S01:E05
A patient in a fragmented home care system can have twenty or thirty different people come through the front door in a month, each delivering one timed task from a list. Buurtzorg sends one nurse, who does whatever that person needs – and whose job includes teaching them to need less of it.
That inversion is the model. Jos de Blok started it in 2006 with a single team and nobody above them. It now runs around nine hundred teams of ten to twelve nurses, who hire their own colleagues, run their own rounds and split in two when they outgrow the neighbourhood. There are still no managers. The first objection it met was that nurses qualified to work that way would cost more – what happened instead was that doctors started sending Buurtzorg the most complex patients they had, because they trusted the nurses with them.
In this episode • How home care was reorganised into billable products and tasks, and why that left patients more dependent rather than less • What a Buurtzorg team actually is: ten to twelve nurses, one neighbourhood, no manager • Why Jos argues that doing the right thing costs the system less rather than more • The two objections the model met first – that higher-qualified nurses would be more expensive, and that it only took the simple cases • Growth without marketing, and teams that split like cells once they reach twelve • April 2016, when around 2,400 domestic care workers moved across and left their managers behind • What happens when a team can’t resolve something on its own, and where the coaches come in • Taking the model abroad – Taiwan, China and the turn towards primary care – and what “humanity over bureaucracy” means in practice
About the guest Jos de Blok is the founder of Buurtzorg and a community nurse by training. He started a business-school degree, left it, and qualified as a nurse instead, working as a nurse for fourteen years before moving into management as a director in Dutch home care. He founded Buurtzorg in 2006 with a single team; it now runs around nine hundred neighbourhood nursing teams with no managers, alongside arms for mental health (Buurtzorg T), youth care (Buurtzorg Jong) and domestic care, and he puts its turnover at around €600 million.
Links mentioned in this episode Buurtzorg (Almelo, Netherlands), the neighbourhood nursing organisation Jos founded in 2006: https://www.buurtzorgnederland.com/ Buurtzorg International, which supports the model outside the Netherlands: https://www.buurtzorg.com/ Buurtzorg in Taiwan, the partner organisation marking its tenth year: https://www.buurtzorg.com/buurtzorg-in-taiwan/ The World Health Organization on primary health care: https://www.who.int/health-topics/primary-health-care
Full show notes and the archive: https://content.changingthenarrative.media/corporation-tax-how-you-know-if-a-company-is-good-or-bad-regardless-of-its-size
Chapters 00:00 Introduction 02:13 Meeting Jos: from business school to the nursing round 03:14 Why he built something different: care going “industrial” 06:33 When care became a product: fragmentation and dependency 10:10 The first steps: a model with every answer, and a five-year plan 12:19 What Buurtzorg is: neighbourhood nursing, and how a team runs 15:56 Why self-organisation: trust, autonomy and learning from experience 20:34 Overcoming resistance: “it’ll cost more” and “only the simple cases” 26:53 A €600m organisation on a strikingly simple financial system 27:05 Growth without marketing: teams that split like cells 29:36 The 2016 takeover: 2,400 workers leave their managers behind 32:19 When teams struggle: coaches and the “self-cleaning” process 35:53 Going global: Taiwan, China and the turn to primary care 39:44 Can it work anywhere? Demography, prevention and the WHO 42:45 The takeaway: humanity over bureaucracy 43:45 Closing reflections and outro
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