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Weekly notes – week 32: Buurtzorg shakes hierarchical organisations

Read about how one organisation in the Netherlands is not just changing healthcare, but challenging hierarchies...


Jenna Lähdemäki-Pekkinen

Specialist, Foresight


How would you feel about a workplace with no bosses or hierarchy, with the employees hiring their own co-workers and the pay being better than the competitors can offer, and yet at the centre of it all would be the employees’ professionalism and independence?

Buurtzorg is a Dutch non-profit healthcare organisation where all of the above is reality. Visiting Finland on recently, the organisation’s founder Jos de Blok worked previously as a nurse and in various healthcare organisation jobs. Along the years he had many ideas on how things could be done differently, and in 2007 he started Buurtzorg with three other nurses.

Buurtzorg is doing well: it has captured a 70% market share in its field in Holland. Currently the company employs 9,500 nurses, treating 75,000 patients a year.

The organisation’s philosophy is based on concentrating on what is essential – that is, care work – and on keeping things simple. One example of this is that Buurtzorg’s net sales are 300 million euros, but their annual report fits onto one page.

The theoretical foundation for Buurtzorg’s operations lies in Frederic Laloux’s Reinventing organizations, which has examples of clever organisations where work has some higher meaning. Sharda Nandram, on the other hand, spent several years interviewing and following Buurtzorg employees and the way they operated, and then wrote Organizational Innovation by Integrating simplification: Learning from Buurtzorg Nederland

De Blok was speaking in Helsinki to a packed audience at the Future of Work seminar. The future of work has seen a heated debate recently and judging purely by the title, participants may have been wondering what the seminar could really offer. Buurtzog and its founder Jos de Blok, however, are something quite different and as a result Finns, confused by the recent debate about domestic healthcare and social services reform, were listening with avid interest. Wow! So it really can be done.

The Buurtzorg model has attracted worldwide interest and is currently being applied in 30 countries, including the US, Sweden, Japan, Korea and now in Finland, too; one of the speakers explained about the pilot project by a company called Debora in Lahti, operating in the Buurtzorg way. 

“We build complex organisations to perform functions that are fundamentally very simple,” de Blok said. “Buurtzorg is a healthcare organisation, but similar principles can be applied to educational establishments, police departments or practically any field. Our vision is: support independence! The core of everything is a shared value base and a jointly created organisation culture, with full trust in the participants’ professionalism and work ethics.”

De Blok thinks it is very important that caregivers are inspired in their work. Healthcare has for a long time tried to standardise the smallest possible task in search of the most economical option. However, this has led to poorer quality, higher expenses and frustrated caregivers, says de Blok.

“The most important thing in healthcare is the connection and trust between caregiver and patient. At Buurtzorg, caregivers work in independent units in different parts of Holland, but still feel they are part of a single organisation, because the shared value base is so solid.”

Buurtzorg is closely related to a larger social trend in which empowered communities challenge old institutions. The period since the 1950s can be described as the heyday of institutions and the building of the welfare state, with different spheres of life – ranging from raising children to city infrastructures – becoming institutionalised. But times change and societies become more modern, and individuals and communities are becoming more powerful, challenging institutions – the very basic fabric of society.

There were many questions to de Blok from the audience, for example on how to resolve conflicts in teams where there are no supervisors. In certain cases caregivers move to work in another team. The last alternative is to leave Buurtzorg, but this must be the caregiver’s choice, too, said de Blok. He added, however, that his first remedy is to have teams with problems with their work atmosphere arrange a joint dinner in which you are only allowed to say positive things about other people. This might be worth trying in quite a few workplaces.

Related material:

Lean and Agile Adoption with the Laloux Culture Model (video)

Learning from Buurtzorg Nederland – New book on organizational innovation by Dr. Sharda Nandram (article)

Buurtzorg Nootdorp – Sportieve Loop 2015 (video)

Sitra’s trends: Voimaantuvat yhteisöt haastavat vanhat instituutiot (article in Finnish)

Weekly notes is a summary of topical issues from Sitra’s strategy and research team

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