Decentralized and autonomous methods of self-organization: What we can learn from Buurtzorg

Decentralized and autonomous methods of self-organization are ways of working and living that empower individuals and groups to make decisions and take actions based on their own needs, preferences and values, rather than following centralized rules, structures and authorities.

One of the most remarkable examples of decentralized and autonomous methods of self-organization in the health care sector is Buurtzorg, a Dutch organization that has revolutionized community care with its nurse-led model of holistic care.

In this article, we will explore how Buurtzorg works, what outcomes and impacts it has achieved, what challenges and opportunities it faces, and what lessons it can offer for other organizations and sectors that want to adopt or adapt its model.

Instead of TL;DR you can check this video.

Buurtzorg’s history, vision and values

Buurtzorg, which means “neighborhood care” in Dutch, was founded in 2006 by Jos de Blok, a former district nurse who was frustrated by the fragmentation and inefficiency of the traditional home care system in the Netherlands.

He with a group of friends and colleagues decided to create a new organization that would put the patient at the center of care, rather than the system. They envisioned a holistic approach to care that would address not only the physical, but also the emotional, social, and spiritual needs of the patients. They also wanted to restore the professional autonomy and dignity of the nurses, who were often overworked and underpaid by the existing providers.

To realize their vision, they developed a simple but radical model of care that operates with small, self-managing teams of nurses (usually 10 to 12) that provide a range of social, and clinical care to people in their own homes in a particular neighborhood.

The teams are responsible for all aspects of their work, from planning and scheduling to budgeting and hiring.

They have no managers or supervisors, but instead rely on trust, collaboration, and peer support. They use a minimal amount of paperwork and administration.

Instead focus on building relationships with their patients and their families, as well as other local actors such as general practitioners, pharmacists, and social workers.

They use their professional judgment and expertise to tailor the care to the specific needs and preferences of each patient, with the goal of enhancing their quality of life and independence.

Buurtzorg’s model of care is based on a set of core values that guide its actions and decisions.

These values include:

  • Respect
  • Simplicity
  • Transparency
  • Trustworthiness
  • Entrepreneurship
  • Innovation

Buurtzorg’s vision is to create a sustainable healthcare system that is based on cooperation rather than competition, and on empowerment rather than control.

Buurtzorg’s outcomes and impacts

Buurtzorg’s model of care has proven to be highly effective and successful in delivering positive outcomes and impacts for its clients, staff, and society.

According to various studies and evaluations, Buurtzorg has achieved high levels of client satisfaction, staff engagement, quality of care, and cost-effectiveness.

Some of the key indicators and results are:

  • Client satisfaction: Buurtzorg’s clients consistently rate their care as excellent or very good, and report high levels of trust, respect, and autonomy. Buurtzorg has the highest client satisfaction scores of any healthcare organization in the Netherlands.
  • Staff engagement: Buurtzorg’s staff report high levels of motivation, satisfaction and well-being. They enjoy their work, feel valued and supported, and have a strong sense of ownership and responsibility.
Buurtzorg has been named the best employer in the Netherlands four times out of the last five years.
  • Quality of care: Buurtzorg’s care reduces hospital admissions, complications, and infections, and improves health outcomes and quality of life.
  • Cost-effectiveness: Buurtzorg’s care reduces the number of hours of care per patient, the use of expensive equipment and medication, and the need for external coordination and administration. Buurtzorg’s care also increases the productivity and retention of the staff, reduces absenteeism and turnover.
Ernst & Young estimated that if all home care in the Netherlands was provided by Buurtzorg, it would save around 40 percent to the health care system.

Buurtzorg’s model of care has also spread to other countries and regions with different cultures and contexts. Buurtzorg has established an international team to lead collaborations with partners from all over the world who want to adopt or adapt its model. Currently, Buurtzorg is active in 25 countries, including Sweden, Japan, China, Taiwan, India, Australia, New Zealand, Canada, UK, US, and more.

Buurtzorg’s challenges and opportunities

Buurtzorg’s model of care is not without its challenges and opportunities. Buurtzorg has faced and overcome some barriers and difficulties such as regulatory constraints, resistance from traditional providers, scalability issues and cultural differences. Some of the examples are:

  • Regulatory constraints: Buurtzorg has had to deal with some legal and administrative obstacles that hinder its flexibility and autonomy. For instance, in the Netherlands, Buurtzorg has had to negotiate with health insurance companies to get reimbursed for its care, and to comply with the national quality standards and indicators.

  • Resistance from traditional providers: Buurtzorg has faced some opposition and criticism from the existing home care providers who see it as a threat or a competitor. Some of them have tried to imitate or undermine Buurtzorg’s model, while others have lobbied against it or challenged it in court. Buurtzorg has responded by maintaining its integrity and quality, and by engaging in constructive dialogue and cooperation with its peers.

  • Scalability issues: Buurtzorg has grown rapidly from 1 to 950 teams in the Netherlands, and from 0 to 25 countries internationally. This growth has posed some challenges for maintaining its culture, values, and standards across different locations and contexts. Buurtzorg has addressed these challenges by investing in training, coaching, and mentoring for its staff, and by creating regional and national support structures that facilitate communication and coordination among the teams.


In this article, we have explored how Buurtzorg, a Dutch organization that provides community care with a nurse-led model of holistic care, exemplifies decentralized and autonomous methods of self-organization that are beneficial for humanity.

We believe that Buurtzorg’s model of care is not only a remarkable example of decentralized and autonomous methods of self-organization in health care, but also a powerful inspiration for other domains and sectors that want to improve their performance and impact. We believe that these methods can create positive change and transformation in various fields such as education, environment, justice, and governance.

We invite you to join us in this vision and mission. We invite you to develop tools and frameworks to support the adoption or adaptation of decentralization and autonomy by your own organization or community.

We invite you to engage in dialogue and advocacy with policymakers, regulators, funders, and stakeholders to promote and support decentralized and autonomous methods of self-organization in your field and beyond.

We invite you to unite, embrace these ideas and make real actions. Together, we can make a difference for humanity.

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