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The Globe and Mail

Learning from the Dutch ‘neighbourhood care’ model

Buurtzorg is the hottest trend in health care today.

The Dutch word, meaning "neighbourhood care," is both the name of an organization and a philosophy that is spreading rapidly worldwide as countries struggle to provide care to aging populations.

Buurtzorg, the non-profit organization, was founded in 2006 by nurse Jos de Blok in Almelo, a small town in the eastern Netherlands. He and fellow nurses were frustrated by the growing bureaucracy of health delivery and how nurses had less and less time for nursing. So they organized themselves in small, self-managing teams to compete with existing home-care organizations.

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The approach was counterintuitive. Instead of having a series of specialized workers carry out specific tasks for elderly and vulnerable patients such as cleaning, bathing and wound care, a single nurse provides the whole range of care.

Further, a team of about 10 nurses is responsible for a town or neighbourhood of roughly 10,000 people and figure out among themselves how to best deliver care in the home, in conjunction with the patient's general practitioner.

No managers are required because the nursing teams are self-managed.

During a typical visit, a Buurtzorg nurse would make coffee, sit and chat with a patient about their health, make sure there is food in the fridge, carry out clinical tasks such as preparing the week's medication and checking blood pressure, then bathe the patient and help them dress. Before leaving, the nurse might also feed the cat and remove a throw rug that increases the risk of falls.

The Buurtzorg philosophy is to provide gentle, unhurried, respectful care. The goal is to make patients as independent as possible.

There is one golden rule: The nurses must spend at least 60 per cent of their time in direct contact with the patient. With this approach, a nurse sees about four patients a day.

While this seems costly and inefficient, what has intrigued health policy experts are the metrics:

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  • A study by KPMG found that having a single nurse provide all care was costlier per hour, but both quality and patient satisfaction were much higher and that, over all, half the number of hours of care were required;
  • Another study by Ernst & Young found that this slow, holistic approach to home care is about 40 per cent cheaper than the more traditional, task-based approach.

Neighbourhood care saves money because, put simply, patients remain in the community longer, and health problems are averted. Buurtzorg patients are less likely to need medical care, less likely to be hospitalized and less likely to be institutionalized in long-term care homes.

In recent years, a number of countries have tried to adopt the Buurtzorg model, including Sweden, Germany, Austria, Britain, Japan, China, Taiwan, South Korea and the United States, with mixed results.

It is not always easy to transplant health programs from one country to another. That's because culture matters a lot.

In the Netherlands, community-based health care is the norm. Every citizen is associated with a GP, who acts as a navigator and a gatekeeper.

All Dutch citizens have private health insurance, and it is highly regulated. Home care is covered and there are financial incentives to keep patients out of long-term care.

There is also a tradition of social solidarity that values caring well for others – particularly elders.

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In Canada, community care is not the norm. Many citizens do not have a GP and the home-care system is piecemeal at best.

In our system, there is such a mania for measurable outcomes that care tends to be task-oriented, and the fact that there is an actual person on the receiving end of care too often seems to be forgotten.

The culture of health care in Canada is also quite hierarchical. It is hard to conceive of self-managing nursing teams catching on; and can you imagine a Canadian nurse cleaning out a patient's fridge before doing their wound care?

The Buurtzorg model is a good one, though perhaps a bit idyllic for the Canadian reality.

What we do need, however, is to embrace the underlying philosophy: That, as people age, every effort should be made to keep them in the community and that the care we do provide should be a lot more respectful.

Metrics matter, but the quality and dignity of care matter more.

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