West Suffolk Gets a Visit from a Buurtzorg Nurse: Meet Madelon Van Tilburg

29th June 2016

One of the key features of the Buurtzorg model revolves around the establishment of self-managed teams. The model aims to empower nurses to deliver all the care that patients need.  Despite the increased cost of this, Buurtzorg has accomplished reduction in hours of care, improved quality of care and raised work satisfaction for their employees.

On 21 June 2016 a group of partners from across the West Suffolk system met with Madelon Van Tilburg, a Buurtzorg nurse based in The Hague, to discuss what it means to be a Buurtzorg nurse and to look at how this type of working might benefit our own system here in the UK.

Becoming a Buurtzorg Nurse

Like many of her colleagues, Madelon joined Buurtzorg to escape the ‘time and task’ approach.  
“The care was really fragmented” she stated when talking about her role before joining Buurtzorg. “A care worker for washing and clothing, a nurse assistant for the stockings and a nurse for the wound care.  As a nurse coordinator I had to give advice to the lower level nurses in very complex situations… but there was no time to connect with the client and find out about their needs… No one had a holistic view of the client… No one felt responsible and no-one took responsibility because they were not used to it…

“As a nurse I wanted to provide good care but in this organisation it was not possible.  It was based on check and control… Then I saw an announcement that they were looking for a Buurtzorg nurse. I searched for more information, and I got really inspired and I applied for a job.  I became a Buurtzorg nurse.”

Hear the full story about Madelon's move from her former organisation to becoming a Buurtzorg nurse here [audio file].

In Buurtzorg the client comes first

Madelon described how Buurtzorg starts from the client perspective with the Buurtzorg Onion Model serving as the starting point to providing solutions that bring independence and improved quality of life. It assembles the building blocks for independence based on universal human values:

  • People want control over their own lives for as long as possible
  • People strive to maintain or improve their own quality of life
  • People seek social interaction
  • People seek ‘warm’ relationships with others (friends)

She described how the nurse attunes to the client and their context - taking into account the living environment, the people around the client, a partner or relative at home - and on into the client’s informal network; their friends, family, neighbours and clubs as well as professionals already known to the client in their formal network.

The nurses work with clients with varying needs: elderly; have multiple pathologies; may have symptoms of dementia; may have been discharged from hospital recently; and, may be chronically or terminally ill.

In describing the relationship with the client Madelon said: “Why is being a Buurtzorg nurse so different? Under Buurtzorg you can see the whole client as one.  It is also about the attitude that you bring.  It is not about going in and putting on stockings and leaving. This is a person with stockings or a person with a wound.  If the wound is not healing you need to look further than the wound itself [the environment, the house] and under this model you have the time to do this.”

Working closely with each individual patient the Buurtzorg nurse works to design and implement the most appropriate and effective care plan based on an individual’s needs.

Supporting independence

All Buurtzorg nurses are responsible for promoting and providing outstanding care. They focus not only on current needs, but also on preventing future problems. 

In describing this approach Madelon used the words: Patient-centred. Holistic. Skilled. Connected. Innovative.

Building trusted relationships and networks in the neighbourhood are all important principles for the teams, both for the way work with their clients.  “The scale of working” Madelon stated “makes it possible to know and use the local resources, to focus on the networks, to start preventive activities.”

This personalized attention and team approach allows individuals to stay in their homes and communities for as long as possible, avoiding more costly institutional care.

Hear from Madelon about the Buurtzorg Way here [audio clip]

Self-managing teams of nurses

Madelon described what she appreciates from working in the Buurtzorg team:  “the small team, working autonomously, making their own decisions with a strong team spirit.”

Buurtzorg’s nurses have professional freedom with responsibility. Each team has a maximum of 12 staff and works at a neighbourhood level (10-20,000 population) with the team handling every aspect of care and business, from client assessment to staff recruitment.

The highly-skilled nurses are ‘generalists’ taking holistic care of a wide-range of patients and conditions.

Nurses are supported by a simple and streamlined organisation:

  • Team members and teams share information, knowledge and advice via Buurtzorgweb.
  • Nurse use ipads to complete the outcome based Omaha system that defines problems, the knowledge the client, or their carer, has about the condition and how their behaviour impacts on the condition on a easy to use system designed by nurses for nurses
  • The back office takes care of admin, billing and payroll to free nurses to nurse
  • For 800 teams and 9,500+ nurses there is one back office of 45 staff
  • 15 coaches support the 800 teams - an intentionally small ratio to avoid building dependency.

Working successfully in self-managed teams also requires learning new skills and developing new mindsets, Madelon explained.  “Trust is important” she stated “trusting that professionals have the right competences to solve the problems”.

Hear from Madelon about working in a Buurtzorg Team here [audio clip]

Buurtzorg’s Success

Buurtzorg has grown from those four nurses to more than 9,000 because it delivers better care at lower cost per client.  Independent evaluation of the impact Buurtzorg has made has shown that 50% of the patients receive care for less than three months and patient satisfaction scores are 30 percent above the national average.

Its staff love it too - the company has won employer of the year in the Netherlands in four out of the last five years.

Madelon’s full presentation can also be viewed here.

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