Community Based Care in a Teal Organization

Buurtzorg, a large Dutch nursing care provider, is a good example of an organization running with Teal management structures and practices. In the early 1990s the Dutch government created incentives for care-giving agencies to merge into larger enterprises, gravitating toward an Orange paradigm. These organizations added more layers of management to increase efficiencies and squeeze out costs – with distressing outcomes for patients and nurses, like impersonal care and degrading work conditions.

Buurtzorg was founded in 2006 by Jos de Blok, a former nurse. His new organization is extraordinarily successful, having grown from four to 10,000 nurses in its first ten years and achieving outstanding levels of care and a market share of 60 percent, potentially saving the Dutch social security system up to $2 billion per year if the whole industry followed its model. Internationalization started by launching in Sweden, US, Belgium, Japan, China, Czech Republic, Korea, Scotland and UK. Clients and nurses love Buurtzorg.

Its 10,000 employees operate entirely with self-managing practices and are supported by fewer than 50 staff people. Fluid, natural hierarchies replace the fixed power hierarchies of the pyramid. Local teams of 10 to 12 nurses work almost completely self-organised, do their own recruiting and purchasing, contracting for specialized medical or legal expertise when needed.

Buurtzorg has a distinctive outlook on the nature of care. Its purpose is not to give shots and change bandages as efficiently as they can, but to help its patients live, as much as possible, a rich and autonomous life.


Jos de Blok is the founder and CEO of Buurtzorg(neighbourhood nursing), a Dutch organization with more than 9000 employees, offering community based (home) care services to more than 60.000 patients a year. Founded in 2006 with one team of four nurses, Buurtzorg has transformed home-based health care and it has created an innovative method for nursing care at home. Jos de Blok is a nurse by education and considered a change agent in the Netherlands when it comes to the organization of community based (home) care. Before he established Buurtzorg he had several senior management positions in home care organizations including director Innovations for medical services.

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