Jos de Blok on Buurtzorg and the virtues of humanising, not protocolising

Lisa Gill: So yes, thank you so much for coming on the podcast. I'm really excited to get the chance to talk to you. We were just talking about, before I started recording, that I met some of your colleagues in the Houten team a few years ago, and interviewed them in the garden. We had cups of tea, kind of true Buurtzorg style, so it's really fun to now get the chance to talk to you as founder and CEO and the person who started it all. So yeah, thank you for being here. So I thought maybe we could start in the present moment. So if I ask you what's giving you energy at the moment, what are you working on that's really energising you?

Jos de Blok: On Thursday and Friday I had two days with the project team and with around ten people who are doing all kinds of projects within Buurtzorg and we were thinking about this situation of course (Covid) and what can we do in a way that the teams feel that they are inspired, supported? Because it's difficult. People are tired. It's exhausting people - almost two years of dealing with Covid. A lot of people have been ill; I have had Corona. So there is a lot of pressure and one of the things we try to do is; okay, it's there, so we have to deal with it, but let's find new optimism; that there are ways to let people get inspired, t hat we say okay, everybody has seen the consequences in their environment or in their team. We have had a lot of patients who had Corona, but now let's find ways how we can deal with the circumstances in a way that it doesn't give us too much pressure, that we can take care of ourselves as good as possible, and then say we can keep on improving ourselves, taking care of personal development for each other, not only focusing on Covid because it will be there next year too. But how can we create an environment where people can keep on learning, keep on developing themselves, and also taking care of each other?

So these two days were amazing with the project team and that was for me very energising. We talked a lot about all kinds of personal things. So everybody has things in their environment that is influencing their ways of looking at the world, so it was a kind of reflection, new ideas, trying to focus also on what will happen in the coming five to 10 years; how do we see the world and how can we work with what we want to achieve? How can we focus on the patient care on one side, but also care for ourselves on the other side and also deal with the system sides. Because it's always complicated. We are in a very complicated environment at the moment where the ministry and the care authority are making plans which are not really based on a vision and on content. So it's really a system thing, which can also create a lot of bureaucracy again, but it feels like we are a collective and that feels very good - that we are aligned, that we like each other. I think we love each other. People around us - everybody's very caring for each other. So that feels good and now it's good to see how we have 950 teams all over the country. How can we communicate in a way that the teams, the nurses feel that they are supported that they get new inspiration? So staying connected with everybody - this is what's happening at the moment.

Lisa Gill: Yeah, it sounds like a really tough moment and it sounds like you're handling it with a lot of humanity and compassion and I'm curious because it was one of the questions that some of the listeners asked about actually was how Buurtzorg dealt with the pandemic, and in what ways you think that how you're set up and your culture helped you navigate that, especially given, as you said, the kind of battle almost with the system and different things going on in the government. So what have been some of the main lessons and things that you're proud of in terms of how you responded?

Jos de Blok: I think what we saw when it started, we learned very fast from the first teams who had to deal with Covid. So it started in Holland, in the south, and we created a kind of what we call the Crisis Team, but with different people, different nurses. We also had an epidemiologist in the house, (we didn't know that, but she became part of the Crisis Team). So we studied what happened in different other countries and we said there are a few things which are very important that's creating safety for the patients and keeping our nurses safe. And that was a different approach than what our government did because in the beginning they even said that we should not wear masks, for example. So we said, but it's an infection diseases - you should stay safety. But there was a scarcity of masks and now we can get them in different places and otherwise we will make them ourselves. But we saw there was a lot of resilience. And if you look at the way teams dealt with it, was very flexible. So what we saw was that the teams were immediately in action when there was Corona in this village or in this neighborhood where they were working.

We heard it also from others that where other organisations were starting command and control strategy; so top down, it's crisis, now we have to put clear protocols on everything. And we said, no, we should ask the teams what they need in their daily work, how they deal with it and then we can translate it into guidelines also for the other teams. So there was continuous communication every day. The Crisis Team was 24 hours a day available. So we said, okay, everybody should be able to go with questions about: "This is what I see now. I don't know. Should I go in quarantine? Or should I do this or...?" And this ongoing process was, I think, felt by the nurses that they were supported in any way. And I think that by doing it this way, they were still very very flexible. So we also saw that it's the same - the communication with the patients is very important that you say, okay, there is Corona, how can we keep you safe? How can we perhaps reduce the amount of visits, but in a way that it's aligned? Not that it's a command from Buurtzorg this way, it's a dialogue. And this may be found a lot of different solutions. But I think you can't protocolise it. So you should ask the nurses and say, okay, you are the owner of your own your own daily work - try to find ways to deal with it in the best possible way.

And that's what I heard also from the environment that people said your teams and your nurses responded differently than all the other organisations. So they were seen as strong, capable, responsible people who took care of all the consequences. And it was, I think, a very important thing throughout the whole pandemic, and still is. So I see that, for example, the sickness rate now in some organisation is also higher but with some other organisation it's exploding almost - it's 12, 13, 14%. In Buurtzorg now it's 8%, which is also higher than the normal. But I think we're very happy that this responsibility is a collective responsibility. Let's go with what we learn from day to day in this pandemic and let's see that there's principles of keeping people as safe as possible, supporting them when it's needed, being there when it's needed, and then, let's move forward and let's learn from it.

Lisa Gill: Yeah, this learning piece feels so strong for me whenever I've heard you talk and when I've read things about Buurtzorg that you have this amazing ability to, as you say, not protocolise things. I think it's also the same when different teams have developed new products or services, that it's very much share the ideas and see where they spread and allow the teams to choose which ones they take on. I know a lot of organisations who really struggle with that, and now you're like 950 teams. So how do you create that learning culture?

Jos de Blok: I think it starts with not wanting to create a culture. So I think that my idea was when you're creating an environment where it can grow, if you have a safety, if you have a nice relationship with the people around you, if you feel ownership, if you can be responsible for what you're doing - all these things, all these elements, they're more or less, I think like sociologic or psychologic principles, that if they are there, then you feel well and you will grow and you will share your ideas with your colleagues. So then it's just happening. You see things in your daily work (this was my own experience when I worked as a nurse). So you see a lot of things, practical things where you say, okay, if we do it this way, perhaps it's a bit smarter. Most people are very creative, in my opinion. So nurses, especially nurses who are working in the community, need to be creative because the circumstances are changing all the time. So just letting people find out what they can do, what new insights they can have, and sharing it with each other creates a lot of innovation - this is kind of assumption.

So I've been Director of Innovations in my former job. Then my board asked me: "Oh Jos, we want to have these kinds of innovations". And then I said: "These are not really innovations that are bringing good things for patients". "No, but we have to show that we are an innovative organisation so then when it compliments the books, or people are writing about it". So the image was more important than what was really happening. So I said, it has to be the other way around - we have to understand that when we are developing new ideas, which are helping for example, 30% of our patients, then it's a big innovation. But it has to come from the daily practice. So my idea was that, okay when we create this, when we have these environments, when we have these teams who enjoy working together, who feel confident about what they're doing because they are the owners of their daily work, who feel the space to explore and to experiment, then all these things will happen.

Lisa Gill: Yeah, it's making me think about this question that I have often with colleagues in this space which is: if you create the environment, does everything else follow? Or is there also something else about how people are being, especially people who have power, or have had power in the past? Because I find that that can so easily sabotage and even the most beautifully set up environment of autonomous teams and things like that. So do you think it's enough to create the environment? Or do you think there's also something else needed? Because it's kind of shifting a paradigm really.

Jos de Blok: Yeah, I think it depends on what you consider as the environment. So for me, it's also the reflection. So you have to be aware that there is always a dynamic in these teams and when there is pressure like we have now with Covid, we should argue, we should discuss what does it do with us? Does it influence our behaviour in a way? For example, we have this discussion about people who are not vaccinated. Then you see that in society, in many countries you see a kind of polarisation where you are against it or you are vaccinated. I don't want to have these kinds of things. In my blogs, (I write blogs) I said: "Let's talk about tolerance. Let's talk about compassion. Let's talk about how can we support each other and respect each other's choices". So in these moments when it's difficult then it's more important than ever. In society as a whole, polarisation is going on between people who always lived in Holland, for example, and immigrants and I think we should go back to what's human - what's a human approach to everything.

This morning I was driving in my car and I was listening to the news, and there was news about Belarus and Poland: there are a lot of refugees. And there was this one mayor of this village who said: "I'm going to do things differently than anybody else. We have to take care of these refugees. There are little children or even babies and who are we to send them back into the forest and say that they're not welcome and that they are people who are making kind of profit of us". My idea is that these values; how do we take care of people, how do we take care of each other, how do we do focus on tolerance and compassion and in my opinion, that's very human and also brings you a lot if you do that. So in this, if you talk about culture - if you say, okay, we want that people are taking care of patients, then we also say we want people, (our colleagues) are taking care of themselves and of each other, but also for vulnerable people in the society. So for example, when it comes to big cities where we have people who are homeless, then we say, okay, even if they don't have health insurance, we will help them. It's no problem. Let's create possibilities that we can help them and that we can advise them and that we can contribute so that their lives can become better. Our nurses have these networks. So when you see in Amsterdam, even when some of the teams are in these buildings, where they also take care of homeless people and we do it together. So for me, it's very important that we say, okay, healthcare is not only about health and taking care of people with health problems, it's also taking care of people in society who are vulnerable and who need support. I think when you talk about it, and then you share it, I think people will feel that it's okay. So it's good that we just spend time. It's not bringing money in, no. But it's important. It's an important thing.

Lisa Gill: Yeah and it sounds like when you write blogs or when you pose these questions about reflection, for example, that seems like a very important part of your role in keeping alive this culture.

Jos de Blok: Yeah, but I think it's important that everybody's feeling that they can do it also, though my opinion is not more important than the opinion of others. But of course, because of the continuity and the way we share ideas or share values, I think, you see that a lot of people feel trust in it or feel that okay, it's also my idea. What I try to write about is what I think that most of the nurses feel - so it's this collective and of course, there are all kinds of different opinions on anything. But there is a kind of general development throughout the years that everybody feels okay, I'm happy that I'm part of this and then I can share, when I'm at a party, for example, or we have an event, then it's nice to see that people feel good, just by saying okay, I've chosen to work this way as we do within Buurtzorg, but I also feel that there is more than that, that it's that I'm interested in what I'm doing, that I'm rewarded in what I'm doing, that I can develop myself and that I can contribute with all my ideas and who I am.

So this idea of 'wholeness' - what Laroux wrote about, it's very good that he used these kinds of words that say, okay, how can you be yourself at a place where you're working? It's so important that you don't wear a mask or you're not somebody else - no, it's you. You have your qualities, your skills, your education, and you're doing it the best way you can do it, but it can be different than another one. So all these things, I think it's creating a continuous kind of reflecting on what you're doing and then I think it's also very connected with the environment where you're working. So these nurses you met in Houten that are connected with this neighborhood, they know everything. They've lived there from for many years, they've worked there for many years, they're very smart nurses and they know what to do when this or that is happening. So if you would verticalise them or say okay, these are the tasks you do, it would be damaging them. And in fact I think that a lot of organisations are creating damage for a lot of people by all the restrictions, by all the protocols, by all the the top down directions. I see Buurtzorg as a kind of a living organism where everybody is organically connected.

Lisa Gill: Yeah and that very much came across when I met Marian and Sheila and Yolanda and Houten, and they talked about the trust and they talked about, really that it's a steep learning curve at the beginning because it was really like they owned their own business and they had to do everything. And they talked about their coach also as being so important and also as you describe, this thing about being human and being yourself, that when they had tough times, that the coach really cared about them and that they could really rely on each other and care about each other when one of them was struggling with burnout, you know - that they would really step in. So that very much came across to me also.

I'm wanting to ask you these tough questions because I think so many people are inspired by Buurtzorg and I've had so many guests on the podcast who have created almost versions of their own of taking inspiration from Buurtzorg, and at the same time, I speak to a lot of people who really struggle, particularly, for example, in the health and social care sector, many people in in the UK, for example, who are within the NHS, this kind of huge system, and really passionate and committed about changing things, and making it more human for patients and for colleagues, but really struggling against the system and many people say to me that in Buurtzorg's case you created something from scratch and that has its advantages, of course. But I'm wondering what your thoughts are for people who are transforming from a sort of traditional organisation, and they're trying to implement. So I talk to a lot of organisations in that sector who are creating autonomous teams, they're bringing in coaches to support them, but they come across challenges, like, for example, managers feeling really threatened by it and saying, "Oh, so now I'm no longer a manager, I'm a coach", or, "does that mean that I'm not valued anymore? Is that because you want to pay me less?" And people at the other end of the spectrum feel sort of scared to step in and are so used to having the structure of a manager telling them what to do, or appraisals or whatever, that it also feels quite challenging and intimidating. So you hear leaders saying, "We've created a self-managing system, why is no one stepping in?" So there are all sorts of pain points for organisations that are transforming and I imagine you've talked to many people in these organisations, yourself as well. So what are your thoughts and what have you learned in trying to support these people?

Jos de Blok: Yeah, like you just said about when leaders say: "We created a self-organised organisation" or something like that, and people are not stepping in, then you can ask yourself, what was the starting point? Because I think, if you're not creating alignment and commitment from the start with everybody, it will not succeed. An organisation is not a thing, it's the people who are in it. I think the starting point, in my opinion, should be how is it influencing the daily work of a lot of people and how is it influencing the services or the products they're making or the services they're delivering? And it's not only in healthcare, it's also in other industries. What's your service? What's your product? How is it made by people and what do they think about that process of making it or delivering it? And what do they see in what way it could be improved or changed that it has a lot of impact on the people who buy it or use it and the people who make it?

So that process, (you can say the primary process), what is the difference between delivering activities by the minute or creating solutions? So for a lot of people in healthcare there's a big difference. But also, you can also see it in banks; are you selling financial products or are you creating value for the people who are your clients? And so that's the starting point; what kind of organisation do we want to be in five to 10 years? How do we want to develop ourselves in a way that we have a strategic advantage? If you just talk about in any kind of business language, then you can say: "Okay, we want to have an organisation where the workers feel well, the products and the services are the best we can imagine and there is a reasonable profit. By doing this, we can survive the coming 10 to 15/20 years".

So the strategy, vision and the way you operate should be consistent. So it should not be something just taught by some people who said: "Okay we have an idea, we structure it in another way, we make autonomous teams". Now it's about dialogue; it's about reflection, about how do you see your work? How do you see these different roles in an organisation? And if you do that in a positive, consistent way that it shows also, you have to show what it means also in behaviour. So the leaders have to use the language. If you say it's another paradigm, you want to create something which is based on another paradigm, and that's sometimes really difficult. Then the leaders have to show new behaviour. So instead of telling people what the vision and the strategy is, you have to have a dialogue about it. So how do you look at the world? How do you see your daily work? Do I really understand what you're doing and understand what it brings you? All these mechanisms of 15, 20 sometimes even longer, 30 years, are inside of all these people. So it's not so easy to say, from one to another day: "Oh, it's not there anymore". No. You did the MBA education so you have all these records in your head and you don't know yet what the new pattern will be. So there is a transformation on a personal level, there is a transformation on an organisational level, and perhaps, (and I think that's going on), there is a transformation on a societal level.

Then you'll get all these complications throughout the process, because then it affects these management positions; how do we deal with that? But if it's built on something you want to achieve together, then people will also say, "Okay, how can I come to contribute?" - that would be the kind of question, instead of: "Am I losing my position?". So this process is not very easy, but I've seen in the organisation I supported or we supported with some colleagues was that the organisations which were led by women, achieved it in a better way than the organisations which were led by men. So it's more about feeling intuition, it's communication, it's continuity, so it's seeing things for a longer period, building on relationships and in general, I think it's easier for people with feminine and also, of course, there are also men with feminine characteristics. So yeah I think, because I've met many, many people from different organisations, and yeah, it always starts with: how do you reflect on yourself? How do you see yourself in this process? And then you can see beautiful things happening all over the world, in all kinds of industries.

So there are more and more examples, very successful examples, and what I see is that part of societal change, if you will, I connect the climate discussion and the energy problems and the big problems in the world today to this process. So we need to deal in a different way with our environment. We can't go on like this. We are destroying the environment by the economical view on everything starts with economics. No, it starts with humans. So it starts with human behaviour, it starts with how do we deal with each other? How do we take care of each other? And then of course, how do we do it in a way that it's also financially healthy? In my opinion, it should be another way of looking at priorities. So If you take care of people in a good way, if people can be themselves in the workplace, it will also be good for the company. These are some reflections on how I see it and sometimes I see that organisations are doing a project on self-organisation, they have a steering group, a project group, they start to work and then they are going to tell the people what it means. But that's not the right way, I think.

Lisa Gill: Yeah. So what I'm hearing in what you're saying some themes are that the way that you start - I really liked the thing you say about it's all about dialogue. Starting dialogues and listening also - really understanding how people who are on the front line, so to speak, how they see things, what gets in the way, how they would like things to be, and so on, to really involve them and enroll them in that process, instead of, as you say, revealing some grand plan. And I'm also glad you said the thing about leaders, because I can really see that it's painful for them in a lot of ways that this paradigm up till now, you know, these people who have done MBAs and have built their career on certain characteristics are now being told, "Oh the game is changing now and now we need you to be in a completely other way". And there are advantages and great rewards in that I think, once people are able to get there, but that transformation, as you say, is a big one. And I'm wondering what you've learned or what your reflections are in terms of what helps leaders in that transformation?

Jos de Blok: What helps? Yeah, I think the very basic thing is to start talking with people instead of telling them things. It's these expectations (and that's also the difficulty) these expectations from managers and leaders in the positions they have, are creating a behaviour that people are easily giving their opinions on everything. So because you are a manager in this position and it's not so easy to just walk up to some people and say: "How do you think about this?". In some organisations people are expecting that from this person. But I always said what's most effective is that you act like (and I hope I'm right) that you act like your home - the way you talk with your family, you should also use that in your work. I expect that it's positive, so the way you treat your dear ones and you talk about all kinds of things in your family, also that can be helpful.

Another thing is that you ask for coaching. We always have our blind spots - sometimes we don't even know. I believe I'm not easily angry. Almost never. But then people say to me: "When you're silent, when you're not saying anything, you have a certain expression". And then people believe that there was something behind it. So you have to communicate how you feel: "Oh, that's okay. Just let me know when this is happening". For example, I've had depression; sometimes I have moods that are not very nice and still I'm just working. But then of course the things I'm saying will have another effect than when I'm laughing and enjoying. But it's good to know this from yourself and then think about how can it influence the communication I'm having. You can learn to reflect on yourself too. I always advise people not to go in what I call, 'a peer group' because then you all have the same language and you're all are supporting the wrong things. So talk with people who you're feeling less comfortable with.

So for example, I think if you have a kind of managerial role or a lead role, I think talking with nurses would be very healthy. As a nurse, (I'm a nurse), you've been talking to everybody with every kind of background, so you have to attune to everybody. So in general, if there is not a hierarchical position, then nurses will tell you what they see. And in that sense, nurses are very important for society on the whole, so they can heal the system. There are some reflections. I don't believe in all these leadership courses; I think it's bringing more and more negative things than positive.

So it's all the same - all talking about leadership and how important is leadership and now I call it being humble; how can you put yourself in a role that people see who you really are as a person, not as a leader, but as a person? And you know, it's too much about techniques and not too much about the things you should learn. I think you should unlearn a lot of things. So you should go back to what's the core of you, how can you show that you are this caring person in your family, and that you also can be this caring person in your personal life and your work? I think a lot of people will appreciate if you show your feelings, but all these patterns, the things you've learned and the way you had to you had to deal with all those dilemmas in your daily work, have put a focus on your more or less, (I call it) cohort characteristics. So if you say the soft side of you - I believe that the soft side of people who have been managers and leaders for a long time, has been underdeveloped. So for example, just showing your emotions: crying when you should cry, talking about your doubts, your fears - these kinds of things. No, you have to be a leader, strong leaders - confident. You can't be confident about everything. There's a lot of fear in all these things. So just say it's there, so how can we deal with it? Building trust. You can only build trust when you talk about the basic things. Or then people can see what trust means for you.

Lisa Gill: Yeah I want to add a reflection on what you said about not believing in leadership training, or what I hear to mean kind of traditional leadership training in the sense of like, this is what leadership is and and theory and blah, blah, blah. In my experience, what I find does help is creating some spaces where people can experience and share and be vulnerable outside of the sort of day to day work as well as kind of integrating it into their day to day work. Because as you said, I see that a lot of people have blind spots of not being aware of, (and I'm biased, of course, because I lead trainings and I'm not saying that trainings are the only answer, I think it's different things for different people), but I see that there's a value in helping people to see because a lot of it is coaching; helping people to see, like the feedback that you got about sometimes when you become a bit silent, I wonder this or that or so that you can get help with your awareness and perhaps practice things, tough conversations or vulnerable conversations, things that you don't normally do in a safe space where you can get feedback and input and coaching and support. I do find that that's really valuable for people, especially in organisations, maybe slightly different to Buurtzorg where there's lots of cross-functional teams and complexity and a mix of managers and I think in an organisation where there's very competent nurses, they're really kind of driving most of the organisation supported by coaches in a support services team and so on, it's perhaps less needed because they know what they're doing and you just need to get out of the way and support them.

But it seems to me like in other organisations, where as I said, there are lots of different cross-functional teams and lots of other layers of complexity, that it's even more challenging and you need to have even stronger levels of communication skills, building trust, listening, being able to really have those dialogues, that that's perhaps not going to happen by just sort of asking people to reflect more or, try this because they'd have no concept of what that is, they haven't done it before.

Jos de Blok: Yeah, but I'm very practical. So there are some things you can do in general, but at the same time you have to build something which is based on very practical things. So the daily routines, for example. So what I did before I started with Buurtzorg, I wrote a lot about my expectations in how it can work in a team and what these principles and routines were, in my opinion, which could lead to results we have. So the design, more or less ,of the new world. So you have the old world, and I think you will have to think about the design of the new thing: the routines, what kind of routines, what kind of principles, what kind of expectations, guidelines. Also in the back office, for example. So if you say we don't have a management structure, what will be the supportive system? What kind of support do we need, and we want? So the strategy on building should be very clear. And I totally agree with you that on some of these topics, trainings are very useful. But what I was referring to was that what I see most of the time is that leaders are talking with leaders and I believe that this language is a very important thing - the language you use, the words you use should be connected with what you're doing and the people who are doing it.

I had a discussion with a researcher who said not so long ago that nurses should use more of the language of their leaders because otherwise they can't explain what they need. And I said: "But that's the other way around. I think leaders should try to understand, (at least they should understand), the people - how they feel about their daily work. That's the beginning". Language for me feels like when I did the MBA education, I thought it helped me to understand how leaders and managers think. But on the other hand it's strange that when they are all using the same language, that there is not any space anymore for something different. So I made a difference between managing or management and organising. And of course you can have all kinds of mixes. But I think if you say: "Okay, I want to use all the intelligence and all the capacity in how people can organise, and I want that they feel ownership about what they're doing, then you should focus more on organising than on management. And you can use all kinds of management elements in this process, but it's quite a big change, in my opinion.

And then language comes very close. But I hear a lot when our nurses are in a meeting, when there are a lot of managers or leaders that they say: "We really don't understand what they're talking about", and when you ask the managers what they are really talking about, I think that a lot of them even don't know exactly what they're talking about. So that's my perception. I've been a lot in management teams and I've talked a lot with CEOs from all kinds of companies and when I see this language, then I see uncertainty - I see that people don't really know and then they use words, but it's kind of a masquerade. They have to say in a very concrete way what they exactly mean. There is this Danish philosopher who wrote a book about it. He called it 'Plastic Language' - so it's using a lot of words, but you're saying nothing. I believe that if the starting point is you and you say, "I want to learn these skills, I want to understand this or that", the results are much better than when there is a kind of standard programme on a certain theme.

So I'm working a lot with Sharda Nandram and Sharda's professor, and wrote a wonderful book about Buurtzorg, it's called 'Organisational Innovation by Integrating Simplification', developed the integrating simplification theory - so simplifying processes is more important than creating complexity. But we talked a lot about integrating different kinds of intelligence - so integrative intelligence. So we've done research on that, so if you have different reflections from different perspectives, together it creates new insights. And one of my observations is that if you look at management trainings, and also this leadership trend, from a management perspective, creates kind of a monoculture, using the same patterns, using the same words all over the world, though it feels comfortable, because you think, "I understand this world". But that's too easy. You have to go through worlds you don't understand. So this reflection from different people around you, I think is very important that you understand: "Okay it's not my language, my behavior, the way I do things has a certain impact on my environment and I have to understand this before I can do it in a different way".

Lisa Gill: Sad to say that we're starting to wrap up now, because I know you have many other things to go on to. But is there anything else that you would really like to share with listeners - people who are exploring new ways of working, more human ways of working themselves?

Jos de Blok: Yeah, I think it's important to connect the ideas with a very practical design where you say: "This is what we are going to do, this is the way we're doing it" and as you can say, "creating conditions, and this is what we want to get out of it". So what I see is that I see sometimes people who are very eager to start something, but they don't have a good business model. That's also what I see sometimes at Buurtzorg - that they say: "This working in teams and taking care of people - wonderful! We also want to do it". But, (I have these discussions a lot in the UK, within the NHS), you need to have a clear business model and it's very simple; if you work this way, what's the financial structure? What money is coming in and what's going out? As simple as that. You need to have a model and lift this model. I always use different scenarios. So when it's working good or I call it medium when it's not going well. Thinking in scenarios, thinking in the design and being flexible, agile in the process you are working. So these elements. But don't think it will happen just by accident. You have to think through these things but it's us, and then I think, just do it.

That's another thing - is that people keep on talking about it for a long time and there should be more people who are acting - just doing, starting. Sometimes you'll fail and sometimes it goes well, but when it's built on a good idea and a good design, and you have the skills to deal with all these different elements, things will work out. We built something beautiful together but all these wonderful nurses, and three of them, you met in Houghton and they are examples. Like they are all like that - wonderful people and it's a privilege to work with so many great people.