Aged Care Innovation: The Buurtzorg Model
How the Buurtzorg model has transformed community-based aged care nursing in the Netherlands, at scale, to keep older adults health and out of hospital.
For those playing at home, this blog is aged care related and would suit readers working within the Primary Health Network, Local Health Network and broader aged care sector.
Originally I was intending to write the front end of this blog post as a set-up for a classic ‘gotcha’ moment. Since the title of this blog post completely gives away the origin, I’ll spare you the embarrassment (you’re welcome).
For the upcoming exercise you’ll need to use your imagination - so let's get into some visualisation. I’ll set the scene, it's the early 2000’s and you are slaving away in the aged care sector as a home care nurse. You and your dearest work buddies are shooting the breeze around the water cooler about the state of the current aged care sector and workforce more broadly. Common items of discussion include:
The government’s concern about increasing levels of spending on aged care and home care organisations needing to better account for their activity.
Contemporary research suggesting a push to include the family in the care of older relatives in their own home.
The building momentum for a shift from publicly-subsidised institutional care to a more privatised home-based care regime.
The push to increase standardisation and specialisation, with different tasks being delivered by different types of care professionals and remunerated at varying amounts.
The majority of home care organisations merging into large, regional home care organisations, where nurses have lower levels of autonomy.
It is now standard that decision powers about the type of care provided to each client are made by external regional assessment organisations.
Cost containment e.g. regional needs assessment organisations specifying in great detail task allocation, ensuring basic domestic services are completed by lower paid staff and medically trained staff were free to see more complex and acute clients.
Arduous reporting requirements - staff constantly driven to report outcomes according to a set of standardised performance indicators.
Stay with me…...
Fast forward to circa 2015. You catch up with your old home care nursing buddies and launch into an aged care whip-around (just for old times sake). As a collective, you notice:
Home care has become fragmented, of lower quality, and inefficient.
Despite intent to reduce costs, costs rapidly increased due to profit incentives favouring the delivery of more care products with cheaper resources (also at the expense of preventative measures).
Patient experience has declined with some patients being seen by more than 30 different healthcare professionals, each administering a different task.
Some patients are visited several times by different care personnel on the same day.
The personal bond between nurses and patients has been lost and no-one is taking ownership for an individual patients overall health (due to lack of incentives and autonomy).
Nurses regularly found patients in a condition they were unprepared for, as a significant amount of time had lapsed between assessment and commencement of care.
Frontline staff were only authorised to provide certain care, specified to the minute - extensive need for timekeeping meant less time could be spent on actual care.
Over the course of the last 10 to 15 years, your colleagues have became disheartened and feel that increased responsibilities for timekeeping and documenting tasks adversely affect personal care.
A lack of autonomy continues to impact the moral and purpose of the nursing workforce.
Many nurses have experienced burnout and state that they are unlikely to remain working in the profession.
Ring a bell, anyone? If I didn’t give you the big reveal at the start of the blog post, what is described above could easily be related to the Australian aged care system. This (now, obviously) is the historical context of the pre-aged care reform period in the Netherlands, experienced from the 1990’s to the mid 2000’s.
How did a company called Buurtzorg begin go turn the aged care workforce around?
Up steps Jos de Blok, a disgruntled home care nurse frustrated with how care was being delivered for older adults in the community.
The Buurtzorg Model was born. The “Buurtzorg” word is from the Dutch language and is made from two words combined. Buurt – meaning neighbourhood and Zorg – meaning care. Together they are interpreted as Neighbourhood Care.
The goal of the Buurtzorg Model is to provide person-centred care that supports individuals to remain at home for as long as possible. It’s program components include:
The Buurtzorg model of care, a person-centred care that supports individuals to remain at home for as long as possible
Source: Buurtzorg, 2020.
Self-governing teams of 10-12 nurses providing medical and supportive home care services (servicing a catchment of 10,000 people / 40 patients).
An IT system relieving nurses of administrative tasks and allowing teams to self-monitor their performance.
Regional coaches promoting best practice and offering advice as needed but without their own performance goals.
Works in close proximity with general practice, integrating clinical care elements.
Maintain or rest patients independence, train patients and families in self-care and create networks of neighbourhood resources.
“Sounds reasonable, but what about the outcomes?!” I hear you ask. Well, take it easy - it seems as though Buurtzorg are kicking goals, demonstrated through:
A reduction in the rate of staff turnover, illness and absence.
Consistently being voted ‘best employer’ in the Netherlands, having held the title for four out of the last five years.
A one-third reduction in the rate of client hospital admissions.
An overall reduction in length of stay in hospital for clients.
Client satisfaction rated the highest of any health organisation.
Successfully helping patients regain their independence.
Effectively scaling the model from 1 to 850 teams in 10 years, inclusive of 10,000+ staff and participation in 24 countries.
Can the Buurtzog model be translated to the Australian context?
Although the Buurtzorg Model is relatively straightforward as a conceptual model, implementing such a model in a system that is set up for rewarding outputs over quality is extremely difficult. Additionally, executing wide scale aged care workforce improvements at scale is always going to be a challenge. There is however a potential light at the end of the tunnel with Buurtzorg setting up in Australia over the last couple of years.
So the million dollar question is, how do we (re)design our Australian aged care workforce to generate outcomes for clients through staff who are engaged? Is it possible to reverse or better leverage the trend of an increasingly non-clinical in-home aged care workforce? How do we shift from delivering aged care services transactionally to relationally?
In closing, the reason why this model has caught our eye is the distinct shift in focus from efficiency back to person-centred care. The essence of how the Buurtzorg Model is different to how providers work in Australia is captured nicely the quote below:
“Buurtzorg’s nurses are more like health coaches, who create sustainable solutions leading towards prevention and care independence. Leveraging existing support systems, they are available round the clock and – working closely with GPs – they organise all the supporting care, drawing in families, friends, and volunteers. They see themselves as community-builders.”
To find out more about Buurtzorg Model click here.