Buurtzorg – an innovative model for caring elderly at home
Åsa Rosengren, Jukka Piippo, Ira Jeglinsky-Kankainen, Jukka Surakka
The Dutch home care provider Buurtzorg Nederland has attracted widespread interest for its innovative approach for caring elderly at home. Buurtzorg – meaning ‘neighbourhood care’ – empowers nurses to help their home care clients retain independence and autonomy. Buurzorg has earned high level of client and employee satisfaction and appears to provide high-quality home care at lower cost than other organizations. The model is spread worldwide, including Sweden, Japan, and United States. Currently this model will be tested and evaluated in Finland.
The Buurzorg Nederland Model of home care
Buurtzorg was founded in 2006 by Jos de Blok and his friends Gonnie Kronenberg and Ard Leferink. As a former district nurse and manager in home care, De Blok was dissatisfied with the bureaucracy-driven healthcare. He strived for an organisational model that focuses on meaningful relationships and no hierarchy. (De Blok 2015) The idea of starting Buurtzorg was born from the conviction that “a more humane or humanistic approach is needed in management so that people can be the owner of their daily work, can enjoy their results, and can contribute to society with meaningfulness” (De Blok in Nandram, 2015). “Humanity over bureaucracy” is the mantra of the organization (De Blok 2914). Starting with a self-managing team of four nurses in the small city of Almelo in 2007 (Monsen & de Blok 2013), the Buurzorg organization currently consist of about 800 teams (van Rossel 2017). In 2015 about 10 per cent of the Dutch homecare clients were serviced by the Buurzorg teams (Johansen & van den Bosch 2017).
The self-managed teams take care of their clients with the aim of making them stronger and independent. To reach this aim nurses provide comprehensive, holistic care which include the whole range of care from medical treatment and care to support services (i.e. dressing, bathing, preparing a light meal) and try to mobilize and involving the client´s own social network to take part in the care. The nurses also work closely with general practitioners and other community healthcare providers. (Kreitzer et al. 2015) De Blok says;” Buurzorg differs from traditional homecare organisations in creating solutions, not delivering services”.
The self-managed teams take care of their clients with the aim of making them stronger and independent.
The teams consist of a maximum of twelve nurses and are self-managed entities. As such, nurses are challenged to organize and manage their own work. Teams schedule their own work, recruit new colleagues and determine the best approach without involvement of a manager. The decisions are made collectively, meaning that the team strives for consensus, not democratically decisions. De Blok believes if nurses are entrusted with the responsibility of their clients, they will do their best. (Monsen and De Blok 2013). If the teams seek advice, aspects of care or how the team functions, the teams receive guidance and support from a regional coach (senior nurse). Whenever the team grows beyond twelve nurses, a new team is formed to maintain the small-scale structure. The self-managed teams are supported by an innovative technology structure that was developed specifically for the Buurzorg nurses. They have a web server and intranet health care platform called the Buurzorg Web, where teams are interconnected and share knowledge and receive support. Within the IT platform Buurzorg uses the Ohama system to record nursing assessments and to document care. (Kreitzer et al. 2015). Key features of this organisational model with a Self-Managed team approach are shown in figure 1.
Figure 1: Key features of the Buurtzorg care model.
| Philosophy |
| Focus on community resources and on community capacity building. Trust on the individual practitioner’s craftsmanship, focusing on the needs of the client in a holistic rather than a task-oriented manner Trust in the motives of front-line staff and their desire to improve care for clients. Shared responsibility between employees. The importance of team working, reflection and dialogue. |
| Goals |
| Become a sustainable, holistic model of community care. Create self-governing teams of nurses to provide both medical and supportive home care services. Build a relationship-based practice, where nurses are interested in client´s life circumstances. Maintain or regain clients’ independence and autonomy. Empower and train clients and families in self-care.Create networks of neighborhood resources. |
| Structure |
| Self-managing teams (with maximum of 12 nurses), who manage themselves and their work, performing all of the tasks necessary to provide care for 50-60 clients in a given neighborhood. Relies on the flexible ICT support – Buurzorg Web for dialog, online scheduling, documentation of nursing assessments and services, and billing. Coaches are available to guidance and solve problems for each team. Small back off handles administration. Simplifying billing, using one rate for a visit, regardless of duration. |
Sources: Bradford et. al, 2015; Kreitzer et al. 2015; Monsen & de Blok 2013; Nadram et al. 2014; van Roessel 2017.
The Project Self-managing teams in Finland
The interest in the Buurtzorg model with the Self-Managed team approach has rapidly grown. Buurzorg self-managing teams were launched in Sweden Bålsta in 2011, in Minnesota 2013, in Japan 2015 and now Buurtzorg has entered Finland.
The aim in our Project Self-managing teams is to evaluate how the Buurtzorg model will be implemented in home care organizations in two Finnish municipalities. The aim is also to follow the development process among the self-managing teams. Research questions are as follows: 1) Can the model be applied to Finnish health care culture? 2) How is the model affecting work ability, well-being at work and client satisfaction? 3) Is the model cost-effective? The sample size within the elderly care consists of totally about 150 – 200 persons.
A mixed methods design will be used including both qualitative and quantitative data collection. All staff members get a questionnaire to answer in the beginning and at the end of the project. Both focus group and individual interviews will be used to evaluate the team members experience of work satisfaction, management, teamwork and trust. Additionally the superiors and responsible superiors of the organizations as well as clients will be interviewed in the beginning of the project, in middle of the project and at the end of the project. Health economical calculations shall be done within both organizations.
Coaching is an important part of the Buurtzorg model.
Coaching is an important part of the Buurtzorg model. The process of coaching will be organized at both municipalities. The idea is to organize coaching ones a month according to the principles of action research. The coaches and researchers bring continuously material from questionnaires and interviews to team members to expose their situation concerning self-management, work satisfaction, independency from superiors and client satisfaction. The process is based on practical form of action research (Cilliers 1999, Newton & Burgess 2008, Koshy et al. 2011) which improves practices and services by developing all participants skills, influences effectiveness, improves professional skills and participants self-understanding and improves development of new kind of awareness. The form of research is also based on mutual co-operation and responsibility between all participants’ inclusive coaches. Coaches and researchers and participants recognize together the actual “problems” and factors influencing them and decide together actions needed to improve the situation. Coaches and researchers also encourage participants to activity and reflections concerning their own actions.
The research project is about to begin, so no results can yet be presented. The two year project is financed by the Finnish Work Environment Fund and A.F. Lindstedts & Svenska handelsinstitutets fond för handelsutbildning. The project is managed by Arcada UAS, and will be carried out through collaboration with the National Institute of Health and Welfare, Hanken School of Economics and Lappeenranta University of Technology.
References
Cilliers, W. J. 1999. An experiential learning process for the advancement of previously disadvantaged employees in an industrial context. University of Pretoria.
De Blok, J. 2014. Jos de Blok on Organizational Structures – presentation on YouTube. Retrieved from https://www.youtube.com/watch?v=BeOrNjwHw58 4.9.2017.
Johansen,F. & van den Bosch, S. 2017. The scaling-up of Neighbourhood Care: From experiment towards a transformative movement in healthcare. Futures, Volume 89, May 2017, Pages 60-73.
Koshy, E., Koshy, V. & Waterman, H. 2011. Action Research in Healthcare. Thousand Oaks, California: SAGE Publications.
Kreitzer, M.J. & Monsen, K.A., Nandram, S. S., & De Blok, J. 2015. Buurtzorg Nederland: A global model of social innovation, change and whole systems healing. Global Advances in Health and Medicine, 4, (1), 40-44.
Monsen, K. & de Blok, J. 2013. Buurtzorg Nederland. A Nurse-led model of care has revolutionized home care in the Netherlands.AJN, Vol. 113, No.8. P.55-59.
Nandram, S. & Koster, N. 2014. Organizational Innovation and integrated care: lessons from Buurtzorg. Journal of Integrated Care, vol. 22, ussue 4, p.174-184.
Nandram, S. S. 2015. Organizational innovation by integrating simplification, Learning from Buurtzorg Nederland. Springer International Publishing.
Newton, P. & Burgess, D. 2008. Exploring Types of Educational Action Research: Implications for Research Validity. International Journal of Qualitative Methods 7 (4), 18-30.
Van Roessel, G. 2017. Presentation of the Buurzorg Model. International day 2 March 2017. Study visit at Buurzorg head office in Almelo.
Åsa Rosengren, Principal lecturer, Arcada University of Applied Sciences
Jukka Piippo, Principal lecturer, Arcada University of Applied Sciences
Ira Jeglinsky-Kankainen, Principal lecturer, Arcada University of Applied Sciences
Jukka Surakka, Research leader, Arcada University of Applied Sciences