Changing The Face Of Healthcare With Jos De Blok

In many ways, healthcare has become more and more complicated throughout the years, even with the advances in technology. But one revolutionary healthcare system could be changing the way hospitals could work down the line, for the better. Dr. Diane Hamilton sits down with Jos De Blok, the founder and CEO of Buurtzog. This healthcare system focuses on building a community rooted in nurses who keep the hospitals of the world running. Jos shows why Buurtzog could be advantageous to hospital systems internationally, not just in terms of cost efficiency but also in motivating the people working in the hospitals.

 

I’m glad you joined us because we have Jos de Blok. He is the creator of the pioneering Dutch healthcare system, Buurtzorg. It’s active in 25 countries. It’s a phenomenon that’s taking over the healthcare industry in many countries because it’s winning all kinds of awards. It’s exciting to talk to Jos.

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Changing The Face Of Healthcare With Jos De Blok

I am here with Jos de Blok, who is the creator of the pioneering Dutch healthcare system Buurtzorg. Jos de Blok has developed a transformational model of collaborative patient-centric community care by empowering nurses in self-organized teams. He’s turned traditional healthcare models inside out with a collaboration key to his model. Jos de Blok has uncovered new ways of working and new areas of care at home and internationally, and he’s active in 25 countries with this organization he’s created. It’s nice to have you here, Jos.

Thank you. It’s nice to be here.

I didn’t get a chance to talk to you. We shared a table at Thinkers50 in London. I had a few people tell me, “You’ve got to talk to this guy. He’s doing amazing things.” Thank you for being on the show. I’m interested in what you’re doing and I’m a little confused. We based on the United States how we do things with nursing and doctors, and who’s in control and who’s not in control. Every time I watched a video about what you’ve done, it’s talking about the nursing aspect, but I haven’t seen a lot talking about where the doctors are involved in all this. I want to get into that part too because the United States has a lot of that involvement. Tell a little bit about your background because you are originally a nurse. I love your story of how you created this company. Why don’t you give a little background and tell me what led to your interest in creating your company?

Before I became a nurse, I studied economics. I should have become an economist or something like that, but I got depressed during my study. I quit my study and I became a nurse. I worked for almost fifteen years as a nurse, most of the time as a community health nurse. I like this a lot because it was a lot of freedom in my daily work, with a lot of autonomy, I could make the decisions myself. I’ve been working with good colleagues but after that in Holland, the system changed. Community nursing almost disappeared, it became home care. They asked me to become a managing director in a home care organization. I did it because I thought perhaps I can transform the organization and go back to the principles of community nursing in the ‘80s.

It was difficult because the system changed more and more towards a production-driven way of organizing. I wanted to go back to the professional ethics of nurses. With some friends in 2005, 2006, I designed a model that I thought would be sustainable for the future based on network thinking and based on a support software, we began to develop ourselves an organization without management. The idea was that we could grow fast and scale up based on an organic way of developing organizations.

My idea was if we develop something that shows the quality increases and the cost goes down and a lot of nurses want to do it, then we can’t fail. That was my assumption. We had the slogan, “Better care for lower costs.” We called it the natural alternative because I thought we moved away from natural ways of organizing. We started at the end of 2006 with one team of nurses. I got contracts with health insurance. I was part of this team and I started to work again as a nurse. At the same time, we developed in several parts of the country’s new teams. Usually, once the teams heard about it, they asked me, “Can we start a team in our region?” I already started a nonprofit foundation. Older nurses could be hired which was the vehicle for this growth of the company.

In 2007, we started with ten teams all over the country. All the time the same things happened, the nurses start their own network. They got the patients. They got the referrals from the doctors from the hospitals and within a few months, never breakeven and they were profitable. We were certain in 2007 that we could grow easily to a few thousand nurses so that’s what we did. In ten years’ time, we grew to 10,000 nurses all over the country. We also started with new services. In total, we have 15,000 nurses and care workers working in self-organized teams. We have around 1,500 teams all over the country. We have only 50 people in the back office and we don’t have a management structure.

This is the way we are organized and this is the way we developed without any marketing. We got a lot of free publicity. From the start, we got a lot of attention from newspapers, television programs, and so on. Everything that we were doing was not logical in the system we were working on. That was what we did and we got many prizes, the most fast-growing company, the best employer, the future of work award, Albert medal, and the Thinkers50 award. We were sitting on the table together for putting ideas into practice.

That’s quite a story. I loved your TEDx Talk in Geneva. I watched that where you talked about how this all came to fruition. I worked for fifteen years in pharmaceutical sales for AstraZeneca. Things are a little different in the United States of how we look at who controls things and what nurses’ roles are, what are the doctors’ roles? I’m curious where the doctors are in all of this. Who’s prescribing medications? Who’s doing that part of the whole nursing aspect? Is this taking care of people who are released from care from the hospital? What kind of nursing are you doing here? Are the medications involved? That’s my question.

It’s important to look at the context of Holland. We have a long history of primary healthcare. We have GPs. Every person in Holland has their own GP. Every GP has around 2,300 patients. Our idea was that we could connect easily locally with our teams with the GPs, who are working in these neighborhoods. The doctors are prescribing medication but when they have a good relationship with the nurses, they ask for advice from the nurses. For example, with wound materials, the nurses are taking care of the wounds and then they advise the GP, and the GP will prescribe the medications. Also, the nurses have their own autonomy in deciding on how much care they can deliver with what kind of patient.

We have a system in Holland that all the community care is paid by the health insurance and 100% of the people in Holland are in short. That’s different than in many other countries. We have contracts with health insurance. Everything that we are doing is paid for by health insurance. That’s regulated by law, the nurses, themselves can visit patients and based on an assessment, they can decide on how much nursing care does somebody needs. When the assessment is done right, then we can bill all the hours delivered. We take care of different kinds of patients, everything you can imagine that needs support at home, people who have dementia, discharged from hospitals, with chronic diseases, or terminally ill and want to die at home.

The idea was to have a team with high educated nurses, generalists, who are able to take care of all kinds of interventions. If we include as many as possible activities needed in the service, then it’s attractive for nurses to work this way. You can build a good relationship with your patient and the patient is happy to be confronted with a few nurses. The system we had before we started in 2006 was product-driven. We had many products and all the different products were put by different people, we said, “We put all the products together and we deliver one service for one price.”

We said to the health insurance, “The service by combining it this way is much more effective and much cheaper per client per year than what we have now.” Our idea was by organizing it this way, by integrating the different services in one service, we said, “We can do it for 30% or 40% less cost than what’s happening now.” That’s also what we showed in time. We did several pieces of research and we saw that this research has been done by KPMG and Ernst & Young and it showed that we have 30% to 40% fewer costs than the average home care organization in Holland.

I’m getting an all-inclusive thought of what you pay for in all you can eat or a cruise situation instead of piecing everything together as a separate line item. As you said that, it made me think of how hospice runs here somehow. The nurses are the main people who come to the houses and deal with a lot of people who are dying in their last few months. In the United States, I’m sure you’re familiar with what we do with hospice, which is a great organization here. I’m curious, from working in pharmaceuticals, how challenging everything is to red tape? You need to get on your pharmaceuticals on formularies, to get people to approve anything. Everybody is suing everybody. Everybody has got all these issues. Who’s got the insurance coverage so you don’t get lawsuits? Is it the doctor? Is it the nurse? Who’s dealing with all of that there?

If you have highly educated nurses who can handle all kinds of interventions, it's very attractive for nurses to work. Click To Tweet

Nobody.

Nobody’s suing anybody?

No.

That’s a little different there.

We are taking care of 100,000 patients a year and up until now, in all those years we were never sued. In total, it’s getting towards 800,000 or something. Suing is not something that happens a lot in Holland. That’s special for the US and for other countries perhaps. The chance that you get sued, by doing something wrong is minimal. The responsibility of the nurses, the ownership of their daily work, and the way that’s perceived lead to the best possible outcome. Usually, when patients are satisfied with the relationship they have with their nurses, the results of the nursing care also the satisfaction rates will be high.

From the start, we had the highest satisfaction rates in the country. It’s 9.3 out of 10. When you build trust and you build a good relationship with your patients, the chance that you’ll get complaints or even get sued is minimal, because of the distress in the system, there were many complaints. When everybody is asking themselves, “How can I get as much as possible out of it like a provider or a patient?” The chance for conflict is quite high. We said, “We have to build on professional ethics and we have to build on trust.” When you build on trust, then you get another relationship than when you build on the interest of the organization. We see that there is a high satisfaction rate with patients and then a high engagement with the nurses and these two things are the main reason that everything goes smoothly and conflicts are solved in an early stage. That’s part of the way our values work out.

You’re getting cream of the crop nurses. My sister is a nurse recruiter. She finds nurses jobs here in the US. They’re not always excited about what they’re doing. Do you find that you have a better work ethic in Holland? I’ve got some people in mind that I’m thinking maybe they need management to some extent because they’re not self-motivated. Do you have that scale or every nurse in Holland are excellent?

The starting points, in my opinion, should be that everybody is motivated, not only nurses. Nurses have more or less vocation and our intrinsic motivator to do the best possible thing. I think that usually the circumstances they are working in or they used to work with are frustrating and that leads to behavior that they are disengaged but that’s a result of the conditions they’re working in. If you create conditions that ask for this accountability and ask for this responsibility and this ownership, then they will behave like that. Usually this mindset about how do you perceive people and how do you perceive nurses and that’s one of the problems. Directly to control and that leads so that we create the conditions that they get frustrated. If you turn it around, if you say, “We will listen to them and we will create the best possible environment to work in,” people will be happy because they can live their profession in the most ultimate way.

That’s interesting because it ties into my work in curiosity of what I’ve found makes people more successful. In curiosity, if you’re allowing people to explore what they’re interested in doing then they’re going to be more engaged. They’re going to be more motivated, they’re going to be more driven. It’s all going to lead to better innovation, better productivity. You talked about perception, that’s the other thing I write about is perception. You’ve tied into everything I’m interested in terms of how we can make the workplace better. A lot of people are misaligned in their jobs of what they could be good at. If you could explore normal curiosity and let people ask questions and go about things in a way that makes them more comfortable, you can get the best out of people. That’s exactly what I’m hearing from you. How are you getting these people to explore their curiosity? Is it by taking the reins off of them and letting them have more control? Is that the key?

Normally in your private life, you want to arrange everything yourself. I hope you don’t ask your husband to manage you and to manage the life of the family and that’s logical. My opinion is that women are much better at organizing than men. What you see in a lot of organizations is that you see more men in management than women. These men who are bad at organizing are telling women what to do. That’s bad for everybody. Management is a disturbance for people.

If everybody can use the skills they have on how to organize your daily work, your daily practice and you work in a team where you honor your colleagues, you like your colleagues and you want to work together, then everything is growing. The relationships are growing. The personal skills are growing and everybody is coaching each other in a positive way. All the control mechanisms which you see in a lot of organizations are disturbing this process because they are based on control, in my opinion, it’s based on distrust. If you say, “We don’t need these control mechanisms,” my perception is that people want to do the best possible thing but they want to regulate it themselves. They don’t want to be led or they don’t want to be regulated by others.

People who are in jobs that they enjoy and who feel what they’re doing is meaningful and all that, definitely, I see that. I’m also though, thinking of a lot of people I’ve worked with who think they’re in jobs that they enjoy, but they like to take advantage of the system a little bit and if you give them a salary and nobody ever looks in on them, they’ll keep taking that salary and do nothing. How do you avoid that in other industries? In healthcare, somebody is sitting there waiting, they’re sick and if you don’t show up, people know it. There are some other industries that maybe aren’t so much that way. It’s something I see a lot of. I’ve taught thousands of business courses. I’ve worked in all kinds of industries, from top organizations to tiny, small companies. Maybe it’s a US thing, but there are a lot of lazy people out there who don’t want to do anything but take a paycheck. How do you avoid that?

I don’t believe that.

I’m with you 100%, I don’t like to be managed. I want to work on my own that’s why I’ve taken the jobs I’ve taken. I’m self-motivated and I only pick jobs that interest me. I have to admit, I wasn’t thrilled about being a pharmaceutical rep and when I was doing that job, I was way less motivated to work. We need to be aligned to do it. Now, you can’t keep me away from my job because I love it so much. The key is to make sure people are aligned with what they do. You talk about how we can make companies less managed, you talk about it as self-organization and agility and things like that. This model could go outside of healthcare, right? What you’re talking about.

 

I’ve been with a lot of other companies and other industries, banks, software companies, even pharmaceutical companies. I’ve been in many different industries and every time I come to these boards, people say, “How do you do it?” I then say, “It’s not difficult. Start it with the intrinsic motivation of people and start it with the idea. “What is the real service to deliver? What do you want? How do you want to connect with the environment, with society? What’s your purpose? There’s a reflection in the board of the organization about who do we want to be? What’s our purpose in society?” You get the real questions. We have to rethink how we structure our organizations.

A lot of things that I see happening creates this what you call lazy people. In my opinion, there are exceptions but these exceptions are clear. When something happens in our teams, which is not right or something, the colleagues see it immediately, they talk about it. For example, a safe culture and safe environment, it’s much more important than an environment that everybody feels pressed by productivity numbers. The idea about what are the most important principles in organizations that leads to happy people, to people who feel responsible is safety, wholeness, a learning environment where you can develop yourself, and support from your colleagues. These things are much more important than strategies on HR, finance, and IT. If we build these organizations with all these MBA minds and this leads to big frustration and frustration leads to negative behavior and negative behavior leads to less engagement and so on. We’re thinking about how to manage people or how to organize organizations. My opinion is that we start usually at the wrong end. The mindset is that people need to be led, then you will do different things, then now you can trust people based on their intrinsic motivation.

What about people who aren’t competent at what they do, who’s going to help them get better if there’s not somebody leading them?

Their colleagues.

It’s a peer helping peer situation.

To prevent from getting people who are not competent enough, it’s wise that the nurses are interviewing their own colleagues. The teams have all the freedom to find their own colleagues. They take care of the way they find their colleagues. If you are responsible for finding your own colleagues, you will try to find the best ones. Every team is careful in who they hire and they are strict in what they ask from them. During the first period, if they see that they don’t have the competencies they thought then say, “How can we support you?” After a while, if they still don’t have this competence, then say, “Perhaps this is not a place for you to work at.” This is what’s happening all the time in all those places. The moment you’re going to manage this, it goes wrong. You take away the responsibility and ownership.

What’s the incentive for the nurse to pick somebody for their team? They’re not taking care of the same patient or are they? I’m curious, what’s their incentive to find somebody else to work with them?

Usually, the teams are growing from the start so they need colleagues because they have a lot of patients who want to be supported by these teams. At the moment you feel that you need a colleague, you can try to find a colleague. They are working together. They see each other a lot. You can see it as a social structure. These people see each other several times a week and they discuss the patients. Usually, when patients need several moments, a day of support, then it’s done by a few nurses who are working together. These teams are supportive social networks. The idea is that they find their colleagues, they include their colleagues, and guide them and teach them how the principles work. Usually, it’s logical for everybody and in a few weeks, you know what to expect from you.

One of the things people are saying when they start to work for us is, “It feels like we landed in a warm bath. It feels like you are rewarded, you are cared for, you are supported.” You can ask anything you want to everybody. You’re part of a community. It’s not only in the team because all the teams are also connected, even our IT systems. You can ask questions on the platform, which looks like Facebook and you say, “I have trouble with this. Can anybody advise me on it?” You get 20, 30 answers. That’s what’s happening all the time.

Do you ever have any conflict? Let’s say, Jos likes to hire Diane but then Bill doesn’t like Diane and the other nurse finds that your choice would not have been his choice, then what?

All the choices are made based on consensus. The teams we have introduced the methods from the start, which is called the Solution-Driven Interaction methods. Every decision should be made based on consensus. The example you mentioned is not possible. If a few nurses in the team say, “We shouldn’t hire this new colleague.” The decision is no. We don’t do it.

If somebody is on and becomes a problem, then it has to be a consensus to get this person removed as well?

Yes.

I’m looking at some of the places, you went to the US, Japan, Sweden, China, the Czech Republic, and Belgium. I was looking at your TEDx Talk that you gave. You listed some places that you’ve been talking about. How did that fly in the United States? What issues did you run into here?

You have to help find solutions for the people you don't need anymore. Click To Tweet

When we started in Minnesota, in Stillwater, it was the result of our connection with the University of Minnesota. We are working together based on the Omaha System, it comes from the US. That’s what we implement in Holland. There was a group of nurses who said, “We want to start an experiment here in the US.” I said, “Let’s find out if it’s possible.” We had read about Medicare and Medicare-Aid and how it works and then they had a connection with the doctors in that region. What was different than what we found out in Holland was that most nurses want to work full-time because they need the salary. In Holland, most nurses work part-time.

How many hours are part-time usually?

The average is 20 to 24 hours. What I learned in the US was that the need for earning money from the start gave a lot of tension with the results of this small company. This freedom, what I saw in Holland, everybody felt responsible for the results. It was different in the US. Everybody felt responsible for their income. The way they dealt with the result of the team was quite different. The moment we discussed it, it changed. At a certain moment, we were breakeven and things were going well, but we couldn’t find enough nurses in that region who wanted to work this way. They thought it was asking a lot of responsibility. We didn’t build a good example as we did in many other countries. In a lot of other countries, we could show by building good examples that it was not difficult to do and that the good examples inspired other nurses to do so. In Sweden, for example, in Japan, in Germany, we have a development that more and more nurses come over, start to work this way and also feel the positive parts of it. In the end, we had to close down our small company in Minnesota.

In the US we do many things differently. It had to be a different reality to come here. There’s a much more competitive feeling, everybody’s working hard. I was wondering how this would fly here and I wondered what you do with leaders and managers in your set up who were already there, then what’s their job?

They don’t have a job anymore.

They can either become a nurse or do something else.

We transformed several organizations towards our model and these organizations have been a process for 2 or 3 years. The people who had been managers before, they start to think about, “What could my role be in the new environment?” Some of them become a coach instead of a manager, but some of them don’t have the skills for coaching. Some of them start to look outside the organization. What we found is that the motivation for change is clear and also you can explain it to everybody because it increases quality and it produces costs. How can you be against it? More or less, it is what I hear sometimes.

When you show people and you also support them in finding something different, another job, then everything goes smoothly. When you only see it as cost reduction or changing the structure, then you’ll get difficulties. You have to have a conscious process. You have to listen to everybody, what their concerns are. You have to communicate a lot with everybody about what solutions can we find for the people we don’t need anymore. Step-by-step, you will find solutions.

With the complicated coding systems, I know you know we have a horrible complicated coding system in everything we offer here in the US. I assume yours was not great there before you made all these changes as well. You had to deal with a lot of code. Has this changed that and in what?

We changed it completely. We had a complicated coding system too. We had an Assessment Institute. It decides what care people would have, what kind of products, how much hours, what the price is. Based on my experience in healthcare, I’ve been working for years in healthcare, I said, “We are going to put all these products together. If the health insurance wants to have a list of products, we will provide them this list of products and the time spent on this product, but it will not be the reality.” We made an IT system, which was able to give the health insurance the list as they wanted them. At the same time, we started the discussion with health insurance. It would be much easier if we had one service then we simplify everything and we have a simple coding system. We have to look at the results of what we’re doing. We said, “If we know more about the income of the outcome, we know what interventions are good practices and how can we improve the results on the quality side but also on the cost side.”

The first one who adopted the idea was the Minister of Health. She visited us and she talked with the nurses and then she said, “How can I help you?” I said, “Perhaps if you’ll make an experiment in Holland, we can grow and we can show how it works, perhaps also others can learn from it.” She made the experiment, she said, “You get the opportunity to have one price and if it works out well, then we will make it a policy and we will make a law which allows nurses to decide.” That took five years and after five years, the government changed the law. We changed the regulations.

Everything that we are doing now is noble in Holland. We saw it as a transition. We thought to take 5 to 10 years to change the healthcare system this way. It is also my assumption in other countries that it needs somebody who is able to deal with the system and to build something in a practical way. That’s what I did all the time, I worked together with the ministry, I worked together with the health insurance, I worked a little bit with the inspection and so on. Seeing that there’s a transition, we changed this part of our healthcare system.

Do you still have formularies or did you ever have formularies for medications and that type of thing like we do here?

We started to use the Omaha System, which is a classification system of problems, intervention and outcome. We integrated it into our IT system. We started our own IT company building all the software and we integrated it. Everybody’s working with iPads or Chromebooks. We don’t use paper anymore. Everything is integrated into our file, the way we make our care plans. We are working together with universities to use the data to show what patterns we see with patients. We try to use as little as possible protocols and as little as possible forms.

 

In the United States, formularies are lists of medications that are allowed to be used in a hospital or from a doctor. We have HMOs and those types of things here. If a doctor wants to prescribe a drug, if it’s not on that list, he can’t write it because he’s associated with that HMO or that hospital and they haven’t put it on their formulary. Do you guys do that there?

The prescription of medications is done by the GPs. It’s a national regulated thing. The pharmacist and the GP regulate the medicine and we provide.

Do you ever get frustrated if you want to give a medication that is available somewhere but not from your doctor?

No.

That’s something we deal with here and it’s interesting to see the differences in healthcare from each country. I’ve always been in sales and I have this naturally competitive wanting to get to the next level thing. If you’re a nurse in this situation, you always are a nurse. There’s no climbing the ladder anymore because there’s no ladder. You stay where you are. Is there any problem with people who want to go to the next level, do something bigger and better? Does it keep you in one thing forever? Maybe you would like to expand and go somewhere.

I don’t believe that the next level is better, as you say it. What I see is a decrease in integrity. If you climb up in the organization, you see more political behavior. You’ll see more things that a lot of people are not proud of. If you would do these things in your private life, you will have a lot of conflicts with your family. I try to focus on how you can develop yourself as a person? How can you develop your talents? For example, if you are good at taking care of people with dementia, how can you have more education on that? If you want to work with people who are terminally ill, how can you focus on that? You can see the way an organization traditionally grows in jobs. It’s a big mistake that it’s improving. What I see is that growing as a person in your daily work by doing more complicated things is a more fruitful, gives you more meaningful feelings than growing in a management job. One of the struggles with a lot of managers is that they don’t feel they’re doing meaningful things. They’re frustrated.

They’re in meetings all day.

They’re in terrible meetings. I’ve been a manager for years and I was amazed. I was the Director of Innovations. Every time I was in these meetings, I thought, “How is it possible that these intelligent people are talking all the time about things they don’t understand? They have decisions about things, ‘Are they right? Are they wrong?’ They’re talking all the time about things that I didn’t like.” I used to have this meeting for a day and sometimes, strategic meetings are important. I had always this more or less starting point that I said some intelligent things then everybody thought, “He has thought about this topic.” My role was done and the rest of the day I was dreaming about how the world could look like if we do it in a different way. If your mindset is that you want to build a career on hierarchies, it creates side effects that are not healthy and it’s creating a lot of disturbance for others. I believe more in how we can create environments that people can develop themselves as a person and personal qualities.

What about the financial aspect of developing instead of hierarchy in terms of job, hierarchy in terms of money-making potential? Do you like any commission-based things? Are everybody set at a salary and that’s where you stay? How does that work?

The salaries in Holland are based on the union agreement and it’s based on experience and education. What we see is that we don’t have discussions about salaries. We want everybody to feel that the way they are paid is reasonable. They should be happy with the way they’re paid. That’s also one of the things that people are happy with their salaries. We have a part which is working with care workers and what we saw was we had a takeover from an organization that got bankrupt. There were 2,400 people care workers doing domestic care and it’s a different part. They have 4,000 people working also in self-organized teams. When they came into the organization, we raised the salaries so they got bankrupt in the organization.

We had a big conference with these people and I was telling them that because of the good financial results, for the first time we could offer them a bonus. They got an extra payment and it’s based on the same people that had taken care of, the organization before they got bankrupt and we have a good financial result by raising the salaries and we can give them a bonus. That’s what intrinsic motivation does, by letting them take the decisions themselves, finding out what are the best ways to deal with their clients and trying to be as good as possible with their team. Without discussing productivity, it has increased.

Do you rate people? Do you have customer satisfaction surveys? Are people rating them like Uber gets five stars? Is there any of that going on?

Yes. We have different ways. We have a national system where people can give reviews so everybody can see it. If you go to what they call ZorgwijzerNetherlands. If you go to this website you can see all the providers in Holland and the review of the patients. If you look at Buurtzorg, you can see 9.3 is the average. All of the countries, wherever we are, it’s between 9 or 9.5. It doesn’t go lower than nine anywhere.

If you get somebody who has a low rating, how is that dealt with?

When you build on trust and good relation, the chance that you'll get complaints or even get sued is minimal. Click To Tweet

We don’t have it.

It doesn’t happen. Do you have a backup plan in case it happens?

I got a lot of questions. I noticed from the UK, and from the US, which is always, “What if?” It’s always these questions. I said, “Why should you spend time and energy on things which are not going to happen?” Why shouldn’t you spend time on how you can increase the quality? How can you increase the conditions for people to work in? How can you focus more on education? How can you create learning environments?” That’s much more interesting.

Do you feel like there should be proactive thinking at all in terms of what could happen in the future or foresight thinking or not?

There are 15,000 people every day thinking about how they can improve what they’re doing because of the ownership, they are using their minds, their brains. Also, with their families, it’s also funny when they have positive feelings about what they’re doing they’re talking at home in a positive way about what they’re doing then they get reflections from their families. For example, when they have a partner or a husband who is an IT person, he starts to get involved, he says, “Perhaps you should try this or that.” “I’m going to bring it to my work.” What we create is not only within the organization or community, but there are also small communities everywhere. Even the patients, they feel they are part of these communities. There are learning places all over by creating these networks. If you have this hierarchy and if you think you have to control people and you have to do this and you have to do that, this will never happen. If you let it grow and respect the differences in how people are dealing with things and respect how they’re learning, it’s amazing what happens.

Were you frustrated at all dealing with the US way of thinking? Being different from the way you’re used to people thinking that wasn’t much more competitive or cynical than what you’re used to.

No. I understand how it works in an environment like the US. I would love to be there for a while to show that things can be different. There are a lot of people who would be motivated to do the same things.

Do you think they feel threatened though, that they’re going to lose their job here more than other places?

No. I was in San Francisco and you see there are always people who are in front of others in development. There are a lot of people in the US who understand that this way of thinking is coming. It’s always there. For example, young people, if you look at the Millennials, most of these young people think this way. They don’t want these hierarchies.

We’re seeing a lot more in the younger generation.

The coming generations will change the way we organize, it’s a matter of time. What we did in Holland was disruptive. We are disrupting mental care in Holland. We have psychiatrists, psychologists, psychiatric nurses, who are treating people at home. They should move out of all these institutions. They should create their environment too because that’s a real sustainable solution and it’s growing fast. Psychiatrists want to work this way. These self-organizing principles, I see them. I was split between San Francisco with Google and Apple and all these bigger companies that are also struggling with the hierarchic ways of working. How can we keep people motivated? Disengagement is a big problem. If the starting point is how can we engage people and how can we create environments where people want to work, then engagement isn’t a problem anymore. In Buurtzorg, we have 92% of people feel engaged. If you’ll see the research, it’s 18%. We are in the change of eras. We need to find other ways to deal with problems in society and we have to rethink the way we organize.

Healthcare is ripe for changing as is the education here in the United States. It’s going to be interesting to see what happens. I serve on board at All4Life, which is an app to connect healthcare people all together in one way so people can share and connect like what you’re talking about. That was started by Heiko Schmidt and it’s an impressive way of making sure everybody shares the best of what they know. People get all-inclusive access, everything. We see more people coming up with ideas like that here, but I could see that the US has a different way of doing things than Holland obviously does in some respects. I’ll be curious to see if you come back and try another state, California would probably be tough. Kaiser and all the big names there would be hard to disrupt, but I could see starting again in the Midwest somewhere.

I had a lot of meetings with Kaiser. Their own structure is one of the problems. I even talked with some senators in Washington. There is a lot of interest. We are working with 25 countries. We are working in Asia with China, Japan, Taiwan, Korea and India, and we want to work with people who want to do this. We have partners everywhere. These partners know the system they’re working in. We need people who want to change the system and who also are able to do it, sometimes entrepreneurs. For example, Germany, we have a great person who was able to deal with system problems. We have meetings with health insurers. We had meetings with the ministry. Also, an entrepreneur can develop these teams in an inspirational way, pragmatic. What we see is that it’s growing. We have an ambitious plan for Germany, we said, “Within a few years, we want it everywhere seen in Germany.” We have been on television and in all the newspapers in Germany. This is part of this transition. You need only a few small examples to show what the impact can be and it becomes bigger. Whenever somebody comes from the US and says, “We see a lot of opportunities here and we want to do it.” We will be there.

You’re doing some amazing things around the world. Everybody at Thinkers50, you were the talk of the town of what you’ve done because it’s such a unique company. You’ve had such success and it was exciting to have a chance to talk to you about it. We didn’t get a chance to talk much there because it was such a busy event. Thank you so much for agreeing to be on the show. If anybody wants to find out more, how could they find out more or contact you?

They can look at Buurtzorg International and they will find the website. We’re happy we get a lot of visitors from all over the world and they organize inspirational days and the commercial part is organized solo consultancy activities. Look at Buurtzorg International and they will find a way on how to connect.

 

Jos, this was great. Thank you so much for being on the show. This was interesting.

You’re welcome. It was a pleasure.

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I’d like to thank Jos for being my guest. We get many great guests. I hope you join us for the next episode of Take the Lead Radio.

Important Links:

• Buurtzorg International
• All4Life

About Jos De Blok

Jos de Blok is the creator of the pioneering Dutch healthcare system, Buurtzorg. de Blok has developed a transformational model of collaborative, patient-centric community care. By empowering nurses in self-organized teams, Buurtzorg has turned traditional healthcare models inside out.

With collaboration key to his model, de Blok has uncovered new ways of working and new areas of care, at home and internationally. Buurtzorg is now active in 25 countries.

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