Creating a culture of self-management in the Buurtzorg Model

2nd November 2017

One of the common responses to testing the Buurtzorg model here in West Suffolk has been a question over culture.  It is easy to concentrate on the cultural differences between the Dutch and the English systems, but does that mean that we can’t implement Buurtzorg here?

A critique of delivering Buurtzorg in this country is around whether we can permit and propagate the cultural change needed to move from what is currently a highly hierarchical system to one where control is devolved through self-management. 

The Francis report into Mid Staffs stated that “The patient must be first in everything that is done: there must be no tolerance of substandard care; frontline staff must be empowered with responsibility and freedom to act in this way under strong and stable leadership in stable organisations.” 

The Buurtzorg model echoes these principles and has achieved success by empowering its teams to manage all aspects of patient care, with a small back office of 45 members of staff supporting a frontline workforce of over 10,000 nurses and assistant nurses with little management direction.

With the Dutch nurses freed from hierarchies, they have been able to reduce the hours of care per patient, while improving quality. Both patient and employee satisfaction levels have risen significantly, sickness rates are low and Buurtzorg has been chosen as the Dutch employer of the year in 4 out of the last 5 years.

So how do we change mind-sets to trust and enable an approach of freedom with responsibility at the frontline in the English system?

In testing the Buurtzorg model in the West Suffolk we are establishing our first non-hierarchical, self-managed team.  We have agreed to be true to the core principles of the model and will allow the team the freedom to design the Test from bottom up.

We have gained the system’s support in doing so.  The Test has been sponsored by the Suffolk Health and Wellbeing Board, and this leadership role has been essential in enabling us to get the flexibilities and permissions needed to work in this new way.

We also know that the immense pressures in the health and care service at present have the potential to distract the Test.  So we have designed a ‘heat shield’ between the nurses and the wider system.  This heat shield will enable the nurses to develop the model in a protected environment, leaving them free to care for their patients without being drawn into the processes of the existing and complex system. 

In practice the heat shield will consist of senior leads from each of the stakeholder organisations, including the clinical commissioning group, the acute, social care and community health, supported by a single back office lead to lift barriers and over-come obstacles that the team may encounter.

However, the team must not be isolated.  The heat shield must be permeable, allowing ideas (but not bureaucracy) to flow between the team and the wider system.  In adapting the Buurtzorg model for the English context the team must not only be given the authority to truly test the model but also to shape its relationship with existing health and care structures.

Alongside this heat shield, the team will be supported by coach whose role will not be to manage the team but to facilitate the team in good decision making and problem solving; keeping them on the Buurtzorg path to embed this new culture of working. 

In the Netherlands, around 15 coaches support the 10,000 plus nurses working for Buurtzorg.  This limitation on time ensure that the coaches are unable to take on a pseudo management role.  We are seeking to replicate this limitation by incorporating the coaching role into an existing staff role to ensure that the team cannot become overly reliant on the coach, whilst still being effectively supported.      

The team will head to Netherlands at the end of November to consolidate their thinking and learning in establishing the Buurtzorg approach to self-management.  This will enable them to learn some of the techniques that support self-management, such as solution focussed decision making, but also offer a chance to see this way of working in action.

As we set off on this journey there will no doubt be learning along the way.  The team will be testing and learning for the next 12 months, and there will be adaptations to the structures implemented at the start.  This is all part of the process and is fundamental to developing our understanding of how to successfully transfer the Buurtzorg model to our own English-system.    

We will be blogging about journey here on the East of England LGA website.  Check back for our next blog which will focus on the other key element of self-management in the Buurtzorg model –empowering patients to self-manage.


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