We find that more and more the senior leaders with whom we work and who define the culture of the organisation are being solicited from their people (including high potential future leaders) to facilitate and cultivate purposeful and meaningful work environments, as well as increased autonomy.
Within these organisations, individuals often face similar leadership challenges but in different contexts: they need to build and lead teams that are engaged, focused, capable and determined to achieve success; they need to deliver on tasks that are more and more open-ended, less structured and less driven by timetables; they need to build a range of influencing skills outside of their natural logical argument; etc.
However, we also find that individuals in organisations often have very little connection with their CEO and senior leaders, especially in large size companies. There is very little compelling affective pull that keeps them connected with the organisation. Meanwhile, the level of trust in leaders in general goes down¹ (Edelman Trust Barometer surveys) and levels of employee engagement worldwide remain low² (Gallup).
Buurtzorg has developed a management approach which addresses all of the above issues, and more! As the fastest growing organization in the Netherlands today, Buurtzorg is a Dutch home-care organization which has attracted international attention for its innovative use of small, flexible and independent nurse teams in delivering high-quality care at low-cost.
Set up in 2007 by 4 nurses including the company founder and CEO (Jos De Blok), Buurtzorg employed 9,000 nurses in 2014, distributed in 800 independent teams across the Netherlands. Their head office is composed of 45 staff who deal predominantly with back office or support activities. The turnover of Buurtzorg in 2014 was €280m, yet the company doesn’t have a CFO or managers… Instead, 15 coaches help and support nurse teams when they are facing certain challenges around collaboration or performance.
My colleagues and I came across Buurtzorg in Frederic Laloux’s book “Reinventing organisations” in which Laloux states that we are ready for a new era for organisations. He studied a sample of organisations with original managerial practices across geographies and industries and came up with a set of principles which he thinks best describe those organisations: Self-management; Wholeness; Evolutionary purpose.
As part of a leadership development intervention, we took a group of high potentials future leaders from an insurance company to Amsterdam in February. The core objectives of the programme was to explore the nature and role of leadership in the 21st Century, promote entrepreneurial thinking and behaviour at work, and finally help participants create and find meaning in what they do. Based on the belief that breakthrough thinking for the insurance industry will not come from talking to likeminded insurance professionals, on day three of the module we invited a coach and a district nurse working for Buurtzorg to share insights and principles about their innovative organisational model.
Buurtorg’s way of working relies on three fundamental principles: (1) Do what’s needed; (2) Reflect on what you’re doing and try to do it better if you think there is a way; (3) Use your common sense.
Jos emphasizes the importance of Craftmanship and customer centricity when explaining Buurzorg’s success. Nurses are broad base free thinkers who go beyond existing constraints: they make assessment of the possibilities, resources and networks available to them and design solutions for the client in interaction with the client and their social ties3. Nurses provide attention to patients even if it is not rigorously the type of care they provide. They make the time to have a cup of coffee and a conversation with the patients.
What nurses appreciate the most about working for Buurtzorg is:
- Working in small teams (there are 12 nurses per team): there is a strong team spirit and they regularly share experiences.
- Being autonomous: nurses organise everything themselves from finance (e.g. they manage their own education budget because they best know what development experiences they need to improve performance) to planning, scheduling and thinking about the best solutions for the patients in their neighbourhood. They learn how to operate without a manager, how to handle meetings and conflicts, and take responsibility in taking tough decisions.
- Authority: to take any decision no matter what issue arises during their daily involvement with their clients. But also responsibility for results and errors (there are no leaders in nurse teams).
Nurses don’t join Buurtzorg because they pay more… “Nurses quit more established health care providers to join Jos and co. because they lost their autonomy, their freedom as well as their craftsmanship” (Jos De Blok). At Buurtzorg, nurses feel supported, trusted and protected. There is also a strong connection between nurses as well as with Jos, who is described as a visionary, a coach and a no nonsense type of person.
Jos sees his role as a stewardship role, putting processes in place to build the capability within the organization to listen to its own evolutionary purpose. He regularly writes a personal blog where he shares progress and concerns with the nurses who are kept up to date, respond and engage in a conversation. When conversations reach an agreement, they become policies.
Buurtzorg believes in the power of informal networks vs. organisational structures.The nurses see Buurtzorg as a network or platform which gives them presence, as opposed to an organisation that gets in the way of their freedom and passion. They have their own networks (e.g. volunteers, the client’s GP, hospital specialist, social workers, etc) and can exert influence in their environment which allow them to assemble and leverage virtual teams when needed for the benefit of their patients.
Of course we can’t expect large and often successful organisations to evolve their organisational model overnight, however perhaps they can introduce certain ingredients from Buurtzorg’s approach? I.e. building an organisation on meaningful relations; thinking about the value for the community; focusing on happiness and health of the employees; develop a new form of leadership which emphasises a higher purpose, servant leadership and stewardship; focusing on solving problems vs. having team meetings to discuss what the solution may be; (and most importantly) keeping things simple.
The strengths and benefits of Buurtzorg’s organisational model are multiple. If interested, you can find numerous articles and videos about Buurtzorg online. My hope in this article is to help readers generate conversations around what their organisation, small or large, can learn from success stories like Buurtzorg’s and what principles – from Buurtzorg’s way of working – they can experiment back in their own context.
¹ “2013 Edelman Trust Barometer Finds a Crisis in Leadership” cited in “Getting beyond the BS of leadership literature, by y Jeffrey Pfeffer”
² “Most Americans Are Unhappy At Work” cited in “Getting beyond the BS of leadership literature, by y Jeffrey Pfeffer”
3 S. Nandram (2015). Organizational Innovation by Integrating Simplification: Learning from Buurtzorg Nederland