Buurtzorg (“neighborhood care”) is an innovative approach in the Netherlands which was set up to deliver home care. It originated in 2006 from the staff’s dissatisfaction of traditional home care organizations. Bureaucratic duties, working in isolation from other care providers, and, above all, neglect of their professional competencies, were amongst the numerous complaints. Since then Buurtzorg has become a major success story in the Netherlands drawing accolades from the Dutch Ministry, patient organizations and others.
In 2010 AARP Minnesota met with the Dutch Agency to learn about their innovative approach to home care. The following article coauthored by Buurtzorg CEO Mr. Jos de Blok and AARP State Director Michele Kimball, describes the Dutch model, its expansion and success in the Netherlands and the promise it holds for the State of Minnesota and the United States.
Jos de Blok: The Beginning - Neighborhood Care the Way It Was Meant To Be
In 2006, a few community nurses with a vision started a new concept in the Netherlands: Buurtzorg, which in English means “Neighborhood Care.” Prior to this, community care was fragmented and the system of paying for activities by the hour resulted in many different tasks delivered by lower-educated caregivers. Patients were forced to deal with multiple caregivers doing individual tasks, while higher-educated nurses grew increasingly frustrated, unable to properly carry out their work.
Having been a community nurse and managing director, I saw a need to develop a new model based on old principles of primary health care: skilled nurses working together in a team of no more than 12, in a neighborhood of 10,000 people, caring for all kinds of patients. These teams would be responsible for the patients and have the autonomy to deliver the best possible care. This would be an organization without management and with low overhead costs so the money could be spent on the patients and their nurses, and so higher quality could be delivered at a lower cost, all supported by an innovative IT system.
What started as a team of 4 nurses in 2006, has grown to 580 teams of 6,500 nurses in 2013. Each team created their own network with support from General Practitioners and is supported by a single “back office” of 30 people. As a non-profit, Buurtzorg has grown to serve 50,000 patients without a single complaint and with revenue of more than € 180 million euro.
External research has shown outcomes from the Buurtzorg model have been consistently better than every other homecare organization. In 2009, Nivel, the Netherlands Institute for Health Services Research, found Buurtzorg had the highest satisfaction rates among patients anywhere in the country. In 2010, Ernst & Young found the average costs per client were 40% less than other homecare organizations, indicating a potential national savings of € 2 billion euro per year!
This drew the attention and support of the Prime Minister, the Dutch Health Ministry, patient organizations and others. Many politicians supported the model as a best practice and used it as an example in reaching agreements. The greatest honor, though, came from our nurses in 2011 and 2012, when Buurtzorg received the national Employer of the Year Award, as determined by employee surveys.
Michele Kimball: Buurtzorg Comes to America
In 2010, I met Jos and a small team of nurses when they walked into the AARP state office while attending a conference in Minnesota. AARP’s International office had first been introduced to the Buurtzorg model while visiting earlier in the year with Jos and the Dutch Health Ministry in the Netherlands, and made the connection with our state office. AARP was – and still is – co-leading an effort of major stakeholders in Minnesota to redesign long-term care services, to find a way to provide better care at a lower cost right where people want to receive it – in their homes and communities – all while struggling with an on-going state budget shortfall that threatens current health services.
The Buurtzorg model was immediately intriguing. Could this be a solution? Could a simple innovation borne out of a complex system in another country work here in the State of Minnesota? Could we actually implement long-term care delivery that would improve quality for the individual, reduce costs to the state, and elevate the nurse experience?
Together with Aging Services of Minnesota, the MN Home Care Association and the University of Minnesota, AARP convened a major group of state stakeholders in 2011 to learn more. Those at the table included legislators, state government agencies, MN Nurses Association, MN Medical Society and numerous patient organizations.
The result was excitement and consensus in the promise Buurtzorg holds, but also the acknowledgement that there are numerous challenges to overcome in Minnesota. Chief among these are a shortage of nurses, a tough regulatory system, a strong need for measurable outcomes, and the inescapable fact that our current payment system is immensely complex with private, state and federal payers. Difficult? Yes. Impossible? No.
To further highlight the need for change, AARP in partnership with the Scan Foundation and the Commonwealth Fund released a national long-term care scorecard that found that while Minnesota was ranked #1 overall compared to other states, we lagged in one important area – home health care. Not only is affordability a challenge, but quality measures are significantly low, among the lowest in the country. Coupled with changes in our health care system thanks to the Affordable Care Act – widely known as Obamacare -- the time had come to take a closer look at the Buurtzorg model.
Earlier this year, a team of MN Nurses, along with leaders from the University of Minnesota and I, made the journey to the Netherlands to see firsthand what Buurtzorg had achieved for patient care, nurses, and indeed, the country. What we found was incredible: immense respect and praise by patient organizations, medical professionals and the Dutch Health Ministry, real improvements in quality achieved, significantly lower costs to the government, tremendous patient satisfaction and a sincere sense of dedication and fulfillment by the nurses.
Very exciting! And yet, the question remains…can this model work here in Minnesota with all of our complexity? We are about to find out! With great support from key stakeholders - including AARP – a team of American nurses is launching the first Buurtzorg model in the US right now.
The coming years hold great promise. In the Netherlands, Buurtzorg is expected to grow to more than 10,000 nurses in more than 1,000 locations. New teams focused on community supports, youth care and dementia are forming. Small groups for assisted living and neighborhood clinics are being created together with General Practitioners and specialists. Teams are starting in other countries like Sweden and Japan. And, in the US, while the first team is preparing to launch in Minnesota, inquiries have already been made by leaders in New York. A revolution begins.
About the Authors
Jos de Blok, Founder and Director, Buurtzorg Nederland
Named the most influential health care director in Holland in 2011, Jos de Blok has transformed home-based health care in Holland by focusing on what nurses should do, not how nurses should do it.
Jos has a long history in community nursing, both delivering care and in management positions. From 2000 to 2003 he played an active role in the National Association of District Nurses (LVW), spearheading a movement by community health nurses to take responsibility for their own professional development and to create a clearer vision for the role of nurses in primary care.
Established in 2007 with one team of four nurses, Buurtzorg currently supports more than 4,700 nurses in 440 teams serving more than 60,000 patients a year. In 2011 Buurtzorg was named the best employer in Holland
Michele H. Kimball, Director, AARP Minnesota
Michele H. Kimball currently serves as Director for AARP in Minnesota where she is responsible for the development and implementation of AARP's advocacy, education and volunteer engagement initiatives on behalf of nearly 700,000 AARP members and their families living in the state. Before establishing AARP’s first State Office in Minnesota in 2001, Michele served on AARP’s Federal Affairs Health Team where she worked with the U.S. Congress and the Administration on issues pertaining to Medicare and Health Care Reform. She also co-led the AARP Medicare Fraud Team that established an award-winning national campaign to fight Medicare fraud, waste and abuse in partnership with the U.S. Department of Health and Human Services and the U.S. Department of Justice. Prior to her work with AARP, Michele was a staff member of the U.S. House of Representatives Ways and Means Health Subcommittee, a staff assistant with the Government Relations Office of Merrill Lynch, and a Courtroom Intern for the U.S. Supreme Court. She serves on the Board of Directors of Stratis Health, the Board of the Minnesota Leadership Council on Aging, the National Advisory Committee for Allina Health, the MN Lieutenant Governor’s “Own Your Future” Long-Term Care Task Force, the Steering Committee for the Minnesota Action Coalition for the Future of Nursing, as an Advisor to the Long-Term Care Chair at the University of Minnesota, and on a number of health panels and committees for the MN Department of Human Services and the MN Department of Health.