• Industry: Healthcare
  • Type: Survey report
  • Date: 10/8/2012

Netherlands: Buurtzorg empowered nurses focus on patient value 

In the Netherlands, the financing and delivery of home care is highly fragmented with various tasks – such as washing the patient, serving meals and putting on elastic compressions – paid through different reimbursement schemes and, more often than not, executed by different professionals. As a result, patient care tends to lack coordination, making it difficult for the care providers to respond appropriately to changing patient conditions, which in turn leads to compromised continuity of care and low patient satisfaction.

Netherlands: Buurtzorg

At the same time, many home care service providers have cut costs by fine-tuning the minimum skill level required to accomplish each task. Dutch home care also tends to be focused on responding to patients’ current problems rather than preventing deterioration, meaning that interventions are generally added on only once the patient’s condition has already worsened.

To respond to these challenges, the home care organization Buurtzorg (meaning neighborhood care) was created to focus on patient value by putting professionals in the lead through reverse task shifting. Essentially, the program empowers nurses (rather than nursing assistants or cleaners) to deliver all the care that patients need. And while this has meant higher costs per hour, the result has been fewer hours in total. Indeed, by changing the model of care, Buurtzorg has accomplished a 50 percent reduction in hours of care, improved quality of care and raised work satisfaction for their employees. In fact, in 2011, Buurtzorg was chosen as the Dutch employer of the year.

How it led to productivity improvement

One of the keys to the program’s success is that Buurtzorg’s home care nurses organize their work themselves. Moreover, rather than executing fixed tasks and leaving, they use their professional expertise to solve the patient’s problem by making the most of their clients’ existing capabilities, resources and environment to help the patient become more self-sufficient. Simply put, Buurtzorg professionals’ aim is to make themselves superfluous as soon as possible, versus other providers who tend to execute the subtasks without truly focusing on the patient’s overall situation.

Buurtzorg uses small self-steering teams (with a maximum of 12 nurses) who attend to an area of approximately 15,000 inhabitants and work together to ensure continuity of care. As a result, the professionals build durable relationships with their community, which further strengthens their ability to find local solutions for patients’ problems. Although the teams are independent and self-steering, they are supported by a centralized service organization which provides management information to both the team and the organizations’ leadership in order to minimize local overhead and maximize the professional’s face-to-face time with patients.

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Key results

In just two years, more than 2,000 nurses have joined the program despite the increasingly tight labor market for nurses in the Netherlands. Indeed, by 2011 Buurtzorg employed 4,000 nurses and nurse assistants working in over 380 autonomous teams.

Preliminary results show that Buurtzorg’s patients consume just 40 percent of the care that they are entitled to and half of the patients receive care for less than three months. As a result, patient satisfaction scores are 30 percent above the national average and the number of costly episodes requiring unplanned interventions has dropped. The company’s financial revenue has also dramatically increased from €1 million to €40 million in a period of five years.

The Buurtzorg approach to healthcare delivery has also led to higher workforce productivity and reduced rates of absence through illness. Indeed, the total Buurtzorg organization requires overhead of just eight percent, compared to more than 12 percent within the regular home care services sector in the Netherlands. In 2010, the company achieved a 58 percent time actually spent with patients, versus a national average of only 51 percent. Given that 45 million hours of home care were provided in the Netherlands in 2010, the higher productivity level represented by Buurtzorg could potentially free up almost 7,000 full time employees nationwide (CVZ, 2011).

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