Culture Case Study: Buurtzorg

Malini
Jun 4
2 min read

Disclaimer: Culture isn’t copy-paste. What works for Dutch nurses may not work for your startup in Lagos or design agency in São Paulo. But exploring real, working cultures helps us stretch our imagination: what if we really trusted people to do great work — no micromanagement, no middle managers?

The Dutch Nurses Who Fired Their Bosses (and Made Healthcare Human Again)

The Problem: Healthcare That Forgot the “Care” Part

Let’s be honest — most healthcare systems are drowning in admin, overwork, and middle management.

In the Netherlands, this was no different. Home-care nurses were spending more time checking boxes than actually caring for patients.

Enter: Jos de Blok, a former nurse who had had it.

In 2006, he started a radical little home-care company with just four nurses, one simple idea, and zero managers.

The idea? “Humanity over bureaucracy.” (Also known as: stop making nurses fill out forms all day.)

The Buurtzorg Model: No Managers, No Silos, Just Care

At Buurtzorg, the entire organization runs on self-managed teams of 10–12 nurses. No supervisors. No call center. No org chart jungle.

Each team:

Hires their own colleagues 👋
Divides tasks amongst themselves 🧠
Manages their own schedules and caseloads 📆
Solves problems locally — no need to "escalate" 💁♀️

And the result? The nurses are happier. The patients are healthier. And the whole thing costs less than the traditional model.

(Yes, you read that right: better care, for less money.)

Culture in Action: How This Actually Works Without Chaos

You might think: “Cool idea. But wouldn’t this just descend into anarchy?” Fair question. But Buurtzorg makes it work with:

Massive trust + solid tools: Teams use a simple IT system to coordinate care, share knowledge, and run logistics. It’s not fancy. It just works.
A tiny, supportive HQ (aka, "the back office"): About 50 people support the whole org — mostly in coaching, legal, and tech. No ivory tower. Just practical help when needed.
A deep culture of responsibility: Everyone is a professional. Everyone is expected to step up. You don’t need a boss when you’ve got purpose.

As Jos puts it:

“People want to be responsible. Just give them the space.”

Results That Speak Louder Than Strategy Decks

💸 30–40% cheaper than traditional care models
❤️ Top-rated patient satisfaction in the Netherlands
👩⚕️ Nurse burnout? Dramatically reduced
🌍 Copied in over 30 countries, from Sweden to Japan

This isn’t a quirky experiment — it’s a scalable, proven, wildly human approach to organizing work.

What It Feels Like Inside

“You’re trusted to make the right call.”
“We solve things together.”
“You’re not a number here.”

It’s calm. It’s kind. And it’s radically efficient.

Nurses go from exhausted cogs in a machine to proud professionals running the show. The vibe is less “corporate” and more “we’ve got this.”

Key Takeaways from Buurtzorg’s Culture

Self-management doesn’t mean chaos. With the right values and tools, it means freedom with accountability.
Kill bureaucracy, not quality. When you trust professionals to use their judgment, everyone wins.
Culture isn’t perks — it’s structure. Buurtzorg’s culture works because the org design reinforces it at every level.
Sometimes less hierarchy = better outcomes. The fewer layers between people and purpose, the more magic you get.