Healthcare: humanity above bureaucracy | Jos de Blok | TEDxGeneva

In his TEDx talk, a nurse presents how he helps simplify organizational structures in healthcare. He explains how encouraging trust while integrating simplification offers a great deal more for society than bureaucratic and pyramidal organizations, making daily work more meaningful and sustainable.

Jos de Blok received the 2014 RSA Albert Medal for his work as founder of Buurtzorg, a transformational new model of patient-centered community health care focused on facilitating and maintaining independence and autonomy.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

I had quite a normal life till I was 20.

I was a good student,

and I studied economics.

And then I made a radical choice.

I became a nurse.

I've got my wings,

but as a nurse, as a male nurse,

as I hope you can see,

I worked the rest of my life

with a lot of women,

and I saw it as something very positive.

I learned a lot from it.

I worked for many years in a hospital,

and after that I started to work
as a district nurse in a community.

And this was the most
beautiful part of my life

because I learned how to deal with
all kind of problems in the community.

And I had colleagues
in the same village I worked,

and together, we solved
all the problems we met.

There was not a big organization,

it was just a team of nurses
who organized the work themselves.

We took care for patients
who were terminally ill,

patients with dementia,

people who were discharged from hospital,

and there was a big variety of activities.

We also took care for little children.

So it was in that period,
the most healthy job you can get.

And we also built support systems
in the community.

It was a very inspiring job,

and I enjoyed it very much till 1993

in Holland we got a big disaster

because the politicians discussed

that community care
should become more professionalized.

And what I meant by that

was that it should become -
it should be part of a bigger organization

managed by managers

and organized not focusing
on solutions for people

but delivering products.

For the nurses, it looked like this:

Instead of thinking helping patients,

they had to think: What kind
of products should I deliver?

We had personal care, personal care extra,

personal care special.

We had nursing care, nursing care extra,
nursing care special.

And all theses nurses
got disturbed by thinking:

What kind of activities should I give,
and how should I code it?

Because there were a lot of codes.

For patients, it was also
even a bigger disaster

because for every task,
they got someone else,

and there were sometimes
people with dementia

who got 30 to 40 different people
coming into their house in one month.

And can you imagine

that every time you have to tell again
what the situation is

and how you want to live your life?

So both nurses and patients

were very, very dissatisfied
about how things were going.

The same time, it looked more and more
like factories, the care organizations,

and I see it in a lot
of countries happening.

So you saw that all the things

that were developed
in industries and companies,

they were also in the organizations,

and you saw that more and more managers
were taking over the profession.

So what you saw was that

there was more and more
management layers in the organizations:

a CEO, directors, managers,

and they almost forgot
that there were also employees.

And it can be done so much differently

as you can see
in the other side of the slide.

The consequences, they were very different
than the politicians expected.

Because the expected
that by organizing this way,

the costs would go down
and the quality would go up.

They also had market incentives.

But what you saw
is that the opposite happened.

The quality went down dramatically

because of the many people
who were involved with every patient,

and the costs doubled in 10 years.

So the assumption
of the politicians was quite wrong.

But what you saw was that
the people who paid us

were even more focusing on efficiency.

So for example, when a nurse
took 10 minutes longer

for travelling to a patient,

she had to explain that
to her manager, why she did that.

In 2006, some friends and myself,
we thought it's time for a change.

I had been director for a few years
in a few organizations,

and I saw that it could be done
very differently.

And our ideas was to change
the healthcare in Holland

and to start a movement to show

that elderly care
could be done much better,

based on trust

and based on self-organization.

So the principles
I worked myself with in the '80s,

we took them again as the basic principles
for our organization.

And for four nurses in 2007,
we grew to 9000 nurses in 2015.

And it just happened by itself.

The first year, 2007,
it was some kind of experiment.

So we started in 10 locations,

and every time happened the same:

we got nurses who just developed
their networks in the community;

they started to work again
on the same principles we did in the '80s,

and within a few months,

they had got their patients,
and they covered their costs.

So there was no financial problem.

So from 2008,

we got 10, 20 teams a month,

and every time it happened the same.

They called me to come
to one of the houses of the nurses,

and we sat all evening talking about
of our profession:

What does it mean to help people?

And how can we do it
just the way we want it

and not be bothered
by any kind of regulations?

So that's what we did,

and the evening of the day after,

I usually got a phone call
from one of the nurses,

and they said, "When can we start?"

And then we started just a new team
in a new neighborhood

focusing on patients as we are used to.

So this went at a very high speed,

and we didn't have problems to manage this
because they were managing themselves.

We had a small back office,

and we still have a small
back office with 30 people.

My wife and me, we are some kind
of a management team,

but we don't have meetings,
and everything is going very well.

My wife is always awake
very early, around 6:00,

and then she tells me what to do
like any other wife, I think,

is telling her husband.

So that's the way we are managing.

And this way, we have a lot of time
just to solve problems.

In my job I had before, I had meetings
from morning till evening,

and I didn't had time
to solve the problems.

So that's quite different.

In 2015, we see that there's
still no management.

Because there was a lot
of criticism when we started.

They said, yes, you can do this easily
when you're with just a few persons.

And then, they said,

oh wait, perhaps next year
they will collapse

or they will have big financial problems.

But the opposite happened

because what you saw that the teams
were more and more in control

and taught a lot of solutions

they could find
for the problems they met.

So it was growing, the knowledge
was growing in the teams,

and it became more and more sustainable.

We still tried to avoid
any kind of bureaucracy.

We built an IT system

[which prevented] all the bureaucracy
to take over the work of the nurses.

So all the bureaucracy was kept outside.

We split the administrative process
with the professional process

so the nurses just can focus
on what they're there for,

and that's taking care for patients,

find solutions for patients
who have severe problems.

In 2015, we can look at it,
if you look back now,

we can say we have, since we started,

the highest client
satisfaction in Holland.

And what's very important
for the policy makers

is that instead it took
more costs, or more hours,

because we're working
with higher educated nurses,

the costs went down with 40 percent.

So last evening,

the Parliament in Holland
was debating about the district nurse.

And they were debating
about the position of the district nurse

in the future in Holland.

And they said, this movement
should be spread all over in Holland,

so we want to support it.

All the political parties agreed on that.

And at the same time,
we became the best employer of the year,

three times in a row.

Just by doing nothing.

We don't have an HR department,

so we don't -

so by doing nothing, and doing less,
you get far better results.

So all these management ideas

about controlling and command people,

are just, in my opinion,
quite destructive.

So if you just let people
organize the work themselves,

you get much better results
and people are much happier

because they can do what they want to do.

And it sounds very logic,

but we make it very difficult for people
to work this way in a lot of places,

also in schools and also with police.

It was not only in Holland
that this happens.

There are a lot of countries
who have the same problems,

and we got questions
from the United States,

from Japan, Sweden, China,
Czech Republic and so on.

I visited 30 countries,

and in every country
I meet nurses who had the same ideas.

And we start the same movement.

Just with a few nurses, that's enough.

And then you show that it can be done.

And then you see that
other people become curious.

And they say, oh, we never expected
that it was possible in our system

because we have such a complex system.

So we also developed a theory on that.

It's the integrating
simplification theory.

Try to make things simple, not complex.

And when you do that consequently,

it's more easy for people
to take their responsibility,

and to think about what can be done
to solve problems.

So, I think healthcare is about trust.

I never met a nurse who didn't want
to do her work as good as possible.

So you can trust nurses.

It's about meaningful relationships,

with each other but also between nurses
and patients, of course.

And it is about empathy.

Try to understand
what the concerns of people are,

and try to do something positive with it.

So, in my opinion, we should -

let's bring the soul
back into the organizations,

and let the complexity
get out of the organizations.

Thank you very much.

(Applause)