Buurtzorg T

Care continuity, trusting relationships, building neighborhood networks and self-management for teams and clients are all key principles for Buurtzorg and Buurtzorg T teams.

Buurtzorg T provides treatment that is focused on people's recovery and restoring contacts within their surroundings, working with the client in their environment to develop strategies that allow them to recover and regain control of their life.

In the Netherlands psychiatric care is strictly regulated by insurance companies, politicians and local authorities. Services are delivered around the needs of the organisation and clients have little choice and very few receive care at home. Buurtzorg T provides home visits to all its client groups. Like all Buurtzorg initiatives, Buurtzorg T believes relationships with clients are the most important factor. Buurtzorg T client-facing time is higher than 60%.

Nico Moleman leads Buurtzorg’s work in mental health and established 12 pilot teams in 2012 in the Netherlands to test and refine the model. The key principles of Buurtzorg T are:

• not talking about the client without the client present
• no time limits on sessions with clients
• equality of patients and professionals
• on recovery, clients give help to peers, contributing to their own and others’ recovery.

Buurtzorg T teams

Buurtzorg T teams comprise 1 psychiatrist and 6 full-time psychiatric nurses. Together the team delivers an action-oriented model of care, focusing on what the client wants: solutions. In doing so Buurtzorg T has removed a lot of the bureaucracy. An important ground rule for the Buurtzorg T teams is that when they talk about a patient, the patient must be present.

Buurtzorg’s innovative use of technology and Buurtzorg T’s e-health tools combine to share and promote self-learning and knowledge sharing.

Buurtzorg T patients

Buurtzorg T has changed the classical role of psychiatric patients and psychiatric professionals so they are more equal in their behaviours and qualities. One of the ways they have achieved this is through e-health tools including e-learning modules for patients and professionals and encouraging joint learning.

Clients follow e-learning courses and learn how to help. They have been able to build up their knowledge of their own condition, take ownership of their electronic record, selecting who to share it with, including families and friends as well as practitioners, and co-create solutions with the Buurtzorg T teams.

On recovery, many patients stay with Buurtzorg T as volunteers, giving meaning to others and in turn benefiting from the relationships themselves.

Relationship to Buurtzorg community nursing teams

Buurtzorg’s interest in psychiatric care emerged from the increasing prevalence of dementia and especially clients with additional complexity such as confusion or depression. Buurtzorg T and Buurtzorg nursing teams work closely together to prevent patients moving from one team to another.

Buurtzorg nursing teams consult Buurtzorg T teams and visit the client jointly, with Buurtzorg T providing advice or psychiatric treatment. Buurtzorg T also coaches or plays an active role in Buurtzorg nursing teams so that they can better manage psychiatric conditions. This also works the other way round, with Buurtzorg nurses providing coaching to or joining Buurtzorg T teams.

Impact of Buurtzorg T

In 2015 Buurtzorg T began its bottom-up scaling phase: growing existing teams and establishing new ones.

• Buurtzorg T has reduced overhead costs by 25%, through reducing administration and bureaucracy.
• Teams describe the Buurtzorg way of working as setting the professionals free.
• The model of care has transformed clients' relationships with professionals.
• Client-facing time for the teams is over 60%.

Steward-owned since 2020

In 2020 Buurtzorg T became steward-owned: in effect, the organisation owns itself. The step brought in capital for growth while keeping Buurtzorg T independent and securing its goals, way of working and vision for the long term.

The shares are split so that control and money are kept apart:

• Steward shares carry the voting rights but no dividend. They are held by stewards, people from inside the organisation who act as its guardians. Founders Nico Moleman and Jos de Blok were the first stewards, with colleagues taking on the role over time.
• Investor shares carry a limited right to profit but no vote. They are held by investment partner Purpose Evergreen Capital, and Buurtzorg T buys them back over time at an agreed price.
• A golden share is held by an independent foundation, which can block a sale of the organisation or a move away from its mission.

As a result Buurtzorg T cannot simply be sold, and what it earns goes into better care rather than outside profit. The ownership now mirrors the self-management of the teams. By 2024 Buurtzorg T had grown to more than 72 teams and over 450 colleagues.

Sources: BuurtzorgT International, Steward Ownership; Purpose, BuurtzorgT case study (2024); Skipr, BuurtzorgT wordt eigenaar van zichzelf (in Dutch).