buurtzorg: first coffee, then care
TRANSCRIPT
BUURTZORG: FIRST COFFEE, THEN CARE
Gertje van Roessel, community nurse, coach
RESULTS POLICY ON HOMECARE 2006
• Fragmentation of cure, care, prevention
• Standardization of care-activities
• Lower quality / higher costs and wrong incentives: delivering much care against low cost is profitable
• Big capacity problems due to demographic developments
• Information on costs per client/outcomes: none!
• Clients confronted with many caregivers
• Professionals were very unhappy
START BUURTZORG 2007Starting an organization and care delivery model for community care with:• independent teams up to 12
nurses • Working in a neighborhood of
5.000-10.000 people• Teams responsible for the
organization and the complete process
BUURTZORG QUICKSCAN
social healthcare focus on relationshipssolutions instead of
indications
seperated care and back office processes
buurtzorgweb- en pleinknowledge, information,
communicationscale of the
neighborhood
VISION: SUPPORT INDEPENDENCE!
ONION MODEL
inside-out:
• empowering and
adaptive
• network creating
• supporting
• additional
• replacement
CLIENT
formal networks
buurtzorgteam
informal networks
self management client
TEAMS NURSES
● 50 - 100 new nurses a month● 80.000+ patients a year
BUURTZORG 2007 - 2017
SUPPORTING INDEPENDENT TEAMS• 50 people in 1 back office; 21
coaches, managers 0!• Back office taking care of
inevitable bureaucracy,so the nurses won’t be bothered with it!
• Tasks of back office:• The care is charged• The employees are paid• Making financial statements
THE BUURTZORG WAY● The relation between nurse and
cliënt is leading in the strategy of the organization
THE CLIENT● Various clients
○ chronically ill, functional disabled, elderly with multiple pathology, clients with (symptoms of) dementia, clients who are released from the hospital and not yet recovered, palliative clients
● Holistic approach, no separate activities
● Satisfied clients● Good quality of care● 1-2 “first responsible”● 3-4 different nurses● Being part of the whole process
○ Assessment, care, evaluation, finishing the care, transferring care between colleagues
WHAT’S NEEDED?● Initial interview,
assessment, care plan
● Coordinate client network
● Informal network
SUPPORT SELF-MANAGEMENT● Try to keep a
person independent ● What does a person
need?● What can and will
the client do by herself?
● Finding practical solutions (medication, stockings,…)
● Practice with client/ informal carers
INFORMAL NETWORK● People want control over
their own lives for as long as possible
● People strive to maintain or improve their own quality of live
● People seek and benefit from warm relationship with others
(SELF)-ORGANIZATION• Optimal autonomy and no hierarchy:
TRUST• Reduction of complexity
(also by means of use of ICT)
• Generalists: taking care for all type of patients
• 70% registered nurses / 40% bachelor degree
• Own education budget• Informal networks are much more
important than formal organizational structures
TEAM● Take responsibility “Just
do it!”● Solution driven
communication (SDMI)● Flexibility● Entrepreneurial attitude,
mindset● Minimizing rules,
regulations● Self- and team reflection
TEAM & TASKS● Framework ● Team “Roles”/ list of tasks● Shifting tasks for the interest of
the team goals ● Respecting the differences in
opinions, attitudes and personality among team members
● Responsibility and accountability for outcome; quality and productivity
● Recruitment ● 24/7 accessibility by phone● Work/life balance
NURSE
• Attitude: being aware, conscious about your being there, connected
• Looking at the context, environment• Improve quality, innovate,
experimental attitude• Take your time to connect
with client and neighborhood
HOW A DAY OF A BUURTZORG NURSE COULD LOOK LIKE
• Visiting clients:- Morning: start around 7.30 am until 12-13 pm- Afternoon: start 4 pm until 6 pm- Evening: start 6 pm until 11.00 pm
• Office / administration• Support colleagues, interns• Team meeting• Assessment new clients (re-assessment),
evaluation• Meeting with family doctor, PT, OT• Planning, team telephone
FORMAL NETWORK IN THE COMMUNITY
• Office in the community, easy to access
• 3 pharmacies • 3 general practices (15 family
doctors)• 4 hospitals• 3 major
home care organizations• Participate in activities in/
for the community• Create network
PREVENTIONThe scale of working makes it possible to know and use the local resources, to focus on the networks, to start preventive activities.
SATISFIED EMPLOYEESThousands of nurses quit their job at traditional organizations and want to work for Buurtzorg
● They appreciate;○ Working in a small team○ Working autonomously○ Make your own decisions○ Independency○ Strong team spirit○ User friendly ICT
Methodes of quality care
Patient related
Team related
Professional development
Methods of quality care – patient related
- Nursing care plan based on the Omaha classification
- Nurse consultation- Multidisciplinary consultation- Family / informal care
consultation( see first one)- Safety management system:
MIC and MIM
Methodes of quality care – patient related
Evidence based practice: - Clinical practice guidelines- Standards- Care protocols- Checklist
Care programmes such as Liverpool Care Pathway for the dying patient (LCP)
Methods of quality care –team related
- Team meeting with subjects as: planning, schedules, holidays, etc.
- Checklists- Reporting- Clinical supervision- Peer review- Planning group for
innovation/prevention
Methods of quality care –team related
Buurtzorg stimulates colleagues to also use other tools in other to improve quality health care:
- Team visits- Join a colleague - Colleague as coach- Patient as source of inspiration- Team evaluation
External control
Government – public health inspection
Health care insurances
Audit by special quality office
IT in Buurtzorg : BuurtzorgwebDocumenting care
Team performance & Learning
COST EFFECTIVENESS FOR THE ORGANIZATION
● Overhead costs: 8% (average
25%) ○ more money for the care and
innovation
● Financially sustainable
COST BENEFITS FOR THE CARE!• Cost savings up to 40 % (Buurtzorg model leads to more prevention,
a shorter period of care and less spending on overhead)• More satisfied employees and clients
• The government and all political parties are stimulating other care organizations to work like Buurtzorg
• Other sectors are interested in the organization model and alsointernational interest…….
BUURTZORG INTERNATIONAL
The future of nursing is there already,we only need to grab him
• We, the professionals, have the right competences to take good care of our cliënts………. the only thing we needis
Trust!
