Buurtzorg and the power of self-managed teams of nurses

Lisa: So Marian, you came across Buurtzorg then and invited Jos De Blok here to your house. How did you find Buurtzorg?

Marian: We know people that started it in Utrecht, and Chila and I went because I like my profession. So we did that and it was a nice meeting.

Lisa: Here in your house?

Marian: Yeah, we didn’t believe it. We were thinking we’d start from start.

Lisa: So how did you begin?

Marian: There are a few colleagues, five at first. We started, and after a month came Chila, and we were with six. And now there are three teams in Almelo. We got a chance here and we found a location together that was alright. That was nice to do, a lot of fun. Then you have a laptop and then you start, and we were together. We go to the hospitals to say that we are starting in Almelo.

Lisa: Then the patients are coming?

Marian: Yeah, the organization they want to come with us because we all left with six or so. Some patients we have, a few patients, and then the rest came through hospitals and doctors. But we were very nervous to start because you do the same job but for yourself. It’s your own shop so you have to do it very good, and we have to build a name here in Almelo too, that we have good care.

Lisa: Very much more responsible?

Marian: In the beginning I think we were, yeah. But it was a little bit hectic sometimes, but we had a lot of fun and we like each other. It’s now family for us.

Lisa: So you said it was kind of challenging and different because suddenly it was you totally responsible for starting this up and everything. So how else is it different to your previous big organization? If you were describing how it is to work at Buurtzorg to other people compared to more traditional healthcare companies?

Marian: You have more time for patients. This was helps. The communication is much more easy. When patients call a big organization, they get the call center and they have to tell the story over and over again. And then with us, we have one number they can call. We know the questions, we all know. So they say “Hi, it’s Marian,” “Okay, I’ll go.” You know? That’s a very big difference.

Jolanda: Yes, if I need a bandage for my arm and when a patient needs more time, then I’ll be with the patient. That’s the biggest difference.

Marian: A higher level too. We all know what to do and we all have…

Jolanda: In another organization they say “We know what you can do,” and that’s also the philosophy of Jos. If you’re a professional, trust you to do your thing, it will be okay.

Lisa: That’s what he does, you know.

Marian: That’s true, people trust each other. There’s good teams with each other.

Lisa: So the feedback, that’s also a problem sometimes in the self-leadership thing, because if you cannot do that in a team, if it’s not safe enough to talk with each other about mistakes or problems or whatever, then you can get very big problems. So how do you do that then? Have you learned something about how to create that safety in a team so that communication happens?

Marian: Yeah, of course training how to do that, but it’s also the feeling of how to communicate with each other. We know each other very, very long. But with new people, you have to have the feeling that they belong to us. We have had mistakes with someone who didn’t feel well.

Lisa: So how did you handle that then? How did you deal with discussing that it wasn’t quite working out? How does that work?

Marian: Two years on our list and it costs money.

Chila: Well, we have that coach. If it’s too complicated for us and we don’t know what to do, what legal problems or something, we call the coach and she helps.

Lisa: So how did the coach help in this instance? What support did they give you in terms of having conversations?

Chila: She took over at one moment, with conversations in English.

Marian: Yeah, it became too big.

Lisa: What other sort of challenges or difficulties have you had in the team and how have you overcome them?

Marian: Um, in what way? What do you mean?

Lisa: Production?

Marian: Do we have to have enough clients to get enough money? Because only clients generate money. But if you work in your office or you were sick or on holidays, it’s unproductive time and no money for the company. Like productivity, yes. So that’s always a challenge because you have holidays and you have to go to courses, and people are sick, and you have to go to the office. But they want about 60-61%.

Chila: She is our financial person. The money and the figures.

Marian: So it’s always challenging to get that right.

Lisa: Does that – do you bring that up as a team? You know, when there’s an issue, when you think something is not working out, is it easy to sort of bring those things up and work on it together?

Marian: Yeah, we have a meeting and discuss the things.

Jolanda: Well, we have a day – we work, we start at 8:00 and we end at 4:00, and then you have several hours that you have no clients from 12:00 to 3:00, three hours, and when we don’t do anything for our clients, we cannot write them. So it’s very difficult to get enough hours.

Marian: But there are several people who have different tasks. I am planning the clients or planning the people who have to work. So we all have different roles, rostering. Yeah, so you can make office hours, but not so much as we have now in three hours in the afternoon.

Lisa: Do you ever have conflicts in the team, like something going on between two people, like a dynamic or something? And if so, how do you handle that?

Marian: Those things you have to talk about. That’s Buurtzorg’s policy. And if you cannot work it out, you call the coach, and then there has to be a solution sooner or later. So we do that. Sometimes it’s difficult, but most time we manage.

Jolanda: We have almost 10 years.

Marian: But there are a lot of teams that have a lot of problems. Of course, it is difficult. It’s not possible if you have in a team, like, everybody is the same. And if you have no team leader, then you have a problem. And when you have many busy people, then you have problems. It’s good you have a balance between too busy or quiet.

Chila: And no fear. No difficult searching for people. You have to put it on the table, and then everybody says something, and everybody is equal. And then you have to come to consensus. And when one person does not agree with something, you cannot do it.

Lisa: So how do you make decisions then? Do you have a different way of making decisions in a team?

Marian: That’s we talk a lot about. And sometimes there are two or three people that see it the other way. So then we decide not to do it because when some people have good reasons why they don’t want it, then we decide to follow something. It’s all about communication. When you have a good team, when you feel safe.

Jolanda: It sounds like there’s a lot of personal development.

Marian: Yes, and you can decide what you want to do with your team. So you let someone come and get…

Jolanda: Yes, that’s when you said you’re not good at that. It’s best if you go do some lessons for us. We also do that.

Marian: I have some personal training because something special. Buurtzorg is also very far with the digital writing and the plans, and we have a very good ICT.

Lisa: So tell me about that. How does that support you, the IT system? Because I understand it’s quite key to having kind of self-managing teams at Buurtzorg.

Marian: Yeah, it makes everything very simple, everything. If a client is registered, then you can order stuff for the clients or materials, whatever. So if you have the client in the system, then everything hangs on that client. So you don’t have to fill any forms or take a lot from goal or whatever. So it makes it very easy.

Jolanda: You make plans.

Marian: Yeah, in one time you have to invest to make a good plan, and then everybody can see what you have to do. And you can change it very easy. But it took a lot of time to learn it. But when you are together, you have to learn it together, so you can help each other. That’s very nice. She is very good at it.

Chila: Oh, never feel alone. And you can also always go to Almelo.

Marian: Very good. For everything we want, something special or we want quality. We want to turn a month free to get a bit more relaxed, and then she contracts from 28 hours to 8, and then she has four times eight hours holiday. And then she’s free for a month. And that’s possible. There are so many solutions. Great. And they are thinking with you, not for you but with you.

Lisa: So somebody’s above you?

Marian: No.

Lisa: So say more about that because I’ve heard a lot about how Buurtzorg evolves in a very collaborative way. It’s not like Jos has a grand idea and then everything follows. It’s a very transparent and sharing ideas. So how does that work?

Marian: When a team comes with a good idea under the Buurtzorg umbrella, and then they do the idea there, and people like it, and then they can bring it into the project. We had a few years, a special project where there were a hundred projects from all over the country if you could sign in. If you had a good idea, you get some money to try to develop it.

Jolanda: We have races in Amsterdam in the Olympic Stadium every year.

Lisa: Radio?

Marian: No, but Jos, if Jos has an idea, he puts it on the web, and then he asks for romance.

Chila: I think that’s it.

Marian: And then he stated everything with interest goes on. So he’s not a dictator. Very democratic. His salary isn’t that high. Jos is getting… Well, Jos has a bit more salary, but he works about 300 hours in a week. The danger for us was in the beginning, we worked and worked, and it was always in your mind because you have to do it fairly well.

Lisa: You feel that?

Chila: Yeah, you want to be successful.

Marian: Yeah, but Jos says to us, “Yeah, we can take over, and when you are free, we take it over. You don’t have to worry.” We feel it so much because we started.

Lisa: So how did that shift? Did you find ways of becoming less anxious or new ways of making sure that you weren’t working too much or too hard? How did you overcome that?

Marian: Yeah, you tell each other.

Chila: Yeah, you say it to the other. You gotta say, “Alright, I can do something for you.” We take care for each other. So sometimes we see each other. We know each other very well. But in the beginning, it was almost hard – very good in the first two years.

Lisa: Do you guys give each other feedback in the team? Is that something you do?

Marian: Yes, how to say something. It’s also communication. That’s very important.

Lisa: Did you always do that from the beginning, or was it something that you had to learn and practice?

Marian: Yes, it’s a problem. It’s also self-development. You have to learn it, but it’s nice.

Lisa: So nine years then. How have things changed? Have you noticed big changes or how are things different now, would you say?

Marian: Of course it’s bigger. External things like the Buurtzorg patients or in foreign countries. Jos is busy with all sorts of things, all sorts of groups, and Jos is not coming at home, I bet.

Jolanda: That was a big change.

Marian: Yeah, very good. But a big change was also when we became big. We had 16 persons in our team. No, it’s too big. You have to have 12. So we have to split, and that was a very difficult period.

Lisa: How did it go with the other team?

Marian: It was a very hard time.

Lisa: Was it like splitting up the family?

Marian: Yeah, yeah. And then now we’re through. We built a new team first, and we took people from Almelo I think.

Chila: Yes, just for that team, and then okay left.

Marian: The second time we were just one team, and we might do all that.

Lisa: So what advice would you give to people listening who are in organizations, maybe not even healthcare, maybe like an IT company or some kind of organization, and they’re inspired by Buurtzorg and they want to work in a more self-managed way? What advice would you give them about how to make it work?

Marian: Communicate.

Jolanda: Yeah, no leadership.

Marian: Everyone has a voice.

Jolanda: And honesty and transparency. Say together they can, use everyone. Nobody is more… You can get more quality out of a person when you’re actually a team.

Marian: Together they can do much more.

Jolanda: You can get more out of a person.

Marian: Yeah, to do that, you think that’s a big difference?

Jolanda: Yes.

Lisa: And what about for people listening who are owners or a company or founders or CEOs. What advice would you give to them?

Marian: Give trust. You can do it. And the work you have to do, what you think.

Jolanda: Only stay and love and listen to people. Say, “You can do it better.” They are from the working floor.

Marian: They are the best. You don’t need to manage.

Jolanda: Yourself, no, you don’t really don’t need a manager. We have had in the other organizations so many managers.

Marian: Progression of learning how you have to deal with problems. And you find out things that you didn’t think you could do. It is the best for yourself. And you stimulate. Go for it!

Jolanda: If one person cannot do it in a manager.

Marian: So if you don’t like it or you cannot do it, then somebody else does. Together you’re strong. But you have to feel it, and you have to want it to do. That’s very difficult to begin and to take the difference. That’s difficult.

Jolanda: I don’t think everybody is capable or wants to be like that. People want yes, who says, “You do that, you go there at that time,” and a bit and a bit, and then they feel safe. If you have to think for yourself, they don’t like it.

Marian: So then we have… We also had in the other team monitors and then she left. She couldn’t do this. No, she needed leadership.

Lisa: Would you like to see this way of working spreading more around the world?

Marian: Yeah, yeah.

Jolanda: Yeah, actually it’s much better for the patient and for us. You also have to take care not to get a burnout, because the illness in Utrecht is higher. There are lots of people who feel too responsible. It cannot let it go. So that’s also what you have to learn.

Lisa: It can be a shadow side of being really committed and passionate, we work too much.

Marian: Yeah, yeah.

Lisa: So what… how is Buurtzorg dealing with that? And you as an organization, you finding ways to address that and support people who were burning out?

Marian: Yeah, the coach. It’s still difficult things. We lost a colleague few months ago, and that was very hard.

Lisa: So is there anything else that you would like to share with the world? If you would wish to spread some wisdom, or what else would you like people to know about this way of working?

Marian: Trust yourself, that you can do it. I think it’s possible anywhere professionals do their thing. You get there, you support that in the right way, anyway. I believe that. So we can do it, so everybody can. And it’s also nice to have a coach. That’s different from a manager. They support you, but they don’t say like, “Do this or that,” but they support you in what you need.

Jolanda: What you need. No leadership.

Lisa: It’s interesting, that distinction between like a manager and a coach, how different that is.

Marian: For us, she’s not above us, but she asks what do you want for the team. And then she does it. She doesn’t say you have to do this. She asks what do you want, solve the problem together.

Chila: She’s also very nice person.

Marian: Yes, we got flower tickets to buy flowers because we lost our colleague, and we had a hard time. So she came by and she brought us that. But she also has many difficulties in teams to solve, and sometimes they are not to solve because there are persons who don’t see that they don’t belong there. They want to be a leader. And this is not about work.

Lisa: And then what happens?

Marian: It’s… they still have problems and it would be nice that the person who is a problem would leave. Sometimes they get away.

Chila: To make a team work, they have to see it by themselves. You cannot say, “You, I have to leave.”

Lisa: So is it always the case then that people choose to leave? They never asked to leave?

Marian: No, or maybe another team.

Lisa: I think it’s great. This is like better than I even imagined it would be. I know you’re wonderful.