Jos de Blok was a community nurse in the Netherlands when he and some friends decided to set up their own group of community nurses. At the time the Netherlands health system was undergoing a shift towards centralisation and "commoditisation" of health care. He cites an example of a patient with dementia being visited by 30 different nurses and another patient who actually counted the number of different nurses and care-givers that visited him in one year - 150.
For quality control, they use the Omaha system , "a research-based, comprehensive practice and documentation standardized taxonomy designed to describe client care" which focusses on outcomes - a recurring theme in self-management.
The group he set up expanded and became Buurtzorg. From 4 nurses in 2006 it grew to nearly 8,000 nurses in 2014. They have 45 staff in the "back office", 15 coaches and no managers, no HR department and no CFO.
In 2014 Buurtzorg turned over €20,000,000
A 2010 Ernst & Young report documented savings of roughly 40 percent to the Dutch health care system, and a 2012 KPMG case study found: "Essentially, the program empowers nurses (rather than nursing assistants or cleaners) to deliver all the care that patients need. And while this has meant higher costs per hour, the result has been fewer hours in total. Indeed, by changing the model of care, Buurtzorg has accomplished a 50 percent reduction in hours of care, improved quality of care and raised work satisfaction for their employees."
Perhaps unsurprisingly IT and communications seems to be central to the success of Buurtzorg, a point mentioned by several of the examples in the case studies.
Buurtzorg have now expanded to the Sweden, Japan and the USA and soon (hopefully) are coming to the UK . The Royal College of Nursing (UK) released a policy briefing in August 2015 which "considers the successes of the Buurtzorg community care programme while also identifying some of the challenges which would need to be addressed if the UK were ever to adopt a similar system approach"