Reinvention of a comprehensive community

care model and learning from copycats

Ard Leferink

23th February 2017

My pre-Buurtzorg experience (1)

• Fun!

• Lot of responsibility

• Satisfied customers

• Problem? Let’s solve it!

• No management involved….

My pre-Buurtzorg experience (2)

• Business & Public administration

– Consultant in a large home healthcare organisation

• ’Our’ Analysis – Homehealthcare 1995

– We need to act more like a business

• Bring in the business managers

– Workforce is not flexible and efficient enough

• Bigger teams, smaller contracts

• Splitting up tasks. Managing on time and task

• ERP, Orderfulfillment.

– Customer (not patients!) needs more focus

• Central smart planning, Callcentre

My pre-Buurtzorg experience (2)

• We did it all:

– Business Proces Management

– Project Management

– Customer Relationship Management

– Supply Chain Management

– Business Intelligence

– Human Resource Management

• And the board was happy with it

• Fun!

• Lot of responsibility

• Satisfied customers

• Problem? Let’s solve it!

• No management involved….

• A lot of management involved

• Dissatisfied professionals

• Dissatisfied customers

• Risk? Let’s avoid it!

• Problem? Let’s manage it!

The birth of Buurtzorg : 2006

The birth of Buurtzorg : 2006

Strong vision on

care

Self organising

teams

ICT Backbone

Start Buurtzorg 2006

Starting an organization and care delivery

model for home visiting personal and nursing

care with:

– independent teams, maximum of 12 nurses

– who organize and are responsible for the

complete process:

• clients, nurses, planning, education and finance;

• and all kind of coordination activities!!!!

(Self)-Organisation

• Optimal autonomy

• Complexity reduction (also with the use of ICT)

• Maximum of 12 nurses a team, 40 à 50 clients

• Assessment and taking care of all types of clients:

generalists!

• 50% Bachelor educated nurses

• Their own education budget

• Informal networks are much more important than formal

organizational structures

What started with one team

• In the city of Enschede

• Exploded within 10 years

– 900 teams throughout the country

– 9000 employees

– 300 mln € turnover

– 50 backoffice employees

– 20 coaches

– 1 CEO

How we support the teams

Supporting the independent teams

Supporting the independent teams

• Design :

– Always fight the complexity monster

• Culture :

– Creating the right service culture is tough but

the maintenance is even tougher

IT Strategy

• SCRUM / Agile

– listening to the teams

– Iterative and incremental development

of software

• If Buurtzorgteams don’t like it, IT’s not good

enough!

Double Agile

Agile Business

Development

Agile IT Develop-

ment

Platform as a Service

Buurtzorg as launching customer

No investements in IT

Just ordering services

IT Services: A lot of ‘regular stuff’

Documenting care

Team performance

My most important ‘IT’ lesson

• Social communication is extreme

powerfull.

• But can only develop in a social

organisation that can handle it.

• And only when it’s fully integrated

in regular work

Corporate ??

What we don’t do

• No strategy meetings. In fact, no structured meetings at

all….

• No policymaking

• No (team)budgetting

• No formalized management of…

– Customer relations

– Supply chain

– Human resources

– Communication or Public Relations

– ....

What we do

• Performance monitoring

• Procurement & following new legislation/regulation

• Learning from trends, discussions. (Knowledge System)

• Stimulating innovation & learning

• Coaching ’on demand’

• Quality System

– Focus on what nurses should do, not on how nurses should do that

– Roles and activities

– Buurtzorg acadamy

Effect

Satisfied employees

• Thousands of nurses quit their job at traditional

organizations and went to work for Buurtzorg

• They appreciate:

– Working in small teams

– Working autonomous

– Independency

– Strong team spirit

– User-friendly ICT

• Price for best employer

Satisfied clients

• Good quality of care

• Compared to 307 other organizations for

community care they give the highest score

to Buurtzorg (NIVEL 2009)

Lessons learned From Copycats

Often heard….

• Our people aren’t suited for self organizing, we’ve got the

wrong ones…

• We want best of both worlds.

• Easy job. Just fire the managers and tell the teams they are

in charge now.

• It can be done without restructuring the backoffice.

• It won’t work, it’s just a hype.

The answers….

• Our people aren’t suited for self organizing, we’ve got the

wrong ones…

– Start with the innovators and the early adopters !

– Yes, in the end you’ve got a problem with the Laggards.......

The answers

• We want best of both worlds. (Let’s manage self

organisation)

– You can’t manage the new direction.

– You can only serve, guide and cut complexity.

The answers

• Easy job. Just fire the managers and tell the teams they are

in charge now.

– You’ve got to work hard if your culture isn’t social. And you can’t

schedule a culture change…

– Most difficult part is restructuring the ’backoffice’ (PR, HRM, FM,

etc...)

– It’s not anarchy, you need a clear framework

– Think of a Proof of Concept with a Minimal Viable Backoffice

The answers

• It can be done without

restructuring the backoffice.

– Not true! Cutting complexity,

redesigning processes and delete

the right protocols and procedures is

hard work!

The answers

• It won’t work, it’s just a hype

• Avoid too much theory.

We’ll see…..

Thank you for your attention