Humanity Above Bureaucracy: How Buurtzorg Reinvented Dutch Home Care

In: BlogDate: Mar 25, 2021By: Billy Burgess

Speaking at the 2017 Happy Workplaces conference, Madelon van Tilburg of Buurtzorg Nederland and Brendan Martin of Public World detail the advantages of a flexible, human-focused approach to home care. 

Madelon has been working for Dutch home care organisation, Buurtzorg, since 2011. Buurtzorg differs from her previous employers in that it lets nurses exercise freedom and responsibility in the job they’re trained for. Brendan founded Public World with the aim of improving public service performance in the UK.

View Madelon and Brendan's full talk below.

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Humanity Above Bureaucracy: How Buurtzorg Reinvented Dutch Home Care

Gemma: Hi, everybody! I am Gemma Beadle. I was going to say I’m the HR Manager, but I think after Louise’s presentation I’m the ‘Human Being’ Manager for the UK. That’s for Advanced Technology Services, ATS for short. Damien O’Neil is my colleague; he’s the Site Manager for ATS, and he’ll introduce himself in the second half of the presentation.

So we’re here today to talk about how ATS is creating happy workplaces. Now, we’re absolutely not the experts and still have a lot to do, but we are really proud of what we’ve achieved so far and the positive impact that it’s had on our people, on our customers, and on our business.

Just a brief introduction to ATS: we are a US-owned business; we have about 3,500 employees globally. We provide services in IT support, industrial parts management, and factory maintenance services. In the UK, our focus is the factory maintenance. So we are a customer service business in the manufacturing environment. I think Louise had mentioned pipes and people; we’re machines and people.

In terms of creating happy workplaces, as Henry mentioned, it can feel really tough for some organisations; we all have different challenges. Maybe for some, it’s impossible. But our message is to find a way because this stuff really does work, and it’s the right thing to do for your people and your organisation.

Just to share some of the challenges we face at ATS: first of all, our business model means that typically when we engage with a customer, about 70% of employees will transfer from the customer to ATS. That means that 70% of employees of any one team actually have a shared inherited culture that doesn’t always align with those of ATS and our values. The second challenge is our employees are regionally based, so they’re not in a central head office location. They’re actually based on our customers’ sides, so every day they’re immersed in another company’s culture. The third thing is, it’s an industrial environment, so quite often where we’re working is around factories; just as often, old factories. Again, they’re our customers’ premises, so it’s very difficult to do anything to do much about that environmental impact to the actual physical environment.

Even with these challenges, we’ve managed to make an improvement in terms of our employee engagement score. We’re measured with Best Companies, we do the annual survey. In 2012 we got the One to Watch award and this year we got our Two-Star award, which we’re really proud of. Although it’s not just about the score; we’ve mentioned that quite a bit today. It’s something you feel, and when you go onto our sites it does feel different.

So that’s taken lots of hard work from everybody - everybody in the team engaging in our mission to be a brilliant company to work for. We’ve looked at areas around recruitment, so that focus on no compromise over recruiting against your values rather than skill set, looked at employee feedback, and also our leadership development are our kind of gatekeepers to culture in those regional areas and our customer sites.

Today I just want to focus on what we’ve been doing about right person, right seat. That’s about people’s alignment to company values and making sure they’re in a job where they can be successful. So we found out that other initiatives in our business that we’ve brought in actually have little impact if there was a right person right seat issue within a team that was causing some disruption.

A story that just reminded me the importance of making sure this right person right seat has some focus in your business was something I read in a book by Jim Collins - I think it was Good to Great - which was around David Maxwell’s bus ride. In 1981, he was brought into Company Corp Fannie Mae - which is a mortgage company - at that point to turn the company around because it was losing a million pounds per week. When he was brought in, everybody said, “What are we going to do? What’s the plan?” and he said that was the wrong first question: he said that it was wrong to decide where to drive the bus until you got the right people on it, and the wrong people off it. He turned about 14 of the 26 people got off the bus, in terms of his team. When he left that business, it was earning four million pounds per week.

So what’s ATS been doing? In 2012, we introduced a tool called the People Analyser which allowed us to measure our employees against our values and also allowed us to highlight any wrong seat issues. It’s a great tool; we found it a really insightful process, but we did struggle as a business to do anything with the information and we were procrastinating over dealing with issues. But then in 2015, we met Happy and we started to do some leadership development with them and then I guess this was our lightbulb moment. Previously we’d focused on the business in all of these situations: how is this impacting the business? How are we going to resolve this for the business? And I think that’s why our managers found a disconnect on how to deal with the issues.

What we decided to do was have a new challenge, and that was to care enough about the people to help them to be the best versions of themselves and that was whether it was with our business, or outside of our business. That presented a range of solutions on how to help people better themselves, so that could have been exiting ATS; or redeployment into a new role; or development, support, and training, so it really just depends on the individual. The key to all this was:

  • Respect
  • Honesty
  • Integrity

So it was about turning the human element back on because these situations are difficult, so it’s easy to switch that off and go back to the traditional HR process and not think about the individual.

This change in focus seemed to help our managers address the ‘people issues’. We have got several examples, but today we just want to talk about one. Initially, there was a personality clash in a small team and this escalated over a period of 18 months. What started off as what we thought was just two people not getting along—we tried the ‘bashing heads together’ approach: “You might get on, these are your goals, get on with it.” We ended up with one person feeling isolated and held back, two people feeling that the other person was being carried because they couldn’t do their job properly; we had to whole team atmosphere feeling awful, so nobody was enjoying working in that environment and the manager just didn’t know what to do. Everybody was just angry that ATS had let that happen and hadn’t supported them; at this point, the engagement score was zero for that team.

So it was a total mess. The grievance process failed and the team seemed to be collapsing; we were on the verge of losing people. Following the Happy Leadership Development  Training that we’d done, we refocused. We decided to really think about how individuals in that situation felt, and at this point we gave one person the opportunity to step out of that team into another team and start their career within a different environment. What happened was that that person is now a respected key member of that team, whereas in the other team it didn’t feel like that at all, and maybe they were having time off because it was a stressful situation.

The rest of the team are in a brilliant place: the team’s grown since, provided additional services for the customer; the revenue in that team has grown. Overall, it’s become a really positive story and the only difference was thinking about the individuals and how they felt rather than the business.

Final thought: one of the key learnings from that particular situation was not procrastinating. The earlier and the sooner you can have these conversations with people using respect, integrity, and honesty, the greater opportunity have to deal with it in a much better way than the traditional processes.


Damien: Good afternoon, I’m Damien. I’m a Site Manager for ATS. My site’s in Titchfield which is on the south coast near Portsmouth. I’m based on a customer’s site: it’s an aerospace manufacturer; there’s about 900 employees on the site, but ATS team are 25 technicians and engineers. I’m here to give you some examples of the things that we’ve done in building trust and then getting out of the team’s way. The other thing I’m here to do is celebrate a mistake, so through this story you’ll see where we went a little bit wrong.

This is my team. We had an issue: the issue was that, through time and circumstance, our shift patterns and the way that our team worked did not work for anybody. It didn’t work for the individuals, our customer, or the business. The effect it was having on the business was we were heavily reliant on voluntary overtime, so we were constantly having to persuade and cajole our employees to volunteer for this overtime. It didn’t work for the individuals because they felt like they were under pressure to volunteer all the time. And it didn’t work for the customer because it was costing them a lot of money in additional overtime payments. This came to a head about two months ago.

We decided as a leadership team we were going to fix this issue. We have a regular weekly management meeting and we spent the whole of one of these sorting this issue out. We sat down with my team and we devised an amazing shift pattern. It met all the needs of everybody: the customer, the business, and all the employees. I was sure it was fantastic. So I went out to the team, presented them with their new shift patterns, and then it all went wrong. The initial reaction was positive, but after a while, people looked at the new shift patterns, took it home to their partners and families and realised the impact it was going to have on them in terms of work/life balance. The next day I came to work, there was a very different atmosphere onsite. I had people coming up to me saying, “If you go ahead with this, I’m going to have to leave.” Other people got into arguments at home. This was not good. Bearing in mind, this was after we’d been through happy. Not good—hence the ‘celebrating mistakes’ bit.

We carried on with the wrong direction. We were having discussions around enforcing this through a consultation process and we were even thinking about who we were going to lose out of our team. Bearing in mind we’d been through the right person, right seat, so we believed we had the right people. Fortunately, we stopped. After the weekend, we reflected as a leadership team and decided: let’s go back to what we were taught through the Happy Leadership Programme. So we got the technicians in a room, told them what the issues were, told them the guidelines, and let them get on with it.

Two hours later, we had a shift pattern that fulfils the needs of everybody. It worked for the individual, so it wasn’t a one-size-fits-all solution. They came up with their own individual work patterns, meaning they only work four days per week - which is virtually unheard of in our industry. They have a much better work/life balance and more control over when they work. It works for the business: I know now who’s working when, all the way out to the end of the year. I have no overtime issues; all my overtime is covered to the end of the year. Also, it saved £5,500 this year for our customer in overtime payments.

So a real good example of the success of this methodology, and the potential pitfalls and how easy it is to slip into the old mindset and the old way of doing things despite everything we’ve been through as an organisation. We carried this theme on—and I’ve got another team, where I could give them even more freedom. We decided to go for it. They’re a Plan Maintenance Team; they service our customer’s machines. They take the machine away from the customer, out of production, so it’s sat there not making money. They service it and give it back to the customer. A typical service takes five days. The factory runs 18 hours a day. For every hour that machine’s down, that’s £100 per hour. What used to happen was the guys worked five days a week on a traditional rota basis and when they’re not there servicing the machine, it remains out of action. So we changed tactics.

We got the guys in a room, told them what the rules were: they had to work 37 hours a week, they had to deliver what they agreed with the customer, and they just had to let me know what they were doing so if I knew if they were supposed to be at work or not. We now serviced the machine in three days instead of five, so we give the machine back earlier. We estimate that will save our customer £11,000 a year in downtime—this year alone. Forecast for next year: potentially up to £50,000.

The team are engaged; they get to work pretty much when they want. The factory’s open from 6am to midnight, so they can work any time between those hours. The guys can go to sports day with their children, plan around holidays, and other things. This team is really driving success within our customer’s organisation. The effect it’s having is they’re doing a better job; the machines are working better than they ever have done, reducing breakdowns; it’s been a real success for us and the team.

Read these statements and discuss amongst yourselves where you feel your organisation fits on this scale and where would you like to be and how would that feel.

Which statement is true for your organisations? (Share examples).

  1. We micromanage our employees to get results.
  2. We get out of the way and let our employees do what they do best.
  3. Somewhere between A and B.

The message that we were trying to get across was that firstly, this stuff works and, despite the challenges, it can work. The right person, right seat, we believe is the fundamental start to this because without that, you’re not going to get anywhere. But once you get people in the right seats, you need to get out of the way and let them get on with doing their jobs.

Brendan Martin became familiar with London’s care at home services while serving as the principal carer for his mum. He noticed that UK home care organisations weren't just typically underfunded, but also managed in counterproductive ways. It’s not that the staff weren’t up to the task, but various bureaucratic rules and systems limited productivity and accessibility. 

Buurtzorg was conceived in 2006 to counter the prevalence of fragmented care practices and associated job dissatisfaction. Buurtzorg provides holistic care for its clients. So, in contrast to situations where clients deal with 30 or 40 caregivers, Buurtzorg supplies one team of 10 nurses who are fully acquainted with each individual client’s needs. This prevents the client from having to repeatedly run through the ins and outs of their care programme. Everyone in the team is up to date and empowered to carry out a range of tasks. 

Madelon underlines Buurtzorg’s commitment to flexibility. The amount of time devoted to clients isn’t dictated by company protocols, which means they’re able to respond accordingly when the client’s condition changes.

Buurtzorg also treats its staff entirely differently to any of Madelon’s previous employers in the field. For one thing, at Buurtzorg she feels trusted. There’s no firm hierarchy in place – while there are nurses and nurse assistants, they’re all essentially equal and decisions are made within the team. 

The organisation’s overarching aim is to cultivate small teams that work within a community and to build informal networks consisting of family members, neighbours and medical professionals, all in the name of improving the quality of care.

Buurtzorg now has roughly 10,000 nurses stationed all across the Netherlands, supported by a centralised IT system that contains assessment tools, care plans, registers, and hours.  

Having identified a multitude of difficulties in Britain’s health and social care system, Brendan and Public World are working in collaboration with Buurtzorg to adopt a similar approach that will improve home care in the UK. 

What You Will Learn in This Video

  • UK home care organisations are underfunded and managed in counterproductive ways.

  • How Dutch home care organisation, Buurtzorg, differs from others in the field.

  • Buurtzorg nurses exercise freedom and responsibility in the job they’re trained for.  

  • Buurtzorg provides holistic care for its clients.

  • Buurtzorg’s commitment to flexibility allows them to respond accordingly when the client’s condition changes.

  • Why Brendan and Public World are working with Buurtzorg to improve home care in the UK. 

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About Madelon and Brendan

Madelon van Tilburg started out as a nurse coordinator with a big home care organisation. However, she felt squeezed in by rules and regulations, with no freedom to be a real professional. After seeing a vacancy for a district nurse position in her local village, Madelon joined Buurtzorg in 2011. In 2014, Madelon travelled to Tokyo on behalf of Buurtzorg, delivering a number of lectures and workshops for nurses and management. She has since visited several countries with the organisation, speaking to engaged and brave nurses who want to make a change in their country.

Brendan Martin is the founder and managing director of Public World. He has facilitated workplace conversations to improve team work and staff engagement, to promote equality and diversity, and to enable frontline freedom and responsibility. Public World is the UK partner of Buurtzorg Nederland, aiming to apply the lessons of its experience of improving care at home through self-organised neighbourhood teams of nurses and nurse assistants.

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