Looking for the revolution: my journey to Buurtzorg

Last week, I went to the Netherlands to visit Buurtzorg - a healthcare organisation, established in 2007, that has revolutionised community care in the Netherlands. Buurtzorg, which means “neighbourhood care”, relies on self-managed teams of nurses to deliver care. This puts patients' needs at its heart, and the results show how effectively this model does compared to more traditional service delivery models, in terms of patient and employee satisfaction and the quality of care.

Having done a lot of research into the model that the organisation uses and its results, it's an understatement to say I was very excited. In my head, Buurtzorg must look like the future, where it was blindingly obvious to anyone who entered that “things are different here”. Yet when I arrived at the address, I thought I must be in the wrong place. The building didn't look as though it housed an organisation that was revolutionising the delivery of care to the people who need it.

And then I saw a small metal plaque in the window of a plain-looking building, which read “Buurtzorg”. I knocked and a nurse opened the door. She confirmed I was in the right place - this was Buurtzorg. I asked if I could speak to her for 15 minutes about her impressions of the organisation. She agreed and led me through the building. I was still confused, though. Buurtzorg looked like any other care home I had been into. Where was the revolution?

We spoke about what it's like working at Buurtzorg, what this different model achieves, and how it is different from other organisations she has worked for. “I can make decisions myself, as a professional, that are the best for the people in my care,” she said. The total autonomy she has to make decisions was evident. “When I have a new client, I can visit him or her and decide for myself what is needed and start the care programme that is right for them, from now.” And it was clear that she genuinely felt that she was delivering better care at Buurtzorg because of this model: “I can do what I am good at here - care for my clients,” she explained.

I can make decisions myself, as a professional, that are the best for the people in my care

Not having to navigate through processes, bureaucracy or hierarchy was something we spoke a lot about. “As there are no processes, we don't have to do more than is needed by the person in our care. I can see for myself which other organisations need to be involved to help care for the client, and ask the family myself what I can do for them.”

The nature of the model allows her to focus on delivering care to the best of her ability. “There are no barriers or processes in the way of me helping the person or their family.”

The nurse also stressed that Buurtzorg gave her a different kind of experience as an employee from any other organisation she had worked at previously. For the first time, she could do what she does best without asking a manager, who didn't see what she saw or had her level of expertise. “In other organisations, I always had to ask a manager, who was not a nurse, whether I could do what I thought was best. That made no sense to me. I am a professional and the manager is not - but I had to ask them about what I do.” In Buurtzorg, she can focus on the only relationship that really matters - the relationship with the person needing care, not the relationship with a manager.

There are, of course, some challenges with working in a self-managed team. “You are not shielded when things go wrong for the person in your care.” Then there is the very human feeling that, as she admitted, “sometimes, especially when you're tired, you do just want to be told to do something by someone above you, and do it without thinking.” Decision by consensus - the mode Buurtzorg trains its self-managed teams in to be able to reach conclusions - can be tough, too, “Sometimes it feels very tiring if people disagree and it can take a long time.”

Buurtzorg is just an organisation that provides the architecture to allow people like her to get on with what they do best

Talking to someone inside the organisation itself gave me a new level of insight into what's revolutionary about the Buurtzorg model. I expected to be blown away by the organisation itself. But actually what struck me the most throughout this conversation was that this nurse had dedicated her career to caring for people - she was a professional at it, and it's why she came to work each day. She was the revolution. And Buurtzorg is just an organisation that provides the architecture to allow people like her to get on with what they do best.

Models like Buurtzorg's recognise that the professionals in them are the change-makers. They recognise that the organisation does not exist to manage, control or track their employees, but only to provide the enabling conditions to allow them to focus on those who need their help.

More and more governments and organisations are trying to shape their institutions to create these kinds of conditions. But we still have a long way to go in many areas of public service delivery. We need to continue to find ways, as Buurtzorg has done, to structure organisations around enablement and empowerment, not management and delivery.

We are exploring and debating the implications of enablement as part of our Future of Government project and we are looking for more case studies of enablement in practice. Contact us at futuregovernment@centreforpublicimpact.org if you work in the public sector or in government and would like to contribute your thoughts and reactions to this debate or suggest more case studies we should explore.

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FURTHER READING:

• The Future of Government: CPI is exploring what the future of government should look like and what it will do. Help shape what comes next.
• Less management, more care: a Dutch nursing revolution reaches the UK. Brendan Martin tells us how he plans to spread the Buurtzorg model to the UK and beyond and revolutionise nursing with the enablement mindset.
• Enablement: how governments can achieve more by letting go: The traditional service delivery model is increasingly being challenged by an enablement mindset.
• The Future of Government is moral, says Victoria's most senior civil servant: Chris Eccles tells us why he feels the moral dimension of government has never been expressly articulated.
• What's next? A design journey into the Future of Government: Lack of diversity at the top, austerity and simplified metrics, Elena Bagnera explore the obstacles to building citizens' trust in governmenT
• The world turned upside down: how governments can change in changing times. Governments are under pressure to improve service delivery and performance in a number of ways - LSE Capstone students look at how technology can help.
• PODCAST: Brown talks to Blair… The Future of Government. We sat down with Tony Blair to discuss his thoughts on how government needs to adapt to reflect societies changing needs.
• Why remaking public policy in the 21st century should be less technical and more human. Elena Bagnera looks at how can governments make themselves fit for the future.