Describe about the Knowledge Audit for Business Analysis.
The home care provider Buurtzorg is the fastest growing organization of Netherland and has become popular all over the world because of its unique business model of self governing nurse teams. Most health care service providers rely on different person for providing different services but in Buurtzorg they rely completely on nurses. The nurses here are responsible for providing medical service along with associated services to its clients. Buurtzorg with the help of its unique business model has able to provide high quality health care at low cost. Further it has also earned high satisfaction rating from its employees and clients (Nandram and Koster 2014). The purpose of this case study is to evaluate the business system and the performance of the Buurtzorg and how this model could be adopted in Australia.
Buurtzorg Nederland is a not for profit organization. It has gained international prominence because of its self governing business model (Gray et al. 2015). This model has helped the organization to achieve low cost while delivering high quality home care services.
It has achieved extra ordinary success over the year. From just one team in 2007 at the time of its inception it has grown to become 700 teams in 2015. It started its operation in Almelo city in 2007 and now it has grown internationally with more than 8000 nurses working in different parts of the world. As per the report published by KPMG Buurtzorg has cared 65000 patients by 2014. The popularity of Buurtzorg business system has forced many of its competitors to adopt similar business models. Many countries like Norway, Sweden, Japan, United Kingdom, and United States etc around the world are trying to adopt the Buurtzorg model for their local health care systems. It has simplified by the management process by creating a flat organizational structure through which all services are provided with the help of latest information technology (Nandram 2014).
The survey conducted by Government agencies show that patients of Buurtzorg has high satisfactory levels (Takashima et al. 2015). As per the report published in nursing journal various surveys have been conducted on the nurses of Buurtzorg for more than one year has shown that it has the most satisfied workforce in Netherland (Monsen 2013).
The growth of Buurtzorg has raised suspicion that it picks and chooses high value patients to boost its success. As a result the Dutch Ministry of health ordered an enquiry. They employed business consulting firm KPMG to study patient characteristics and business model in comparison to its competitors. The study showed that criticisms are unfounded Buurtzorg has indeed developed a low cost model that has contributed to its success (Kroezen et al. 2015). As per the study there is no sufficient evidence to suggest that it has achieved success because of its patient mix.
In Netherland the types of Home Care services that are provided to patients are temporary home care services after discharge from hospitals, patients with chronic medical conditions, patient with dementia and for end of life care. The organizations that are engaged in providing Home Care Services are required to enter into contract with government funded insurance companies. There are ten different types of services that are offered by these organizations and payments are made based on authorized hours. These authorized hours are calculated on assessment of individual patients (Mossialos 2015).
The home care services can be divided into two parts medical service and associated general services. The medical service requires nursing experts but for providing other associated services like bathing, washing etc to patients generally nurses are not required. In traditional home care service model nurses are deployed to do the medical work and other semi skilled workers are employed for associated work. Generally there are no interaction between nurse and other care givers thus in most cases it was observed that nurses are generally not satisfied with their services. On the other hand patients are also unhappy with the quality of the service. Thus it can be said that both patients and nurses were dissatisfied with the traditional model (Shane 2015).
Buurtzorg took a different approach and adopted a model that gave value to life and humanity over bureaucracy. The main aims, goals and structure of the model are discussed in the tabular format given below:
|
Aims |
Goals |
Structure |
|
· To create teams of nurses that are independent; · The self governing teams are to provide both the medical and supportive services; · To become a community care model that is both holistic and sustainable; · To regain or maintain independence for patients; · To teach self health care to patients and its families; · To create local network of resources; · To have faith on professionalism of its nurses. |
· It has teams of 12 nurses that take the responsibility to provide complete care of almost 50 to 60 patients. · It relies heavily on Information Technology System for scheduling, documentation and billings; · It has also appointed coaches that are responsible for solving problems in the team. This coaches are themselves trained nurses. · For other administrative purpose there is a small back office. |
Thus Buurtzorg care model has teams of 10 to 12 highly trained nurses that work with patient’s families for providing them health care services. Each team is responsible for caring of 50 to 60 patients in a particular neighborhood and they provide complete service. The services that the nurses are responsible to provide includes assessing the need of the patients, developing a proper action plan for each patient, implementing developed plans, scheduling medical services and visits as needed by patients and also responsible for documentation of medical history and billings. The most of the planning, scheduling and documentation works undertaken are done with the help of latest information Technology systems. The self regulated teams provide flexibility to both patients and nurses (Kreitzer 2015).
The concept of managers has been changed to coaches that are responsible for solving problems in the team. As on 2015 Buurtzorg has 700 members and 15 coaches. The main function of the coach is to help team function rather than advising on patients care. These model offers independence to the nurses so they are not required to report to managers but their attendance and timing re maintained. The back office is very small and it is only responsible for financial administration (Monsen 2013).
As per the agreement the remuneration of the nurses are based on their education level. Further there is also standard annual increase and bonuses depending on the level of performance and work done for Buurtzorg. Buurtzorg uses surplus revenue effectively by building community projects, encouraging innovation in organization and training nurses.
Buurtzorg has grown rapidly over the years. The main reason for such phenomenal growth can be analyzed as follows:
In a study published by Earnest & Young in 2009 has shown that Buurtzorg was able to satisfy customers need in just 40% of the authorized patient care hours in comparison its peer companies required 70% of patient care hour. Further benefits that the study pointed out includes patients of Buurtzorg requiring care for less time, patients were quick in regaining autonomy, and there is also decrease in emergency admission of the patients in the hospital. In terms of operational efficiency the study suggests that it has achieved lower overhead cost than any of its competitor’s, further employee’s turnover and leave is much below the average industry standard. This study has successfully pointed out that Buurtzorg could meet patients need in fewer hours than its competitors. Thus providing high quality services at much cheaper price this helped the organization to gain government support and achieve high growth.
The success is always accompanied by criticism. The competitors of Buurtzorg have claimed that in case of unplanned emergency its patients had to seek help from other organizations. There are other critics who claim that Buurtzorg chooses patients with multiple requirements so that they can show more billable hours (Nandram 2015).
But there are no substantive proves or study to support this claims of its competitors. Rather it is argued that complex patients are referred by physicians to Buurtzorg thus justifying the patient mix this argument is also supported by the 2009 study done by Earnest & Young. Further it is also argued that effective health care reduces the need for unplanned emergencies.
The constant criticism by its competitors had forced Dutch Ministry of Health to appoint a consulting firm KPMG to look into these allegations. The study published in 2015 has shown that Buurtzorg is the best health care service in the country as per the reported experience of the patients. Further it provides fewer hours of care than other organization thus helping in savings. The study shows that its case mix adjustment cost is significantly low than other care providers.
Statement showing cost Comparison
|
Particulars |
Buurtzorg |
Other service provider |
|
Average Hours of care per client per year |
108 hours |
168 hours |
|
Average cost of Home Care |
$6990.00 |
$8695.00 |
|
Average follow up cost mainly nursing home cost |
$2207.00 |
$2730.00 |
|
Average follow up medical cost |
$8468.00 |
$5641.00 |
|
Total Case mix adjusted cost per client |
$16701.00 |
$17243.00 |
This analysis was extended by KPMG after noticing the nursing home and associated cost of home care patients such as physician and hospital cost. It was noticed that in comparison with other organizations patients of Buurtzorg have less probability to go into nursing homes but the cost of subsequent curative care were much higher than its peers. After including all costs the case mix adjusted cost of Buurtzorg was just below the national average. The reason behind such low nursing cost and high curative cost wee not analyzed in their report leaving such analysis for a follow up research report. The findings were ambiguous and contradictory because low nursing home cost suggests high efficiency and good home care whereas high curative cost suggests just the opposite. But in spite of this high credential of their nurses, increase in referrals from physician and the high satisfaction rate of the organization suggests that Buurtzorg is engaged in providing high quality health care services.
The most patients of Buurtzorg are from referrals of physician. It is more likely that large share of population of patients may include more critical patients with downward health trajectory thus justifying high curative health cost. But the report fails to address this point. After complete analysis it may be concluded that Buurtzorg has satisfied self managed nurses providing low cost high quality home care to their patients.
The next crisis that may be looming before Australian government is in health care system. The government is likely to face shortage of fund for delivering proper health care to its citizens because of rising health care cost. The challenges are faced from various quarters:
For implementing an effective health care system it is required to have proper plans (Drummond et al. 2015). The system should be effectively designed so that it can address the problem of bureaucracy and shortage of funds effectively.
The main aim is to provide effective health care in Australia by being:
From Buurtzorg model Australian Health care system can improve a lot. The prevailing problem of bureaucracy in Australian health care system could be addressed. The most important feature of Buurtzorg is that there are no managers and HR department in Buurtzorg so there is minimum bureaucracy (de Blok 2015).
Thus teams of nurse enjoy autonomy regarding their task. This has shown to improve employee satisfaction. This could solve the problem of manpower shortage in health sector of Australia. The team enjoys the power to recruit new personnel’s so they effective choose their own team.
The adoption of Buurtzorg model will revolutionize Australian Health Care facility by putting the needs of the patient in centre and letting the autonomous team to organize the health care package. Everything in Buurtzorg is aimed at providing enough independence to professionals for enriching their services. There are no rules except need.
On analysis of Buurtzorg model in United States it is observed that it faces many problems. It does not have proper referral source and it suffers from lack of work force of nurses to provide all the services. It also faces the problem of dealing with multiple players that have different payment rule and regulations. This has made it difficult for the nurses to follow the Dutch model where they only had to deal with government insurance company that has flat rate per hour.
This similar problem exists in Australia thus success of USA model can be successfully adopted in Australia. Thus overall analysis shows that problem faced by the Health care industry can be effectively addressed through Buurtzorg model.
References
de Blok, J., 2015. Guest editorial: Nursing has got stuck in ‘the system’, so let’s CHANGE THE SYSTEM!. Journal of Research in Nursing, 20(7), pp.532-535.
Drummond, M.F., Sculpher, M.J., Claxton, K., Stoddart, G.L. and Torrance, G.W., 2015. Methods for the economic evaluation of health care programmes. Oxford university press.
Gray, B.H., Sarnak, D.O. and Burgers, J.S., 2015. Home Care by Self-Governing Nursing Teams: The Netherlands’ Buurtzorg Model.
Kreitzer, M.J., Monsen, K.A., Nandram, S. and de Blok, J., 2015. Buurtzorg Nederland: a global model of social innovation, change, and whole-systems healing. Global Advances in Health and Medicine, 4(1), pp.40-44.
Kroezen, M., Dussault, G., Craveiro, I., Dieleman, M., Jansen, C., Buchan, J., Barriball, L., Rafferty, A.M., Bremner, J. and Sermeus, W., 2015. Recruitment and retention of health professionals across Europe: A literature review and multiple case study research. Health Policy, 119(12), pp.1517-1528.
Monsen, K., 2013. Buurtzorg Nederland. AJN The American Journal of Nursing, 113(8), pp.55-59.
Monsen, K.A. and de Blok, J., 2013. Buurtzorg: Nurse-led community care.Creative nursing, 19(3), pp.122-127.
Mossialos, E., Wenzl, M., Osborn, R. and Anderson, C., 2015. 2015 International Profiles of Health Care Systems.
Nandram, S. and Koster, N., 2014. Organizational innovation and integrated care: lessons from Buurtzorg. Journal of Integrated Care, 22(4), pp.174-184.
Nandram, S.S., 2014. Organizational Innovation by Integrating Simplification: Learning from Buurtzorg Nederland. Springer
Nandram, S.S., 2015. Implications and Discussion. In Organizational Innovation by Integrating Simplification (pp. 163-170). Springer International Publishing.
Runciman, W.B., Hunt, T.D., Hannaford, N.A., Hibbert, P.D., Westbrook, J.I., Coiera, E.W., Day, R.O., Hindmarsh, D.M., McGlynn, E.A. and Braithwaite, J., 2012. CareTrack: assessing the appropriateness of health care delivery in Australia. Medical Journal of Australia, 197(10), p.549.
Shane, C., Shapiro, T., Dunn, J. and Davis, J., 2015. Traditional Health Care as a Model for Modern Health Care.
Takashima, R., Tanabe, K., Morita, T., Amemiya, Y., Fujikawa, Y., Yasuda, H., Kashii, T. and Murakami, N., 2015. Usefulness of a Collaborative Home Visit Program Between Hospital and Visiting Nurses. Journal of Hospice & Palliative Nursing, 17(6), pp.524-535.
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