Socialudvalget 2014-15 (1. samling)
SOU Alm.del Bilag 246
Offentligt
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Jos de Blok
Visit Denmark jan. 8th 2015
Buurtzorg: Humanity above bureaucracy!
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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Buurtzorg – Quick Scan
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New organization and care delivery model
Started in 2007 with 1 team/4 nurses
Delivering Community Care/working together GP’s
2014: 9000 nurses in 800 independent teams.
45 staff at the back office and 15 coaches
70.000 patients a year
Turnover: € 280.000.000,- in 2014.
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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WHY: a transition was needed!
• Fragmentation of cure, care, prevention
• Standardization of care-activities: products!
• Lower quality / higher costs: wrong incentives:
delivering much care against low cost is profitable
• Nurses quit working because of losing their
autonomy and craftmanship
• Big capacity problems due to demographic
developments
• Clients confronted with many caregivers
• Information on costs per client/outcomes: none!
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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Start Buurtzorg 2007
Starting an organization and care delivery model
for community care with:
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independent teams
of max 12 nurses
– Working in a neighborhood of 5.000-10.000 inh.
– who organize and are responsible for the
complete process:
• clients, nurses, planning, education and finance;
• and all kind off coordination activities!!!!
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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(Self)-Organisation
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Optimal autonomy and no hierarchy: TRUST
Complexity reduction (also with the use of ICT)
Max 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
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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Different types of clients
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Chronically ill and functionally disabled clients
Elderly clients with multiple pathology
Clients in a terminal phase
Clients with symptoms of dementia
Clients who are released from the hospital and are
not yet fully recovered
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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Vision: support indepence!
4. Formal networks
3. Buurtzorgteam
2. Informal networks
CLIËNT
1. Selfmanagement client
Onionmodel Buurtzorg
Buurtzorg works inside-out:
empowering and adaptive,
networkcreating, supporting.
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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Quality system
• Monitoring outcome instead of production: the
Omaha system (becoming the national standard)
• Roles and activities instead of processes (ISO)
• High education level: 70% is RN (average NL10%)
• Buurtzorg academy: E-learning environment
• And of course: clientsatisfaction!
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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Supporting the independent teams
• 45 people in 1 back office; 15 coaches,
managers 0!: 2 directors: a happy couple!
• Taking care of inevitable bureaucracy, so the
nurses won’t be bothered with it!
– The care is charged.
– The employees are paid
– Making financial statements
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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ICT makes it possible! - Buurtzorgweb
Shared values
View on quality of care,
transparency
Community
Instruments
Communitation
in the care chain
Production
Position in the care-chain,
relationship whit other caregivers.
Grip on the business
Relationship
professional
and client
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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Buurtzorgweb – some aspects
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Community: sharing experiences; blogs
Sharing values: the Buurtzorg identity
Clients and employees data
Sharing documents; innovations
All the necessary administration for accountability
to health insurance, inspection etc.
• Planning, scheduling, reporting, registration
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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Innovations
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E-Health: new services at home: INR selfguidance
My Shopeye: serving the teams
Neighborhood clinics with GP’s
EHR: E-messages: everything is digital
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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Buurtzorg in the whole country
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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Satisfied employees
• Thousands of nurses quit their job at traditional
organization and went to work for Buurtzorg
• They appreciate:
– Working in small teams
– Working autonomous
– Independency
– Strong teamspirit
– User-friendly ICT
• Price best employer of the year 2011/2012/2014
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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Satisfied clients
• Good quality of care.
• "Compared to 307 other organizations for
community care they give the highest score to
Buurtzorg. (NIVEL 2009)“
• Highest clientsatisfaction rates: 9,1
• Supported by patient- and elderly organizations
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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Rollatorrace: bottom-up innovation
http://www.yout
ube.com/watch?
v=Q-fPDrN5pBU
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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Cost effectiveness for the organization
• Overhead costs: 8% (average 25%)
more
money for the care and innovation
• Profit rate: 5% (for innovation, education)
• Sickness rate: 4% (average 7%)
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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Cost Benefits for the Care!
• The home care would be 65% of the costs (Buurtzorgs
model leads to more prevention, a shorter period of care
and less spending on overhead)
• More satisfied employees and clients
• The government an all political parties are stimulating other
care organization to work like Buurtzorg.
• Other sectors are interested in the organization model
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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New concepts based on same principles
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Buurtzorg Jong: youthcare: 15 teams
Buurtdiensten: domestic care: 85 teams
BuurtzorgT: psychiatric homecare: 12 teams
Buurtzorgpension: short stay/rehabilitation
Buurtzorghuis: hospicecare
Buurtzorgplus: OT and PT
Sweden, Belgium, USA, ASIA……
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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New paradigms needed
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Integrating simplification theory: Sharda Nandram
Reinventing organizations: Frederic Laloux
The Netherlands is flipping: Prof. Jan Rotmans
Leading professionals: don’t! Prof. M.Weggeman
In the shadow of the care system: A. van Dalen
Humanity above bureaucracy: Jos de Blok/A. Pool
 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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 SOU, Alm.del - 2014-15 (1. samling) - Bilag 246: Oplæg fra udvalgets studietur til Aalborg og Holland den 7-9/1-2015
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Thank you for your attention