Organizational innovation and integrated care: lessons from Buurtzorg

Abstract

Purpose – The purpose of this paper is to describe the case of Buurtzorg Nederland as a good practice example of integrated care, focussing in particular on the organizational aspects of its innovation. As the field of integrated care is still in many ways in its infancy, it is hoped that lessons learned could help other agencies and other systems seeking to reform community-based care. Design/methodology/approach – Drawing on a grounded approach, this case study is based on individual interviews with 38 respondents comprising staff, founder, co-founders, coaches, nurses, clients and a trainer and analysis of internal company reports. Findings – Based on the case study the authors suggest an integrated approach as the main explanation of the good practice at Buurtzorg rather than a focus on one single concept such as management structure, information and communication technology, community-based care or a patient focus. Next to the multi-level approach it furthermore shows a multi-dimensional approach as explanation for its success. In this perspective the primary process is the leading process but fully supported by the secondary process containing support facilities from a head office of the organization. Practical implications – Buurtzorg Nederland has been awarded with several prizes for its good management practice in integrated care and attention internationally is growing. Originality/value – This paper provides the first case study write-up of the Buurtzorg model for an international audience, based on extensive research to be published in an international book.

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

“…Causal link 3:10 -care planning and boundary spanning Nine studies 21,66,68,78,83,90,91,93,94 provided further evidence that boundary-spanning roles facilitated many forms of care 'integration'. These roles may be filled by care co-ordinators, nurse practitioners, CHWs and many other occupations.…”

“…Several studies 21,68,78,83,90,93,94 reported how MDT members in boundary-spanning roles helped co-ordinate the MDT to effect individualised care strategies co-ordinated around the patient and her family, make use of a health and social network to provide education for patients and their families, and put their counsellors at their disposal, providing the patient with good overall care, at the right moment, by a better team, at lower cost. Briot et al 66 describe this in mental health services in Utah.…”

“…Although the GPs in a study in Australia did not have the time or resources to deal with psychosocial aspects of patients' health, the general practice liaison nurses were able to arrange case conferences between all necessary professionals and develop care plans for patients. 90 A case study of Buurtzorg 21 found that, by working in this way, a MDT was able to deliver more person-centred care by allowing staff to organise care that made sense to them and the patient, which made them feel able to deliver good-quality, holistic care and allowed the MDT to organise itself so as to achieve the best possible outcomes for patients. In the HealthOne Mount Druitt project (Australia), McNab et al 90 found that primary care providers appreciated the familiar face and voice of the boundary-spanner, with whom they felt they could, over time, build an ongoing relationship of mutual trust.…”

“…That gave users good overall care by a better team at lower cost, reduced GP workload and freed specialists to support more severe cases. 66 Causal link 3:10 -multidisciplinary teams produce care planning at the patient level Ten studies 21,66,68,76,78,83,90,91,93,94 suggested that MDT working facilitated care planning at the patient level through the operation of boundary-spanning roles and by giving greater access to enhanced primary care.…”

“…Work co-ordination relies heavily on an IT system based on spreadsheets devised by the teams themselves and a shared EHR. 21 Reflecting practice in the Netherlands generally, the teams do not include doctors (separately organised in small general practices, much as in the NHS).…”