An Alternative Approach for Public Sector Organisations

We live in challenging times for the public sector.

An ageing population and a decrease in wellbeing across all age groups mean an increased cost of service for our NHS; Increasing economic inequality across the UK is putting pressure on our social services; The climate crisis means we need to drive major societal change in energy consumption to reach net-zero carbon emissions.

These are just some of the unprecedented challenges that face our public sector organisations. The question is can these challenges be overcome with their existing ways of working?

I think we need to rethink how our public sector organisations operate to make them sustainable for the future. We need new organisational structures focused on purpose, human relationships and new economic principles. This is more than just reorganisation. Through collectively reaching a new level of human consciousness we can improve the quality of life for all citizens at a lower cost.

This might all sound a little unachievable, but this is exactly what has been achieved by a healthcare organisation in the Netherlands called Buurtzorg .

Started in 2006, Buurtzorg is a movement of nurses who decided to take full responsibility for their patients in small self-organised teams. The group believed that by simplifying the organisational structures of the Dutch healthcare system, they could develop communities and build trusting relationships between nurses, patients and neighbourhoods.

Now there are 9000 Buurtzorg nurses, working in 800 self-managed teams, serving over 70,000 patients a year. Amazingly, there are only 45 back-office staff, who provide support services, which means nursing teams is responsible for doing the intake, planning, and administration, they even decide where to rent an office and how to decorate it!

Because of this, a problem-solving culture thrives. Nurses can’t offload difficult decisions to a boss and there is no structure to blame. This lack of hierarchy means teams have all the power to solve their own problems and the absence of rules and procedures imposed by headquarters creates a huge sense of freedom and responsibility throughout the organisation.

Buurtzorg Growth

The Buurtzorg approach works. An Ernst & Young study found that Buurtzorg requires 40% fewer hours of care per client than other nursing organisations. Patients stay in care only half as long, heal faster, and become more autonomous. Buurtzorg’s approach has saved the Dutch social security system an estimated €2 billion in healthcare costs.

I have spoken about Buurtzorg to several people within the UK public sector organisations who have been impressed at their achievements but wondered what the cost would be of attempting this approach in the UK. My question is, can we afford not to?

If you’re interested in finding out more about Buurtzorg I recommend reading Reinventing Organisations or watching founder Jos de Blok’s talk on organisational structures.