Monday, 14 May 2018

Self-management: Buurtzorg Identity

Frederic Laloux in "Reinventing organizations" describes the teal-evolutionary companies as those based on the personal growth of their employees and chooses Buurtzorg Netherland as an organization to which we should be paying attention to if we are among those who believe that the time to do things differently has arrived.

What is Buurtzorg Netherland?

Buurtzorg Netherland is a non-profit company, which was founded in 2007 in the Netherlands, when a group of community nurses rethought their work and came to believe that, instead of only going to homes and exercising the functions of their profession, they should advance to becoming the patients’ referee and take charge of attending to their global needs.

Ten years later, Buurtzog Netherland is a company that has already more than 70% of the market share. It has hired 10,000 nurses and 4,000 family employees, organized into 850 self-managed teams, each comprising of a maximum of 12 professionals who serve 40-50 home patients. In a study by Ernst & Young and collected in Lalouxs’ book, the results of Buurtzorg compared to the other companies are spectacularly good: 40% fewer hours are spent per patient, this despite the fact that the Buurtzorg nurses take time to chat and have coffees with the people they attend to, the health care plans last half the usual time and patients recover their autonomy earlier, a third of the hospitalizations are avoided, and when people do have to be admitted to hospital, the stays are shorter. The consultant estimated that if the Buurtzorg model were to be implemented in the US, the health system would save 49 billion dollars.

Inside Buurtzorg Netherland

The work teams don’t have a boss, and to make self-management viable, everyone, when joining the company, must attend a course: "Interaction methods oriented to find solutions", where they learn to listen, communicate, drive meetings and help each other (coaching). Team meetings should ensure that all voices are heard, but no one has the right to veto a proposal. They avoid, as much as possible, conceptual discussions and consensus and instead, there is a tendency to say: "if you have it clear, try it, and we will value the goodness of what you say with the facts". The test-error system is the preferred one. If a team gets stuck, it asks for the help of an external coach, usually a veteran nurse with prestige, who has no executive capacity and is only a facilitator for the resolution of conflicts. As there is never any decision made by an outside official, there is never a manager to blame. According to Laloux, learning to live with this degree of freedom and responsibility can generate confusion and frustration, but this is a journey of personal development from which mature professionals emerge.

Are there general rules?

There are very few, of which Frederic Laloux, in his analysis of the organization highlights the following:

- The teams must know how to distribute tasks in a way that is adjusted to the capacities of each of their members and they must be alert not to concentrate too much on one person, since this could be the seed of a traditional hierarchical form.

- The coaching should be used on a regular basis not only in the resolution of conflicts but in order to encourage the team's ongoing learning.

- Once a year team members should evaluate each other according to the competencies they had defined.

- The teams must prepare annual plans with the initiatives they want to implement, mainly in the areas of patient care, quality, training and organization.

- It’s a sign of maturity that the teams manage to allocate 60-65% of the time for direct care work which means that they have enough time for community work, internal teamwork, training, personal growth, etc.

- The hiring of new professionals, personnel management, task planning, administrative work and investments are the responsibility of each of the 850 work teams. There is no central staff for any of these issues. Laloux admits that with this decentralized model economies of scale are lost, but he says that this is compensated for in sufficient quantity by the enthusiasm that professionals feel for a job well done.

- BuurtzorgWeb, more than an intranet, is a Facebook where all professionals put questions, answers and feelings. This network has the utility of being a substitute for traditional planning. When someone has a proposal that affects the organization as a whole, the debate is generated on the internal website and, if there is sufficient support, a specific work group is created to study its opportunity and viability from a more technical perspective. 

- Each month, the compared productivity data of all the teams is openly posted on the intranet. 

The video includes a lecture by Jos de Blok at King's Fund in London, in which he asks if the Burtzoorg model would work in England.

The spectacular growth of Buurtzorg, the results it credits, and the fact that, right now, the Dutch government encourages competing companies to adopt its model, suggests that self-management, difficult as it may seem, should be the answer to the burnout of professionals. 

Frederic Laloux states that when people have the power to make decisions and the resources to work for a meaningful goal, they don’t need motivational speeches and challenging targets.

Jordi Varela

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