Buurtzorg: could this Dutch approach to service re-design and digital transformation work here? asks Socitm briefing
Could the approach to service re-design and digital transformation developed by the Dutch care organisation, Buurtzorg, work here in the UK? asks the latest briefing from Socitm.
The briefing says that a 2009 study for the Dutch Ministry of Health found that Buurtzorg Nederland’s productivity was 6.4% higher than comparable care organisations, while overhead costs and sick leave were less than half, and labour turnover 50% less. Patients improved in half the time, and experienced one third fewer visits to the hospital emergency department.
In Buurtzorg Nederland: a model for future public services?Socitm describes how the Buurtzorg approach was developed following market-based reforms to the Dutch care system which were intended to reduce costs but which triggered a high degree of regulation. Reimbursement of costs became tied to individual nursing actions and services, resulting in fragmentation of patient care, more paperwork and less time spent caring for patients.
Buurtzorg was created in response to this, achieving its objectives of improved patient outcomes, reduced costs and greater patient and nurse satisfaction by enabling nurses to form self-directed teams that provide the home care services with minimal managerial and administrative oversight and in collaboration with patients, their families, physicians and the community.
In this way, says Socitm, Buurtzorg has pulled off the trick of responding to austerity by delivering targeted and timely interventions. It replaces a market-based system where organisations are reimbursed purely for the hours of care delivered rather than the outcomes achieved.
While market-based reforms have led to most care activities being delivered by less well-educated carers, Buurtzorg carers have a relatively high level of professional training and this supports a self-help, self-organising and managing approach. Consequently management and administration is minimal, with a tiny administrative team supporting carers responsible for more than 70,000 patients.
This lean organisation is enabled by a bespoke ICT system tightly integrated into the administrative and managerial processes of the organisation, minimising the need for reporting and bureaucracy.
The functional administrative and management system covers employee details, rotas and scheduling, timesheets and billing, patient details, care plans, and performance management. There is also a knowledge base that supports interactions and collaborations between nurses drawing on the style of social media and designed for ease of use by the nurses.
The briefing cites Buurtzorg as an excellent example of service (re-)design and digital transformation, achieved by giving people space and scope to the job that they are qualified to do in the way that they want to do it. If the same team member to supervisor ratio (better than 142:1) were achieved across the whole UK sector, the savings would be huge, and could happen while productively was simultaneously increased.
A key point to note about Buurtzorg, says Socitm, is that the initiative came from the ICT-consuming front line, not from the administrative and technical back office or ICT-specifying senior administration or management cadre – exemplifying a radical change from traditional organisational top-down led change processes.
Socitm ends the briefing with a call to those of its members that might want to support such an approach to share their ideas about new operating models and governance structures where ICT might be the catalyst or facilitator of wider organisational changes. This is the subject of a new Insight report being prepared.
Buurtzorg Nederland: a model for future public services? Is free of charge to Socitm Insight subscribers and can be accessed via the Socitm Insight Group on the Knowledge Hub at https://khub.net/group/socitm-insight/library (login required).
Vicky Sargent, Socitm Press Office
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Martin Greenwood, Programme Manager, Socitm Insight
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