In February 2015, Bradford Gray, the lead author of a case study for the Commonwealth Fund, visited Buurtzorg’s offices in Almelo, a small Dutch city. On the table lay a large stack of letters, each sending an employment contract to a new nurse, waiting for the chief executive’s signature. Jos de Blok told him the organization hired about 150 new nurses a month on average.
De Blok, an experienced home-care nurse with management training, had started Buurtzorg (Dutch for “neighborhood care”) with one team in Almelo in 2007. By 2015 it employed 8,000 nurses in 700 teams. In 2014 they cared for 65,000 patients.
Most Dutch home-care organizations, the case study explained, sent nurses only for the services that needed a nurse’s training, and less costly staff for the rest, such as help with dressing or bathing. With different caregivers arriving at different times on different days, continuity of care could suffer. In an article de Blok co-wrote, the industry’s focus had “shifted from care to production, protocols, and administration.”
Buurtzorg’s teams of up to 12 nurses take on all the home care for 50 to 60 patients in a neighborhood: assessing needs, writing and carrying out care plans, scheduling, and the documentation that billing depends on. An IT system handles online scheduling, records and billing. “Nurses do not report to managers,” the case study notes, “though their work hours are tracked.” In early 2015 there were 15 coaches for the 700 teams, and a back office of fewer than 50 people handling salaries, contracts for team offices and financial administration.
As the company grew, competitors suspected it of picking the most profitable patients. The health ministry commissioned the consulting firm KPMG to compare Buurtzorg with other providers, adjusting for differences in patients. Its January 2015 report, as the Commonwealth Fund summarized it, found Buurtzorg among the best home-care agencies on patient-reported experience, and using 108 hours of care per patient a year against an average of 168. But its patients’ later physician and hospital costs were higher than average. With everything counted and adjusted for case mix, its total cost per client came out just below the national average, at the 49th percentile.
The case study’s authors named one more risk. Growth could become a problem “if the number of Buurtzorg teams continues to increase at a much faster rate than the headquarters office that provides administrative support.”
On the day of Gray’s visit, the new nurses’ contracts were still waiting on one table, for one signature.