Buurtzorg runs Dutch home care through 10-to-12-nurse teams with no middle managers

Buurtzorg ('neighborhood care') was founded in the Netherlands in 2006 by Jos de Blok, a nurse who had watched home care degrade under a system where agencies won contracts by bidding low and nurses spent much of their working day on administration. His answer reversed the direction of organization: instead of building care around agencies and managers, build it around the nurses themselves.

Each team of 10–12 highly trained nurses serves 50–60 patients in one neighborhood and is fully self-governing: the team handles intake and care planning, hires its own colleagues, and manages its own budget. There are no managers above the team. Some 15 coaches — themselves mostly experienced nurses — support roughly 700 teams, and a back office of fewer than 50 people handles routine administration. One shared IT system, BuurtzorgWeb, shows every team its workload and its outcomes, so problems surface inside the team instead of in a manager's inbox.

The numbers backed the bet. Ernst & Young found Buurtzorg met patients' needs with 40% of the authorized care hours where other providers used about 70%, with overhead of 8% of costs versus 25%. KPMG's 2015 analysis of similar patients recorded 108 care hours per patient-year versus 168 at other providers, and average home-care costs of €6,428 versus €7,995 — patients needed less care because they recovered independence sooner. Patient satisfaction scored 9.1 out of 10, and Buurtzorg was named the Netherlands' best employer in 2010, 2011 and 2012.