Dutch News

10 March 2014
Dutch innovative care model is revolutionising home care

Care is one of the prominent issue's in the upcoming local elections on March 19. Since a few years 'Buurtzorg', a new care model is revolutionising home care in the Netherlands. In the direct 'nurse led' care model there is no room for management and luxurious offices. The nurses are responsible for their own financial results. The innovative model is introduced in Sweden and the US, and there is interest from countries like Switzerland, Scotland, Canada, Japan and China.

Care is one of the most important issue's in the upcoming local elections on March 19. Local councils will be given responsibility for long-term non-residential care from 2015. Since a few years a new care model is taking the Netherlands, and also other countries in the world, by storm. The 'nurse led' care model is totally non-profit and has the goal to offer the best care possible. The district nurses and district healthcare workers themselves have the authority and they are  responsible for their own financial results. So no management and luxurious offices. The innovative care model is revolutionising home care. The model is introduced in Sweden and the US, and there is interest from Switzerland, Belgium, Scotland, Canada, the US, Japan, China and Korea.

Buurtzorg: The reintroduction of the district nurse
He has turned homecare in The Netherlands completely upside down. With Buurtzorg Nederland [Neighbourhood care Netherlands], Jos de Blok has reintroduced the work of the district nurse. ‘I saw that the profession was dying a slow death and that is what I wanted to prevent.’ Jos de Blok (50) was originally a district nurse and, until 2006, worked for regular homecare organizations. He also had management functions in those organizations. ‘I entered the healthcare sector out of passion and compassion. I very much wanted to add something to the lives of others. District nurses don’t have a job, they are their job. Over the past few years, that has seemed to disappear. Providing care had become something entirely different. It was suddenly all about production, protocols and administration. It was heading in the wrong direction.’


Personal responsibility
De Blok made an agreement with himself that he would not be a contented person until the profession of district nurse had regained its explicit social value. He then decided to start organizing that care himself. It started out on a small scale, but his organization, Buurtzorg Nederland, has expanded to the current two hundred and fifty independent teams throughout the entire country. Buurtzorg Nederland is an organization in which district nurses and district healthcare workers themselves have the authority. ‘Every team is responsible for its own clientele and is in close contact with family doctors and families. The teams are also responsible for their own financial results. The supporting office in Almelo is just that: supporting.’ For Buurtzorg, there are no fancy locations or luxurious offices. The supporting office operates from the extension to his private home and is run by his partner, Gonnie Kronenberg. The Buurtzorg teams throughout the country also work from simple locations.


By acting ‘normal,’ the initiator is denouncing the system that has led to the over-paid managers of traditional and commercial homecare organizations. ‘These days, it is incomprehensible why all these middle managers are necessary. And that does not even begin to explain the huge compensation that these people are given for taking part in the ‘meeting circuit.’ I feel that it is unethical that top management in healthcare is earning so much money. I think that even the ‘Balkenende-norm’ [civil service salary cap equal to the salary of the prime minister] is too high. What you must do, is to ensure that the people providing care to the clients are well paid. That is an important pillar of our organisation.’


Many awards already
Jos de Blok’s star is rising quickly. For example, over the past months, he has spoken regularly with under-secretary Jet Bussemaker and Health Minister Klink and he was even invited to talk to Prime Minister Balkenende. ‘I am delighted to be able to say my piece at various think-tanks and committees. These are excellent opportunities to say what I think. I also think it is wonderful when Ms. Bussemaker expresses her appreciation for our approach on her weblog, as long as she presses on and turns that appreciation into concrete measures, says De Blok pragmatically. De Blok’s organization has already won various prizes: Case of the Year, the Nima Marketing Prize, the Best Practice Award and the Spider Award. In 2009, a comparative study done by Nivel showed that clients valued the homecare by Buurtzorg Nederland most of all.


The lightning-speed success in no way presents problems for the native of Zeeland who now lives in Twente. However, behind his down-to-earth attitude can be found an all-consuming passion. He seems almost prepared for the success. ‘If you do something precisely the way it is meant to be done, it can, I believe, hardly fail. District nurses and healthcare workers apply to us spontaneously. We have never had to do any active marketing. That certainly says something. Strangely enough, I had sort of expected this kind of success. I had heard from so many colleagues that they had had enough. This new approach with the re-establishment of the old-fashioned and universal care values could almost not fail.’


As early as September 2007, Jos de Blok announced that he was striving to achieve national coverage with Buurtzorg Nederland within three years. In February 2006, after ten years’ experience in management functions, he quit his permanent job with the Twente healthcare organization Carint and established Buurtzorg Nederland. With a business plan, he was able to secure a loan of € 250,000 from a bank. He also put in some of his own money. Wasn’t that risky? ‘I have always believed in this. But the risk lay, of course, entirely on my shoulders. If it were to fail, I would have had it. For the first six months, I did not take any salary.’ But it did not fail. After the first team in Enschede, a second team quickly followed in Utrecht. By September 2010, there are two hundred fifty teams. ‘By the way, the overhead has not increased accordingly: fourteen staff members at the head office in Almelo and ten coaches who each manage 25 teams. The annual turnover is also growing. For 2010, it is moving in the direction of ninety million Euros.


Transfer of homecare teams
The spectacular growth can be attributed to the fact that entire teams from other homecare organizations transfer to Buurtzorg Nederland. For some time now, De Blok has been negotiating with dozens of regular homecare organizations for more intensive collaboration. De Blok certainly does understand that restructuring an existing homecare organization is much more difficult than starting a new one, just as he started Buurtzorg Nederland. They will have to dismantle a major part of their overhead, and that costs time. In the Buurtzorg formula, there is no place for schedule planners, coordinators and mid-level managers. ‘That restructuring takes years. We will probably start with a few teams which work according to the Buurtzorg Nederland method. In that way, an organization can gain experience and see if it suits them.’


They must then work according to the Buurtzorg-method. Thus far, the negotiations have stranded on the costs of laying off the supporting staff. In the Buurtzorg concept, there is hardly any room for schedule planners and coordinating managers because the teams organize that, for the most part, themselves. The negotiations with, in particular, Thuiszorg Groningen, a subsidiary of the disentangled Meavita Nederland, were in an advanced stage. The Ministry of Health, Welfare and Sports [VWS] was prepared to finance the retraining. The costs for the social plan would have to be coughed up by Thuiszorg Groningen itself. That, however, turned out to be an insurmountable hurdle. And that was even without paying one penny on recruitment. ‘The motivation of the staff is the motor behind the growth,’ says De Blok.  Read more >>



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