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CEO Q&A: Nurse-led 'neighbourhood care' in the Netherlands

March 28, 2018

    Policy makers and health care leaders point to primary care doctor shortages, patient complexity, ineffective payment models, and care fragmentation as reasons for decreased quality care provision. Innovative solutions to overcome these struggles are piloted widely.

    One organisation that has worked to solve these challenges is Buurtzorg, a Dutch home care organisation that has attracted international attention for its innovative use of independent nurse teams in delivering high-quality, relatively low-cost health and preventative care. “Neighbourhood Care” translates to “Buurtzorg” in Dutch. Its value proposition is to swap a traditional care team for tenured nurses to provide comprehensive care management, reduce fragmentation, and keep patients independent and at home for as long as possible.

    We spoke with Jos de Blok, CEO of Buurtzorg about the organisation's history and goals, as well as their keys to success. What follows is an edited transcript of the highlights of our conversation.

    Q: Why did you start the Buurtzorg model?

    A: In Holland, during the 1990s, we developed a new payment system that caused fragmentation in the elderly and health care systems. Before then, the Netherlands had a primary care system focused on community care and prevention; after, primary care became task-oriented and prevention became secondary. Providers were paid for activities rather than holistic care.

    Many organisations restructured. They shifted their attention from identifying health care problems and solutions to performing the activities they were paid for.

    As a result, health care service provision deteriorated. Patients started to receive much longer and more care than they should have, had doctors intervened earlier. Quality went down.

    The change in payment structure also brought about administrative burdens and complexity around choosing the right care approach due to multiple payment layers and transaction costs. This was highly frustrating to nurses, who couldn’t provide the care they wanted and needed, but were pressured to make care decisions based on funding.

    With a focus on cost and activity, rather than quality, many nurses felt less fulfilled in their jobs. It actually got worse as time went on because patients increasingly complained about the quality of care they received. Nurses became the target.

    Then in 2006, I realised that things had to change. This was the starting point for Buurtzorg.

    Q: What type of change did you envision?

    A: I decided to launch an organisation to improve care provision and staff satisfaction, based on the principles of community-based care. The new organisation was built on integrated budgets, horizontal organisational structures, and a solid IT system.

    The solution I envisioned wasn’t only one that would improve care quality and stakeholder satisfaction, but also allow for cost savings. The goal was to pay little for overhead cost by streamlining administrative tasks through IT capabilities and reducing care team participants to one point of contact.

    We switched from care provision by a team comprised of lower-skilled medical support staff and doctors to care managed by tenured nurses who could provide comprehensive care and keep patients independent and at home for as long as possible.

    It took more than six months to move from vision to operation. We were careful not to launch another home care organisation similar to those that already exist but create a system change instead.

    There were already too many home care organisations in Holland, and they all shared the same problems—high cost and low quality care provision. Their overhead costs were around 30%. Our goal was to decrease these costs to around 5%-10%. And we did. Over time, our overhead costs became significantly lower than the average of home care organisations within the Netherlands, allowing us to reinvest money into highly skilled labour. The experience and skill level of our nurses allows them to work at top of license, replacing the need for a primary care doctor and a bigger care team.

    The Buurtzorg model has transformed the traditional model of home care in the Netherlands. Like Buurtzorg, other organisations around the world are experimenting with innovative models of health care to cope with escalating patient demand and limited resources. As part of this innovation, health systems have increasingly embraced a vision of health care that extends beyond acute care or the GP.

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