Jos de Blok: self-management helps to simplify complexity with autonomy

This is the first episode of 2023. And it is a special one! It was an honour and real pleasure to chat an hour with Jos de Blok, the founder and CEO of a renowned self-managing neighbourhood nursing organisation called Buurtzorg. Jos is the creator of the pioneering Dutch healthcare system, empowering nurses in self-organised teams to collaboratively provide the best patient-centric community care. Founded in 2006 in Holland with one team of four nurses, Buurtzorg has transformed community-based home care services and employs now more than 15 000 nurses around the world. I was fascinated to learn more about this transformational organisation and the man himself. And I am really glad that Jos will join us at the Estonian Human Resource Management Association's annual conference this spring as one of the keynote speakers. “I worked for many years as a community nurse in the 1980s. It gave me all I wanted. I had the freedom to decide how to take care of patients. I had very good colleagues. There was no management structure, we didn’t have strategic plans and we didn’t have planning tools. We just did what was needed. It was effective. In the 1990s, a lot of changes were introduced, and in Holland, it led to a very product- and activity-driven way of delivering health care, so health care was defined in terms of products and delivering activities instead of solving problems. It added layers of managers. And the language changed so that people were not talking any more about how best to take care of our patients. It was about effectiveness and growing revenue. In 1994, I was asked to become a manager, and I saw how little interest there was in how the system was helping patients and I learned how management was frustrating the daily practice of good professional workers. People think that there has to be somebody who pounds the table as the manager. That’s not a solution, because it will damage people’s sense of ownership and responsibility. In 2005, I decided with some friends that we can create an alternative with better quality of care, and an environment that our nurses will want to work in, and that will also have a big impact on society because it will be much cheaper than the current way of doing things. My idea was to create small teams with nurses who organise everything themselves. We would let them focus on the excellent nursing care; let them work with patients in a way that they think is the best – based on professional standards – and create a support system around them, including a back office and IT system that helps them in their daily work. It would grow by itself and improve quality. It’s about simplifying complexity and seeing where the complexity is and how you can simplify the environment so that you can deal with the complexity in the most effective way. Every day, nurses have to deal with sometimes very complex situations with a lot of uncertain factors. They have to make their own choices in the moment to have the best result. In health care, that’s very complicated because there are many factors that influence outcomes. My idea is to have nurses around these problems who feel personally connected to them and can make the choices they think are the best choices. Then you create an environment that’s simple so they don’t have to put any effort into thinking about what management is saying. I started with one team at the end of 2006. If you create these small environments where people feel ownership, you can replicate it all over the country and all over the world. Based on these principles, we started to grow from one person to 15 000 nurses in around 15 years.”– Jos de Blok Listen and enjoy!