Buurtzorg's Back Office

Recently at the Mannheim Drucker Forum I listened to a talk from Jos de Blok, Founder of neighbourhood nursing group Buurtzorg.


Maybe you’ve heard of Buurtzorg, a Dutch company that is leading the way in transforming healthcare with an organization model based on purpose and self-management principles? If not, check them out here.


Before hearing Jos speak, I’d already learned a lot about Buurtzorg’s self-managing teams of nurses – with no managers and no hierarchy. Like many people, I was inspired by the way Buurtzorg works with a collective purpose, customer orientation and empowered employees. However, I still had questions about how governance and process are steered. What about IT, HR and Finance?


So, when Jos shared more about how Buurtzorg’s back office is designed and operates, I was very interested in the details.


From the earliest days when Buurtzorg was founded, it was about enabling employees to focus on patient relationships by giving them autonomy to provide the best possible care to each patient. But the prevailing health care approach in the industy forced nurses to spend significant time on administrative tasks. The Buurtzorg team asked,


“How can we use IT to take away the administrative burden?”


This led to a technology solution that helps employees maintain and share valuable information. For me, the most interesting point is the intention behind this question. Instead of applying technology with a focus on cost and risk reduction, Buurtzorg aims to reduce administration so that customers have a better experience. The outcome is improved effectiveness ahead of efficiency. It might seem like a subtle difference, but this model is starkly different from healthcare organizations that have endured waves of efficiency driven interventions leading to poor customer and employee satisfaction. Furthermore, when effectiveness is the goal, efficiency improves anyway. Buurtzorg claims an incredible 40% cost savings as a result of their approach.


This way of thinking applies not just to technology but to every function. When someone asked Jos where Buurtzorg’s head office is located, he answered,


“We don’t have a head office. We have a back office.”


Jos believes they don’t need a head office to oversee activities. This made me reflect deeply about the companies I’ve worked with, where there’s an understanding that the headquarters calls the shots. In contrast, at Buurtzorg the back office seems to be in service of the rest of the organization.


“The back office does the inevitable bureaucracy so nurses can focus on customers.”


To make it more concrete, here are the staff numbers. Buurtzorg employs 15,000 nursing staff, 50 back office staff, 21 coaches and 2 directors (one is Jos de Block). If you work in a company of similar size, you might find this ratio surprising. How they operate with so few back office staff? Well, there’s a few things they DON’T do:


No-one creates standardized processes for how nurses should work. Instead, teams manage the complete process for a neighbourhood. No-one writes strategy, vision or mission. Rather, the directors share their ideas on a company wide blog and employees give inputs. No-one defines different levels of pricing, because there is only one simple pricing approach. No-one approves hiring decisions, because teams are free to hire and fire people. No-one sets and tracks efficiency related targets.


So, what do they do? In his presentation Jos identified the three main tasks of the back office.


  • Care is charged.
  • People are paid.
  • Financial statements are prepared.


It was a relief to hear him mention these processes are standardized. It’s a good reminder to make deliberate choices about when to apply self-organizing principles. Sometimes consistency is the best approach.


I did notice that Jos makes things sound very simple. Maybe the reality is more complicated, but nonetheless I was inspired to consider how I would design the back office of an organization focused on just these three tasks.


One question often asked about Buurtzorg is:


“How can we convince stakeholders such as regulatory bodies, government, auditors or unions, to support the approach?”


Buurtzorg’s approach is to invite people to accompany nurses on patient visits so they can experience how things work. It’s important to show them the outcomes rather than the “instruction manual”. Of course, some stakeholders are convinced and become supporters. Jos talks about creating a pull rather than push. It seems to be working, as governments and organizations around the world are looking to Buurtzorg for inspiration.


If you are thinking about how to reduce bureaucracy and hierarchy in your organization, use these questions to generate new ideas.


  • How would your IT solutions be different if they focused only on reducing bureaucracy?
  • What support functions do you need to take care of inevitable bureaucracy?
  • What would happen if you stopped doing everything except the three main tasks?


If you are interested to know how Orgdesign Works can help you design better ways of working, contact info@orgdesignworks.com

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