In the sprawling, metric-driven landscape of modern healthcare, the human element of care often becomes the first casualty of efficiency, a reality that once deeply plagued the Dutch home care system. By the 1990s, a wave of reorganization had swept through the Netherlands, merging home nursing and home help services into large, regional corporations. This shift, intended to streamline operations, instead created a system that research showed was highly fragmented and bureaucratic. Care was carved into standardized “products,” with specific time allocations for each task, while layers of management, often disconnected from frontline realities, were introduced. Community nurses found their roles reduced to technical procedures, their professional judgment supplanted by rigid protocols, and the crucial continuity of patient care severely undermined. This environment of frustration and inefficiency set the stage for a radical rethinking of how care could and should be delivered, challenging the very notion that bureaucracy was an unavoidable component of large-scale healthcare.
1. A New Philosophy for Neighborhood Care
Buurtzorg Nederland, co-founded in 2006 by former community nurse Jos de Blok, emerged as a direct and powerful response to the systemic failings of the traditional model. The organization was built on a deceptively simple yet revolutionary ideto replace centralized, product-based care with small, autonomous neighborhood teams that take full responsibility for their patients. This approach prioritizes patient needs and professional autonomy over administrative efficiency. Today, Buurtzorg employs approximately 14,000 professionals, the vast majority of whom are nurses organized into over 900 self-managing teams that provide care in communities across the nation. Astonishingly, this extensive network is supported by a central back-office staff of only a few dozen people, a testament to the model’s radically low overhead. The core principle is to trust the professionals on the ground, allowing them to make decisions, manage their schedules, and deliver holistic care tailored to the individual rather than a checklist.
The success and appeal of the Buurtzorg model have transcended national borders, sparking significant international interest as healthcare systems worldwide grapple with similar challenges of bureaucracy and an aging population. The model is now being implemented or piloted in more than 24 countries, including Sweden, Japan, and the United Kingdom, demonstrating its global relevance. This outreach suggests that the emphasis on continuity of care, professional freedom, and building strong neighborhood-based relationships is increasingly viewed as a viable and superior alternative to traditional, top-down home care systems. The organization’s principles have also been extended beyond nursing to other community-based services, such as “Buurtdiensten” for practical household assistance, Buurtzorg T for psychiatric care, and Buurtzorg Jong for youth services. Each initiative operates on the same foundational belief in empowering frontline workers and focusing on genuine human needs rather than administrative outputs, a vision detailed further in its 2024 annual report.
2. Core Principles Guiding the Model
At the heart of Buurtzorg’s operational philosophy is a set of guiding principles that act as a constant filter against bureaucratic creep. The first and most fundamental principle is serving, which relentlessly asks whether any given activity truly helps the client, the team, or the organization’s overarching purpose. If a task primarily exists to satisfy an external administrative requirement without adding value to patient care, it is challenged and often eliminated. For instance, rather than adopting the standardized assessment systems common in home care that catalogue what patients cannot do for billing purposes, Buurtzorg rejected them entirely. Instead, its nurses created their own digital platform, BuurtzorgWeb, simplifying documentation to focus only on information that supports care delivery and professional judgment. This shift freed nurses from excessive paperwork, allowing them to dedicate more time to patients. The principle is applied ruthlessly; if a form or procedure doesn’t serve care, it doesn’t survive.
The second principle, attuning, recognizes that not all work is created equal and that the method must match the task. Buurtzorg distinguishes between “mindless” and “mindful” activities. Mindless activities are routine, predictable tasks like basic scheduling, supply re-ordering, and standard time registration, which can be efficiently automated or systematized without losing value. In contrast, mindful activities demand deep professional attention, contextual judgment, and relational engagement. These include assessing a client’s evolving health, interpreting subtle changes in their condition, coordinating with family caregivers, and making complex ethical decisions. While many healthcare systems attempt to standardize these mindful activities through rigid protocols and decision trees, Buurtzorg deliberately does the opposite. It automates what is genuinely routine while fiercely protecting the space for professional wisdom where it is most needed. This ensures that human virtues like attentiveness, responsibility, and empathy remain central to care, rather than being engineered away in the name of consistency.
3. The Power of Autonomy and Accountability
Building on the foundation of its other principles, Buurtzorg champions a culture of trusting, which determines the degree of autonomy professionals are given. The organization’s nurses and caregivers operate in small, self-managing teams of about 10 to 12 members with virtually no hierarchical oversight; a mere 20 regional coaches support the entire national network. These teams are empowered to make critical decisions themselves, from designing care plans and managing their own schedules to hiring new colleagues. This high degree of freedom is not a lapse in oversight but a strategic decision to place accountability where it is most effective: among peers and with patients. When challenges arise, they are addressed collectively by the team, fostering a powerful sense of shared ownership and responsibility. A financial controller noted that the system thrives because nurses, when genuinely empowered, take their responsibilities with the utmost seriousness.
This principle of trust does not advocate for the complete abandonment of structure but rather for a discerning application of it. It requires distinguishing between activities where professional judgment must prevail and situations that benefit from standardized procedures. For routine compliance tasks or administrative functions where consistency is key, some formal structure is logical and necessary. However, for the complex, unpredictable, and deeply human work of patient care, professional autonomy is treated as essential. The result is a system where accountability is not enforced by managers reviewing spreadsheets but is instead woven into the fabric of the team’s daily interactions. The team answers to each other for the quality of their work and directly to the patients they serve, creating a feedback loop that is far more immediate and meaningful than any top-down performance review. This balance ensures that procedures support the professionals rather than constraining them.
4. A Framework for Continuous Improvement
The final three principles—needing, rethinking, and common sense—function as a dynamic system of checks and balances that prevents organizational rigidity and ensures the model remains agile and client-centered. The needing principle acts as a “fundamental law,” insisting that patients’ actual needs, not prescribed care packages or funding allocations, must drive all decisions. This commitment has produced remarkable results. A comparative study by KPMG found that Buurtzorg delivered substantially fewer hours of care per client than other organizations after adjusting for patient complexity. For example, in 2013, Buurtzorg clients received an average of 108 hours of home care annually compared to 168 hours for clients of other providers, yet they reported exceptionally high satisfaction. This data suggests that Buurtzorg nurses focus on what genuinely supports patient independence and well-being, refusing to provide unnecessary services simply because funding allows for them.
Complementing this client-first focus are the principles of rethinking and common sense, which embed a culture of continuous evaluation and pragmatism. The rethinking principle demands a constant reassessment of whether current methods still serve their intended purpose. Founder Jos de Blok actively encourages this process through internal blog posts and discussions, posing questions like, “Is this still the best way to work?” or “What would happen if we simplified further?” This keeps the organization from falling into complacency. The common-sensing principle acts as a final reality check, ensuring that solutions remain practical and unburdened by unnecessary complexity. When one team needed a protocol for crisis situations, for instance, they did not create an elaborate new procedure; they simply agreed to contact each other and their regional coach. Together, these principles form a virtuous cycle of reflection and adaptation, keeping the organization true to its purpose.
A Blueprint From a Human-Centered Revolution
The Buurtzorg model provided a compelling framework for how organizations, particularly in healthcare, could successfully integrate ethical decision-making with operational efficiency. It encouraged leaders to define and serve an ultimate purpose that resonated deeply with employees, which in turn fostered a powerful sense of meaning and client-centeredness. This approach ultimately enhanced the quality of care and patient satisfaction by developing a profound coherence between organizational goals and the moral values of its workforce. For other businesses that sought to apply this framework, implementation entailed several key strategic shifts that moved beyond mere imitation of structure.
These organizations learned to develop explicit criteria for evaluating all activities that extended beyond metrics of pure efficiency or profitability, constantly asking whether each task genuinely served their core purpose. They distinguished between activities that required a nuanced, human touch and those that could benefit from standardization, protecting professional judgment where it mattered most while automating tasks that did not demand human wisdom. Critically, they cultivated a broader form of rationality, one that allowed moral and human values to shape action alongside financial reasoning. This was not about rejecting structure or accountability but about ensuring that systems served a higher purpose rather than becoming the purpose itself. Across different contexts, the most transferable lesson was this commitment to discernment, which kept the means and the ends clearly distinct, proving that it was possible to build systems that supported the greater good while thriving in a competitive world.
