A few months ago I read a wonderful book called ‘Reinventing Organisations’ by Frederic Laloux. It borrows a framework from Ken Wilber in describing the evolution of organisations towards ones that are freer of ego and control, ones that believe in abundance and in wholeness. What makes the book wonderful, though, is not the framework but the case studies of organisations that run this way. This is, in brief, the story of one of them.
This example comes from the Netherlands. In the nineteenth century, every neighbourhood had a nurse. Originally they were self-employed, but in the 1990s the health insurance system, which mostly paid for them, thought it would be more efficient to group them into organisations. Between 1990 and 1995, the number of organisations dropped from 295 to 86.
Alongside the rationalisation of organisations came the rationalisation of work. Time norms were established for different tasks: “wound dressing 10 minutes”, for instance. Treatments were rated: only the more experienced and expensive nurses could perform only the more difficult treatments. In order to keep track of how long visits were taking, a barcode was placed on every patient’s door: the nurse had to scan it on entry and exit.
Nurses hated the new system. Here are the sorts of things they said about it:
The whole day is making you crazy. Some day I had to go and see 19 patients.
The planning went wrong so many times that I could no longer explain why nobody would come.
The final straw came when (they) wanted us to sell stuff to our patients.
Buurtzorg was founded in 2006 by one Jos de Blok, as a reaction to all this control-freakery. Between 2006 and 2013, when the research for the book was done, it grew from 10 nurses to 7,000. By 2013 it employed two-thirds of all neighbourhood nurses in the Netherlands.
Here’s how it runs. Nurses work in teams of 10 – 12, serving 50 patients in a neighbourhood. They have no boss and they take all decisions. Decisions are not taken by consensus but on the basis of a lack of principled objection.
Buurtzorg has a tiny headquarters staff of 30 people. Another difference from traditional organisations is that, instead of having regional managers, who control, they have regional coaches, who support. Their role is mostly to ask the questions that help teams find their own solutions. The coach lets the team do that, even if she believes she knows a better way. Part of the job of the coach is to give the team the belief that they have what it takes to solve their problems.
One of the striking effects of the lack of official hierarchy is that it enables natural hierarchies to evolve. People get to do what their best at within their team. Some of them become known for their expertise in a particular area and are consulted by other teams across the country.
The results speak for themselves. Buurtzog’s nurses take as much time as they wish with patients, as opposed to being bound by ‘time norms’, but in fact Buurzorg’s patients require 40% less time than those of other organisations. Patients stay in care only half as long. A third of emergency hospital admissions are avoided. Among nurses, absenteeism for sickness is 60% lower. Just wonderful….