Buurtzorg’s Organizational Structure

Buurtzorg, a Dutch home-care organization, is renowned for its innovative organizational structure, which is often categorized as a self-managing or self-organizing model. This structure shares many principles with holacracy but is more specifically tailored to their unique operational needs in the healthcare sector. Here are the key aspects of Buurtzorg’s organizational structure:

Key Features of Buurtzorg’s Organizational Structure

1. Self-Managing Teams:
Buurtzorg operates with small, self-managing teams of nurses who work autonomously to provide care to their clients. Each team is responsible for all aspects of their work, from scheduling and administration to direct patient care.

2. Decentralized Decision-Making:
Decision-making authority is distributed throughout the organization, allowing teams to make decisions that directly affect their work and their patients. There is no traditional hierarchical management structure.

3. Role Flexibility:
Roles within the teams are flexible and dynamic, allowing team members to take on different responsibilities as needed. This promotes a high level of collaboration and adaptability.

4. Minimal Bureaucracy:
Buurtzorg has minimized bureaucratic overhead, relying instead on a supportive IT system and a small back-office team to handle necessary administrative tasks. This allows the focus to remain on patient care.

5. Empowerment and Trust:
The model is built on the principles of empowerment and trust, with the belief that professionals are best equipped to manage their work and make decisions that benefit their patients.

6. Focus on Holistic Care:
Buurtzorg’s approach emphasizes holistic care, where nurses are encouraged to consider the overall well-being of their patients, integrating social, emotional, and medical support.

Pros and Cons of Buurtzorg’s Organizational Structure

Pros for the Organization:
High Efficiency: By reducing bureaucracy, Buurtzorg allows nurses to spend more time on patient care.
Employee Satisfaction: Nurses report high levels of job satisfaction due to autonomy and the ability to make meaningful decisions.
Quality of Care: The holistic, patient-centered approach has led to improved health outcomes and high patient satisfaction.

Cons for the Organization:
Scalability Challenges: Scaling the model while maintaining the same level of autonomy and effectiveness can be difficult.
Coordination Complexity: Ensuring consistency and coordination across numerous self-managing teams requires robust communication systems.

Pros for People:
Autonomy: Nurses have significant control over their work, leading to greater job satisfaction.
Professional Growth: The flexible roles allow for diverse experiences and professional development.
Empowerment: Trust and responsibility empower nurses to innovate and improve patient care.

Cons for People:
Responsibility Burden: The high level of responsibility can be challenging for some individuals.
Need for Self-Discipline: Success in this model requires strong self-management and discipline, which may not suit everyone.


Buurtzorg exemplifies a self-managing or self-organizing structure that emphasizes decentralization, autonomy, and holistic care. This model has achieved notable success in improving both employee satisfaction and patient outcomes, making it a compelling example of innovative organizational design in the healthcare sector.