Care in the neighbourhood: better home care at reduced cost

Why was this example implemented?

Buurtzorg originated from noted gaps between (a) needs of the client and care and support delivered by usual home care, (b) competencies of the staff and the care delivered, and (c) care and support delivered by home care and care by other organisations and professionals.

To deal with the first gap, Buurtzorg has built in a holistic assessment of client’s needs, which includes medical needs, LTC needs and personal/social needs. Aside from primary nursing care, the individual care plan provides information that will support the client in his/her social roles and in taking up self-care and becoming more independent.

The second gap seems to be bridged by self-managing teams, which allows for a better use of staff’s competence and for taking responsibility for a greater diversity of care tasks.

To deal with the third gap, the network of informal care of the client is being mapped and involved in the care. In addition, the formal carers are identified and included. Finally, Buurtzorg has initiated new teams for social support (‘Buurtdiensten’), based on the same principles as its home care. In locations where such ‘sister-activities’ exist, it is possible to bridge the gap between various kinds of services more easily.

Description

The objectives of Buurtzorg is to provide integrated home care, i.e. with connections to social services, general practitioners, and other providers, for all persons who need care at home.

The Buurtzorg model was designed by experienced district nurses who started an initiative group in 2006.

The organisational principIe of Buurtzorg is to deliver care by small self-managing teams of 12 professionals at a maximum, and to keep organisational costs as low as possible, partially by using ICT for the organisation of care.

The Buurtzorg method has six sequential components, which are delivered as a coherent package and cannot be delivered separately.

• Component 1 is to assess the client’s needs; the assessment is holistic and includes medical needs, LTC needs and personal/social needs. On the basis of the resulting information, the individual care plan will be drafted.
• Component 2 is to map networks of informal care and involve them in care.
• Component 3 is to identify and include formal carers.
• Component 4 is care delivery.
• Component 5 is supporting the client in his/her social roles.
• Component 6 is to promote self-care and independence.

The six components are run in a continuous iterative process. The model was introduced on the strictly regulated quasi-market of Dutch home care in 2006, and from then it had to compete with usual home care for clients and contracts. By mid-2010, teams were active in 250 locations, the total number of staff in these teams were 2,600 (amongst them 1,500 qualified district nurses); they serve about 30,000 clients annually. The growth rate is about 70 staff members in 5 to 10 teams per month.

Apart from an initial subsidy, costs are completely covered by regular sources from which usual home care organisations also draw their income. It is the care market that makes the Buurtzorg initiative possible. Policy makers, other providers (always private), other interested organisations, are not contributing stakeholders. The initiative mainly thrives by virtue of the high engagement of professionals.

What are/were the effects?

So far no hard data are available for the evaluation of results or impact for clients. So the question about whether this novel method of working can effectively bridge gaps in LTC provision cannot yet be answered. There are, however, some indications about positive effects.

• Buurtzorg ranks number 1 amongst all home care organisations in user satisfaction according to results of the mandatory national quality of care assessment. This may reflect satisfaction about cooperation that addresses gaps between home care and informal and other formal care, and between expected care and delivered care.
• Apart from users’ satisfaction, also the high satisfaction of GP’s and local authorities on the cooperation with Buurtzorg has been shown by qualitative research (de Veer et al., 2008).
• In 2011, Buurtzorg has been chosen for the award as the best employer of the Netherlands in organisations of more than 1,000 employees. With now more than 4,000 employees Buurtzorg scored (on a scale from 1-10) 9.5 for involvement, 9.1 for low turnover of employees, and 8.7 for staff satisfaction.
• A significant result is the alleged enormous decrease of cost: the consultancy agency Ernst and Young have calculated that Buurtzorg seems to be less than half as expensive as usual home care (Maatschappelijke Business Case Buurtzorg, 2009).
• Another indicator of success is duplication and imitation: Buurtzorg has been expanding from 2006 onwards, and its methods are being adopted by new Buurtzorg-like companies as well as by usual home care organisations.

What are the strengths and limitations?

Strengths

• Buurtzorg may be setting a new standard for home care in the Netherlands. Its main strength is to successfully bridge gaps in local level home care by having recognised what the problems are and then designing working methods that cope with the problems. Thus, it meets the needs of patients for integrated care.
• The Buurtzorg model has been shown to be highly competitive: it is attractive to both patients and staff, and it can be easily introduced in almost every location even if usual home care is available in the area.

Weaknesses

• Demands on staff are very high because of self-managing teams.
• Activities have to be accomplished below or beyond those connected to professional education, and both within planned hours and unplanned in the middle of the night, as there is no night shift. For some staff, this is incompatible with other personal activities and interests at home, and they have to leave.

Opportunities

• International transferability of the Buurtzorg model is feasible only when the conditions of a free competition, free choice for users, motivated staff and self management of teams are met.

Threats

• As other (usual) home care is adopting the Buurtzorg model (piecemeal, however), room for Buurtzorg initiatives will shrink. However, from the perspective of integrated care, it is not important who supplies integrated home care, it is the model and delivery systems that count.

Credits

Author: Pieter Huijbers
Reviewer 1: Elisabeth Hirsch Durrett
Reviewer 2: Laura Cordero
Verified by: Jos de Blok, CEO of Buurtzorg NL

External Links and References

Publications

• de Blok, J. / Pool, A. (2010). Buurtzorg: menselijkheid boven bureaucratie. Boom-Lemma Uitgevers, Den Haag (ISBN 978-90-5931-556-3)
• Maatschappelijke Business Case (2009) Buurtzorg Nederland.  
• van de Pas, T. (2010) 'De visie achter Buurtzorg' in: Tijdschrift voor Ziekenverzorgden, Vol. 120(5): 11.
• de Veer, A.J.E / Brandt, H.E. / Schellevis, F.G. / Francke, A.L. (2008). Buurtzorg: nieuw en toch vertrouwd. Een onderzoek naar de ervaringen van cliënten, mantelzorgers, medewerkersen huisartsen. Utrecht: Nivel. ISBN 978-90-6905-919-8.
• de Veer, A.J.E. / de Boer, D. / Spreeuwenberg, P. / Brandt, H. E. / Schellevis, F.G. / Francke, A.L. (2009). Ervaringen van Buurtzorgcliënten in landelijk perspectief. Addendum bij het rapport “Buurtzorg: nieuw en toch vertrouwd”. Utrecht: Nivel. ISBN 978- 90- 6905-943-3.

Weblink

• Buurtzorg Nederland
• Tijdschrift voor Verzorgenden: Article on Buurtzorg