Source: The Conversation – France – By Sharda S. Nandram, Full Professor Business & Spirituality & Hindu Spirituality & Society, Vrije Universiteit Amsterdam
Bureaucracy once swallowed Dutch home care. Buurtzorg flipped the script by trusting nurses and focusing on purpose.
Europe’s aging population is calling for home care services that deliver care and support to individuals within their homes.
“By the 1990s, home care in the Netherlands had been reorganised. The provision of home nursing and home help were integrated and most nursing home organisations merged into large, regional home care organisations.”
Research shows that traditional home care restructuring in the Netherlands narrowed community nurses’ roles to technical tasks, replaced many care activities with cheaper helpers, and created managerial layers unfamiliar with frontline work, undermining continuity and quality of care.
In a talk at Erasmus University, Jos de Blok, a nurse and home care innovation manager who co-founded Buurtzorg Nederland in 2006, explained that before Buurtzorg, Dutch home care had become highly fragmented and product-driven. Care was divided into standardised “products” or packages, each linked to a specific task and time allocation.
Buurtzorg was explicitly designed as a response to this fragmentation, replacing product-based care and centralised coordination with small, autonomous neighbourhood teams that take responsibility for the whole person rather than for isolated tasks.
“Many community nurses were frustrated with the efficiency-driven, bureaucratic way care was delivered, leading to new models such as Buurtzorg being founded by former community nurses.”
Humanity above bureaucracy
De Blok’s radical idea: prioritise patient needs over administrative efficiency. His approach raises a crucial question for all organizations: What enables organisations to remain human-centred in systems designed for control and efficiency?
Buurtzorg Nederland and its different entities currently employs around 14,000 professionals, the vast majority of whom are nurses working in self-managing teams. These teams, numbering over 900, provide home care in neighbourhoods and villages nationwide. The organisation operates with very low overhead, supported by a small central back-office of only a few dozen staff, while most employees work directly with clients.
Internationally the Buurtzorg model has attracted significant interest and is being implemented or piloted in more than 24 countries, including Sweden, Japan, and the United Kingdom. Its outreach suggests that the Buurtzorg approach, with its emphasis on continuity of care, professional autonomy, and neighbourhood-based relationships, is increasingly seen as a viable alternative to traditional, highly bureaucratic home care systems. Further financial details on Buurtzorg’s operations can be found in the 2024 annual report.
“Buurtdiensten” are neighbourhood support services developed in line with the Buurtzorg model’s principles. Unlike traditional home nursing, these services focus on practical, everyday assistance – such as household help and independent living support – delivered by a consistent caregiver who works with the client and their informal network to promote autonomy and well-being. The concept is part of Buurtzorg’s broader suite of community-based services alongside initiatives like Buurtzorg T (psychiatric care) and Buurtzorg Jong (youth services).
Buurtzorg’s 6 core company values
Our new study “Crafting the Virtuous Corporation Through Spiritual Discernment” published in the Journal of Business Ethics explores how Buurtzorg answers this question by following six principles of “spiritual discernment”. We understand spiritual discernment in the sense of a “practice” that enables organisations to navigate the complex interplay between internal goods (excellence in “practices”) and external goods (financial success) in creating their virtuous corporate character.
This is not about religion or mysticism; it’s about systematically asking what truly matters and what should guide choices to maintain moral clarity while pursuing legitimate business goals.
1. Serving: does this truly help our purpose?
The first principle asks whether activities genuinely help clients, teams, or the organization’s purpose. If something serves mainly to satisfy bureaucratic requirements, it gets eliminated. At Buurtzorg this principle is applied very pragmatically. Instead of accepting all standardised administrative requirements inherited from traditional home care organisations, The company redesigned its care processes and information systems around what genuinely helps clients and teams. For example, documentation and intake procedures were simplified and embedded in Buurtzorg’s own digital platform – BuurtzorgWeb, which focuses on information that supports care delivery, continuity, and professional judgement.
Administrative activities that existed mainly to satisfy managerial control or reporting layers were reduced or eliminated. As founder Jos de Blok has repeatedly emphasised, teams record what is meaningful for the client and the team, rather than filling in forms “because the system demands it.” This approach has significantly reduced administrative burden and allowed nurses to spend more time on care rather than paperwork. Buurtzorg applies this ruthlessly.
Most home care organisations use assessment systems that catalogue what patients cannot do. These systems generate data for billing and compliance purposes, but they offer little guidance for actual patient care. Buurtzorg rejected this entirely.
Instead, nurses assess what patients actually need. This shift may sound simple, but it proves radical. One nurse described approaching an elderly client who had family members willing to help but was uncertain about how to proceed. Rather than following a standardised checklist, the nurse took the time to understand the family dynamics and coach relatives on providing appropriate support. It means some visits take longer. Some require no formal medical intervention at all. The serving principle requires asking whether each activity truly benefits rather than whether it merely satisfies administrative requirements.
2. Attuning: match the method to the work
The second principle acknowledges that different activities require varying levels of engagement. Some tasks can be automated or standardised efficiently. Others demand deep attention to individual circumstances.
Buurtzorg nurses distinguish between what they call mindless and mindful activities.
Mindless activities (routine scheduling, standard documentation, supply re-ordering, and time registration), follow predetermined expectations, scheduling, basic documentation, and supply ordering. These can be systematised without losing value. Technology handles them efficiently.
Mindful activities, by contrast, require professional attention, contextual judgement, and relational engagement. These include assessing a client’s changing health or social situation, interpreting subtle signals such as increased anxiety or decline in self-care, adapting care plans in dialogue with clients and families, coordinating with informal caregivers or other professionals, and making ethical decisions when standard protocols do not fit individual circumstances. Such activities cannot be reduced to checklists or time slots without undermining care quality. Should this patient’s informal support network be more involved? Is the current care plan still appropriate given changes in the patient’s condition?
Healthcare systems often attempt to standardise mindful activities by translating complex human situations into detailed protocols and decision trees. A common example is care planning for frail older adults with multiple conditions: organisations prescribe fixed assessment tools, predefined risk scores, and mandatory intervention pathways that determine when family members should be involved, how frequently care should be delivered, and which professional is responsible, regardless of local context or personal relationships. While designed to ensure consistency and control, such protocols can reduce professional judgement to box-ticking and overlook subtle but crucial contextual factors, such as trust, family dynamics, or gradual changes in a patient’s coping ability. Buurtzorg structures its workforce into small, self-governing teams of approximately 10–12 nurses responsible for the holistic care of 50–60 patients in a neighbourhood. This team size facilitates close coordination, shared accountability, and continuity of care, and is central to Buurtzorg’s integrated, person-centred model of community nursing.
Buurtzorg deliberately takes the opposite approach. It automates what is genuinely routine, such as scheduling regular visits, registering standard care actions, or ordering supplies, while protecting space for professional judgement precisely where uncertainty, interpretation, and human values are involved. Decisions about mobilising informal support, adjusting care intensity, or responding to changes in a client’s wellbeing remain with the nursing team. In doing so, Buurtzorg foregrounds human virtues such as attentiveness, practical wisdom (phronesis),
responsibility, and relational sensitivity as core elements of high-quality, client-centred care, rather than attempting to standardise them away.
The organisational logic of Buurtzorg Nederland can be understood as a deliberate response to VUCA conditions in healthcare. In “Integrating Simplification at Buurtzorg Nederland,” Sharda Nandram argues that Buurtzorg addresses complexity not by adding rules and control, but by radically simplifying structures and decentralising authority to self-managing teams, while using technology to reduce administrative load. This perspective aligns with the analysis by Frank Martela and Sharda Nandram who show how the company scales self-management without middle managers by automating routine tasks and deliberately preserving professional judgement in complex, human situations.
3. Trusting: autonomy with accountability
The third principle determines the level of autonomy professionals receive. When trust runs high – embodying virtues such as integrity, honesty and loyaulty people exercise their expertise freely.
Buurtzorg’s 1,400 nurses and domestic caregivers in the Netherlands work in self-managing teams with minimal hierarchical oversight. Just 20 regional coaches and a small back office support them. Teams decide on care, schedules, and hiring.
This creates natural accountability. Teams answer to each other and to patients, not to distant managers. When problems arise, the team addresses them collectively in meetings.
One financial controller explained that the system works because nurses take responsibility seriously when genuinely empowered:
“Because that is, of course, one of the great things about this profession: you can organize your own work. You can schedule your own appointments and decide when to come. So, you have a lot of freedom and they trust you.”
The trust principle doesn’t mean abandoning all oversight. It means distinguishing between activities where professional judgement should prevail and situations requiring standardised procedures. For routine compliance tasks, some structure makes sense. For complex care decisions, professional autonomy proves essential.
4. to 6. Needing, rethinking, and common sense principles – Continuous reassessment
The final three principles (needing, rethinking and common-sense) provide ongoing checks and embody the virtues of practical wisdom, discernment, and pragmatism, forming a cornerstone of Buurtzorg’s operational philosophy. They prevent the organisation from becoming rigid or bureaucratic over time.
The needing principle at Buurtzorg is a “fundamental law” that defines the company vision of placing the client at the centre of its activities. It insists that patients’ needs, not prescribed care packages, drive decisions. A comparative study by KPMG (published in 2015), commissioned by the Dutch Ministry of Health examining Buurtzorg’s added value found that its self-managing nursing teams deliver substantially fewer hours of care per client than other home care organisations when adjusted for case mix; suggesting a stronger alignment between actual need and delivered care rather than simply billing all allocated hours. Dutch healthcare funding allocates specific hours for different patient categories.
In 2013, Buurtzorg clients received, on average, 108 hours of home care per year compared with 168 hours for other providers, yet reported high satisfaction and quality of care. This suggests Buurtzorg nurses refuse to provide unnecessary care simply because funding allows it, focusing instead on what genuinely supports the patient.
The rethinking principle requires constant evaluation of whether current approaches still serve their purpose. Buurtzorg’s founder regularly challenges teams through blog posts on the company’s intranet and discussions like, “Is this still the best way to work? Are we adding unnecessary complexity? What would happen if we simplified further?”
The common-sensing principle acts as a reality check. One team needed to adjust their approach for crisis situations. Rather than creating elaborate procedures, they simply agreed to contact each other and their regional coach for complicated questions.
Putting Buurtzorg’s holistic principles into practice
The Buurtzorg model provides a framework for healthcare organisations to integrate ethical decision-making while maintaining operational efficiency. It encourages organisations to define and serve an ultimate purpose or end toward which activity is directed that resonates with employees, fostering a sense of meaning and client centredness. This approach can enhance the quality of care and patient satisfaction by developing coherence between organisational goals and employees’ moral values and motivations.
For businesses seeking to apply this framework, implementation entails several key shifts.
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Develop explicit criteria for evaluating activities beyond efficiency or profitability. Ask whether each activity serves your core purpose.
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Distinguish activities that require a human touch in client interactions from those that benefit from standardisation. Protect professional judgement where it matters, while automating tasks that don’t require human practical wisdom.
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Cultivate a broader rationality, one that lets moral and human values shape action alongside financial reasoning. This isn’t about rejecting structure or accountability but about ensuring that systems serve a purpose rather than replace it.
Across contexts what transfers is the commitment to discernment that keeps means and ends distinct. The goal is to build systems that support the greater good. In metric-driven workplaces, this framework offers a structured alternative that acknowledges business realities while insisting some things matter more than the bottom line.
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Sharda Nandram in the past advised Buurtzorg with Self Management research.
Puneet K. Bindlish et Raysa Geaquinto Rocha ne travaillent pas, ne conseillent pas, ne possèdent pas de parts, ne reçoivent pas de fonds d’une organisation qui pourrait tirer profit de cet article, et n’ont déclaré aucune autre affiliation que leur poste universitaire.
– ref. Home care: The Dutch model that challenges bureaucracy – https://theconversation.com/home-care-the-dutch-model-that-challenges-bureaucracy-272381
