Buurtzorg Nederland: A Global Model of Social Innovation, Change, and Whole-Systems Healing

Abstract

Countries around the world are facing very similar healthcare issues: the quality and cost of care, poor outcomes, lack of access to care, lack of transparency of information, and a growing dissatisfaction among both patients and caregivers. In the United States, healthcare constitutes 15.7% of the gross national product compared to 9.7% in the Netherlands, 8.9% in Norway, and 7.5% in Ireland. According to a report recently released by the World Economic Forum,1 with no reforms underway that would affect the fundamental drivers of healthcare expenditures, some estimate that by 2040 total expenditures could grow by another 50% to 100%. Increases in expenditures are often not commensurate with health outcomes, as illustrated by the United States, which spends more money on health-care than any other country in the Western world and has health outcomes near the bottom of the Western world. In the United States, even after the passage of the Affordable Care Act, it is estimated that 30 million people will not be able to afford care. The topic of “healthcare reform” is a pressing issue for most countries as it is becoming more apparent that required investments in healthcare adversely impact the ability to invest in education, infrastructure, social welfare, and a host of other priorities. The healthcare workforce itself is also a dominant issue. While the reasons for this are complex and differ around the world, in many countries, there is a growing dissatisfaction and disillusionment with practice. Most often when healthcare professionals retire early or leave the profession, it is not due to dissatisfaction with caring for people. Rather, it is dissatisfaction with bureaucratic systems that need to be contended with in order to deliver care. Within nursing, major drivers of dissatisfaction include loss of autonomy, frustration with bureaucracy, and adverse working conditions. Dissatisfaction contributes to workforce shortages. The reform agenda around heathcare often focuses on the financing of healthcare and the coordination of care, given that care is highly fragmented, which leads to errors, poor quality, and poor outcomes. Ironically, both of these strategies strive to give access to health-care systems that are inherently flawed, are not patient-centered, emphasize the treatment of disease over prevention, and are oriented more toward the provision of provider-delivered goods and services rather than empowering people to better manage their own health and wellbeing. Healthcare is an excellent example of a social problem that is complex and “wicked” and not amenable to easy, predictable solutions. “Wicked” problems, as defined by Conklin,2 are difficult or impossible to solve because of incomplete, contradictory, and changing requirements that are often difficult to recognize. Solving wicked problems requires innovation, novel solutions, and a systems approach. Innovations that radically and fundamentally change the what, how, and why of healthcare delivery are scarce and desperately needed. The fundamental root of many issues in healthcare is the failure to focus on the primary process of delivering care to patients. The focus is on the wrong issues. Instead of focusing on sustaining bureaucracy, new ways are needed to focus attention on humanity and the relationships between people who promote and optimize health.