Buurtzorg cut nursing overhead by giving each neighborhood its own 12-nurse team

By the mid-2000s Dutch home care had industrialized nursing into discrete, separately billed tasks — a wound dressing, a medication check, a bathing visit — each scheduled centrally and often performed by a different nurse who had never met the patient before and might never see them again. Continuity of care collapsed, patients saw a rotating cast of strangers, and a growing share of every euro spent went to the scheduling and management layers coordinating the fragmentation rather than to care itself.

Adding better software or more careful central scheduling would only optimize the fragmentation, not remove it — the coordination burden existed only because no single nurse or team was accountable for a patient's whole course of care, so someone centrally had to stitch fragments back together. The obvious fix, hiring more coordinators, would have added exactly the overhead de Blok was trying to eliminate.

Gave each neighborhood a self-managing 12-nurse team owning the whole caseload, so coordination overhead vanished because no handoffs existed.

A small team knows its patients and coordinates informally, so no separate scheduler is needed.

Same team handles intake to discharge, so no handoffs require a management layer.

Team owns the outcome, so it uses fewer hours by recruiting family and neighbors.

No manager means the team itself absorbs the coordination work that used to be a separate cost.

When coordination costs balloon, don't optimize the fragmentation—reassign the whole customer to one small team and let them absorb the coordination.

Buurtzorg runs on about 8% administrative overhead versus up to 25% at peers, and grew to over 10,000 nurses within a decade. Buurtzorg's model became one of the most studied cases of self-management in a licensed, regulated profession, was ranked the Netherlands' best employer multiple times, and the approach has since been exported into home-care pilots in Sweden, Japan, the US and elsewhere, along with a body of academic and health-policy research examining whether the model transfers outside Dutch financing and regulatory conditions.