Too many managers

“More than two-thirds of employees around the world say they have to consult with more than one boss to get their jobs done,” The Wall Street Journal quoted a Gartner report in 2018. Nearly the same waste significant time waiting for guidance from senior leaders.

Buurtzorg, a Dutch home-care nursing organization, has no managers. In just 10 years, it has grown from 4 employees to 14,000. It has the highest client satisfaction in the Netherlands, along with the highest employee satisfaction. The costs it incurs are 67% lower than its Dutch peers because it cures its patients faster. Yes, it has no managers. Nor has it a planning, HR or marketing department.

The Buurtzorg model is becoming a global phenomenon. How is Buurtzorg so radical? Because its center is not some fancy headquarters; it has only 50 people at a modest HQ. Its center—its beating heart—is the interaction between its nurses and they people they help.

The golden rule at Buurtzorg is that nurses must spend at least 60% of their time with their patients. Nurses’ work is not measured by what they do but by how independently their patients can live. These metrics are radical because they measure use, not production. They measure outcomes, not inputs.

Historically, every aspect of a nurse’s job was measured, timed and monitored. If a lace came loose in a patient’s shoe, then, as they tied that lace, they were “delivering product 67” and they were expected to deliver that “product” in less than 45 seconds.

If a lace comes loose when a Buurtzorg nurse is with a patient, they may respond in the following manner: “Oh, John, this has happened a couple of times. How’s your eyesight now? Should we get it checked again? Have you been doing your yoga classes recently?”

With a Buurtzorg nurse, John will be less likely to trip and fall down the stairs, because the Buurtzorg nurse is focused on helping John live as independently as possible.

Buurtzorg believes in radical decentralization and active collaboration. There are no more than 15 people in any one multidisciplinary team. The technology is used to bring these teams together, share best practices, compare notes and help solve problems.

The Buurtzorg teams “do all the work required (i.e. nursing, planning, personal development, recruitment, hiring, firing, decision-making, etc.),” Pim de Morree writes. “Now, there are 1,000 self-managed teams, each enjoying huge amounts of autonomy. As one of the nurses said to us, “We feel more liberated, appreciated, and fully in control of how we can provide the best possible healthcare to our clients. Instead of having to work with lots of frustrating bureaucracy, we now do what we love to do—delivering care to patients.”

Buurtzorg represents one of the great potentials of web-based technology. Instead of using an increasingly jaded and counter-productive model involving monitoring and controlling of employees, the new model involves empowerment, independence, and collaboration among those closest to the customer.

Give smart people smart phones so that they can get as close as possible to the customer, because those who stay closest to the customer will be the ones delivering the most value as the digital economy matures.

Trust-based radical autonomy models can be a better alternative to command and control structures. By Pim de Morree

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