EU Models of Care

EU Models of Care webinar – introducing Buurtzorg

17 September 2015

NHS European Office

• Who are we?– Established 2007– Part of the NHS Confederation– Funded by national NHS bodies

• What do we do?– Represent NHS organisations in EU policy-making and legislation– Assist the NHS with the implementation of EU law– Offer strategic advice on EU funding opportunities– Promote partnerships between NHS organisations and bodies from

other sectors/countries

www.nhsconfed.org/europe

EU Models of Care

• Working with NHS England to support Pioneers and Vanguards to develop links and share learning with organisations at leading edge of integrated care in Europe

• An in-depth look at four different EU Models of Care throughout 2015-16:

• Spain (Alzira)• Netherlands (Buurtzorg)• Sweden (Jonkoping)• Germany (Gesundes Kinzigtal)

• Webinar, followed by study visit – look out for the registration links

• EU Models of Care conference in spring 2016

• Other events and activities throughout the year

• Integrated Care Model Pillars

1LEADERSHIP

AND EXECUTION

2PERSON-CENTRED

MODELS OF CARE

3WORK-FORCE

Agile and supported

4OUTCOMES

AND QUALITY

INCENTIVES

5CULTURE

Empoweringcontinuous

improvement

6 ENABLING CAPABILITIES

Understanding the Buurtzorg model

Jos de BlokDirector

Buurtzorg

Jos de Blok

Buurtzorg: community based integrated care in a teal organization.

Buurtzorg – Quick Scan

• New organization and care delivery model• Started in 2007 with 1 team/4 nurses• Delivering Community Care/working together GP’s• 2015: 9500 nurses in 800 ‘independent’ teams.• 45 staff at the back office and 15 coaches• 70.000 patients a year

Results policy on homecare 2006

• Fragmentation of cure, care, prevention • Standardization of care-activities• Lower quality / higher costs: wrong incentives:

delivering much care against low cost is profitable • Big capacity problems due to demographic

developments (shortage of 400.000 nurses within 10 years)

• Clients confronted with many care givers• Information on costs per client/outcomes: none!

Start Buurtzorg 2007

Starting an organization and care delivery model

for community care with:– independent teams of max 12 nurses – Working in a neighborhood of 5000-10.000 p. – who organize and are responsible for the

complete process:• clients, nurses, planning, education and finance; • and all kind off coordination activities!!!!• Integrating nursing/medical and social care

CLIËNT

4. Formal networks

2. Informal networks

3. Buurtzorgteam

1. Selfmanagement client

Onionmodel Buurtzorg

Buurtzorg works inside-out: empowering and adaptive, network creating, supporting.

Vision: support indepence!

(Self)-Organisation

• Optimal autonomy and no hierarchy: TRUST• Complexity reduction (also with the use of ICT)• Max of 12 nurses a team, 40 à 50 clients• Generalists: taking care for all type of patients• 70% registered nurses/40% bachelor degree• Their own education budget• Informal networks are much more important than

formal organizational structures• Training SIM: selfsteering and coaching

Different types of clients

• Chronically ill and functionally disabled clients• Elderly clients with multiple pathology• Clients in a terminal phase• Clients with symptoms of dementia• Clients who are released from the hospital and are

not yet fully recovered

Quality system

• Monitoring outcome instead of production: the Omaha system

• Roles and activities instead of processes (DK)• High education level: 70% is RN (average 10%)• And of course: client satisfaction!

Supporting the independent teams

• 45 people in 1 back office; 15 coaches, managers 0!

• Taking care of inevitable bureaucracy, so the nurses won’t be bothered with it!– The care is charged. – The employees are paid– Making financial statements

ICT makes it possible! - Buurtzorgweb

Grip on the business

Position in the care-chain,relationship with other care givers.

View on quality of care,transparency

Shared values Community

Instruments

Communitation in the care chain

Production

Relationship professional

and client

Buurtzorgweb – some aspects

• Community• Clients and employees data• Hour registration. • Sharing documents• All the necessary administration for accountability

to cost providers, inspection etc. • Planning

Community • Shared values. Nurses work all over the country

but feel like ‘one’• Nurses can ask for good examples from colleagues

all over the country.• Man. Dir. can easily check the ideas of the teams• The back office has an easy way of communication

with all the nurses • Contact between nurses and informal care and

other caregivers from the neighborhood

Buurtzorg is Dutch most fast growing organization

Started in 2007 2015: 8000 nurses in 800 teams

Buurtzorg in the whole country

New theoretical model?

Frederic Laloux: reinventing organizations:• Self-management• Wholeness• Evolutionary purpose

Sharda Nandram: Integrating simplification• Needing principle• Rethinking principle• Common sense principle

Satisfied employees• Thousands of nurses quit their job at traditional

organization and went to work for Buurtzorg• They appreciate:

– Working in small teams– Working autonomously– Independency– Strong team spirit– User-friendly ICT

• Price for best employer 2011/2012/2014/2015?

Satisfied clients

• Good quality of care.• “Compared to 307 other organizations for

community care they give the highest score to Buurtzorg. (NIVEL 2009)“

• Highest client satisfaction rates: 9,1• Supported by patient- and elderly organizations• Less admissions in hospitals and nursing homes

Radio Steunkous

http://www.youtube.com/watch?v=Q-fPDrN5pBU

Rollatorrace

Cost effectiveness for the organization

• Overhead costs: 8% (average 25%) more money for the care and innovation

• Profit rate: 4%

• Sickness rate: 4% (average 6%)

Cost Benefits for the Care! • The home care would be 65% of the costs (Buurtzorgs

model leads to more prevention, a shorter period of care and less spending on overhead)

• More satisfied employees and clients

• The government an all political parties are stimulating other care organization to work like Buurtzorg.

• Other sectors are interested in the organization model

Is England ready for a transition?

• There are persistent problems in health care: • - quality: fragmentation• - demographic and costs: exploding?• - human capital: frustrated professionals • Problems can’t be solved with current solutions• Public world is coordinating Buurtzorg activities in

UK together with Resolis (Scotland)

Thank you for your attention

Understanding the Buurtzorg model

Any questions?

Next Steps

• We will:

• Share the recording • Organise a study visit to the Netherlands soon• Follow up with colleagues interested in developing direct links with Buurtzorg– please

talk to your account management team to incorporate into your support planning• Share webinar evaluation survey – please do complete!https://www.surveymonkey.com/r/YMR3GX8

• Next EU Models of Care examples:• Jonkoping webinar – 19 October at 12.30 UK timehttps://attendee.gotowebinar.com/register/3395771662321356545 • Gesundes Kinzigtal webinar – 26 November at 11.30 UK time

For more information, please contact: england.integrationpioneers@nhs.net or kate.ling@nhsconfed.org