in Victoria, Australia in 2010, announced the construction of a 500-bed hospital without using bricks. This virtual hospital currently receives 33,000 patients per year. And the introductory paragraph of the article ends by asking: What was the incredible technological progress that made it possible? Caring for the patient at home!

Let's continue without leaving the house. I remember post by Jordi Varela introducing the experience of Buurtzorg Netherlands, the Dutch home care company, described as a success story by King's Fund. During a Congress in Barcelona, I heard Jos de Blok, the leader of the project, explaining the experience as a paradigm of innovation success. Let's see why.

Buurtzorg Netherlands from an initial team of 4 nurses in 2006 now currently has 8,000 nurses who serve more than 65,000 patients throughout the Netherlands and countries such as Japan, Sweden, Norway, the United Kingdom and the United States. Its professionals are organized in teams of 12 nurses each with an assigned population. A minimum management team and a small back office for administration complete the structure.

Its growth is an unmistakable sign of success, corroborated by its excellent results in patient satisfaction surveys and the fact that it has been named best employer in the Netherlands many times. The key factors that have been highlighted in different reviews are:

• Small teams with autonomy in making decisions that encourage creativity; 
• Agility and training of teams that dedicate quality time to patients in favouring their empowerment and facilitating the reconciliation of the work of the professionals with their personal lives.

Remaining in the house, let’s consider the reality of our health system. I believe that the patient’s home is no longer questioned as the ideal space for their care, in various situations. But we continue with a fragmented organization with domiciliary programs managed by primary care, others by hospitals and lines specialized in palliative care or in the case of home oxygen patients which is covered by other institutions. Could we bring together all the professionals of the different institutions working in specific territories, organized as per the Buurztorg model, in autonomous teams of 12 nurses with an assigned population? And could we work without managers and institutions that spend a lot of time discussing where resources should come from and who are fighting to secure their share of power?

At the Hospital Clínic in Barcelona we are developing a Strategic Plan for the next few years. It’s a program focused on patients, its reason for existence and on professionals – its driving force; increasing the satisfaction of both parties. Surely, by breaking traditional hierarchical organizational models and by generating spaces of creative participation where all professionals have a place: Buurtzorg Netherlands is undoubtedly a source of inspiration.