A cursory glance around the business world globally and you can tell that all is not well. Systems are broken. Bureaucracy is running riot. Management frequently does more harm than good. And despite the constant chat about culture, you can often find more culture in a pot of yoghurt. So as businesses begin to acknowledge how disengaged staff really are, we ask: how do you now build a business or an organisation that people genuinely want to work for?
Many business books have been written on management but very few have sighted management as the stumbling block to fulfilled and engaged employees. After reading a library full of these tomes and then dropping out of formal business training, Jos de Blok is the Dutch nurse who started Buurtzorg, a company that has become one of the most successful in the Netherlands.
One of the things that we love at Renegade Inc. is this idea of ‘thinking differently’. It is difficult to find somebody who more epitomises those two words.
Where did it all stem from? De Blok tells Renegade Inc. that for him it doesn’t feel like thinking differently, at all.
“I think as I think,” he says. “Already as a little boy I always questioned things, at school or with my parents. When we had discussions at secondary school I always took another position to a lot of my school mates, suggesting perhaps we should also think about this in another way. I think it became kind of a habit, but I also thought a lot about why are things the way they are in life. I think I developed my own ideas very easily about how it could be.”
The businessman says he’s never been shackled to someone else’s way of doing things. Just because things have ‘always’ been done a certain way, is not an argument for why it should continue in that vein.
“If people say these kinds of things then I usually say no,” he says. “Then we have to question it.”
“I think it came from a feeling that some things in life are not shared well. We have a lot of systems and institutions which are influencing people’s lives. From it I think, why? Why should we? There are other ways to deal with things, so I was always thinking about how can we have a good normal life, develop ourselves and care for each other in a way that is sustainable.”
Education systems tend to have the capacity to knock the idealism out of people, but not de Blok, who says he was one of the most punished students in school.
“I was sent away from school a lot,” he says. “My three sons learn a lot outside of school. I believe that schools should follow your talents and should create environments where your talents can grow and where you can become a good, developed personality, not only teaching and testing, but also in the very early states, you have to think about what you’re going to do in your life as a job. I think first you have to grow up and become a good person and think about what’s fulfilling your life. Most of the things I learnt the last 30-35 years has all been based on economical principles. How can we deliver things for different industries? How can we be useful to others? How can we be useful for ourselves?”
At 15, de Blok discovered a love of economics, having taken up a book keeping holiday job.
“I got paid much more than my school mates,” he said. “For me it was not difficult because I was talented with economics. I thought working with farmers or working in hospitals, it’s much more exhausting or intensive. I thought it’s not honest, to earn more money doing simple things than doing useful things, in my opinion.”
So de Blok returned to school, only to be punished again, and eventually suspended. He decided to leave school, and by 19 had tried his hand at a number of different jobs, but found himself beset by depression because the world wasn’t as he would have liked it to be.
From economics to nursing
“After I studied economics for two years at business school, my perception of how things were in life, in society, depressed me,” he said. “So I quit my study and did some volunteer work and then I decided to become a nurse because an aunt of mine was working in Indonesia, in Jakarta, who said ‘if you want to support us or if you want to do something useful, first try to learn something useful.'”
So he began studying to become a nurse and said he enjoyed most of the work a great deal. But he struggled with the hierarchy and ‘office politics’.
“The head nurse was responsible for the program, the routine, how the schedule was made during the day,” he said. “When it was not supportive to patients, I questioned it, but the head nurse saw it as criticism and got defensive and then I received lower grades because of that.”
He found the way nurses and doctors were dealing with patients were not in their best interests. For example, the way the top nurse had designed the schedule meant that nurses would get a coffee break around 10am. In de Blok’s opinion, it should be the other way around. The nursing program ought to have been putting patients’ needs first.
“I started to discuss with colleagues and find ways to change the schedule and what I noticed is at a certain moment, more and more colleagues saw that it was better for patients to change some things, but nobody was thinking about questioning the routine. So we did that for many years. At 10 o’clock it’s coffee, whatever patients have, we will have coffee at ten. So I said no, first we should take care of everything that patients need and then see if the coffee can be scheduled for half past ten or eleven. This awareness about putting patients first allowed for a bit more flexibility, that grew in time.
“Everywhere I worked, I started again to question the same things.”
Most of the workplace leaders would receive him either very openly, or very defensively, he said. Nothing in between.
“After being a nurse, they asked me to become a manager,” he said. “The CEO asked me, he said he thought I could close the gap between the nurses and management, there was big frustration at the organisation.”
The task of overcoming the departmental challenges was not so difficult, in de Blok’s experience.
“I said if you just used the language of the nurses instead of management language, listen to them and find ways to let them do the work the way they want to do it, then things will change.
“But then I got problems with the financial director… In my opinion he was not open on how he was managing the money flows. He wanted to save some money for his own projects. To enable that, everybody had to work faster, productivity had to increase. He was not open on that. They were trying to save money for a big IT project, which failed every time. So then I said I won’t take responsibility for this state of affairs, I will leave the organisation.”
And he did.
From nursing to better nursing
With regards to what happens when Chief Financial Officers or directors become CEOS, he says that in general, within society, the economical perspective is too dominant.
“If you’re working in healthcare or education or the police force, it’s very important that the craftsmanship, the knowledge, the tested knowledge of people, is leading in what they are doing,” he says.
“But if you look at what has occurred over the last 30 years, the Ministry of Finance, for example, is steering the other ministries, and what you see in organisations is that the CFO’s are steering a lot of policies.”
So after putting nursing behind him, de Blok got together with some friends to think about what he was going to do next.
“I had this concept, that in almost in every way we can do things better than what we have, in general in Holland,” he said. We are going to work with higher qualified nurses. We are going to work in the structure where nurses become happy by the way hospitals are organised. We are going to use IT so that we don’t need so much overhead. We can reduce overhead costs and we will do it without a management structure. So this was the idea we had in 2005-2006.”
He floated the idea with his former CEO who told him it was too risky.
“The first thing I said was, ‘okay we disagree on a lot of things and a lot of policies and the way we are structuring things’. But then I said ‘you can, because it was a regional organisation’. I asked him, ‘if you send me around the country, I think I can do it everywhere. But he said it’s far too risky so…”
Nonetheless, his original idea more or less became the blueprint for his business, Buurtzorg Nederland, Dutch for ‘neighbourhood care’, a pioneering, nurse-led healthcare organisation modelled on holistic and revolutionised community care.
“First, before that, I tried to implement the concept in other organisations, and every time when I brought up the management structure, HR and finance said, ‘no, we are going to leave it as it is’. So then I said, okay then we will just start small. So I created the foundation. We hired some nurses. I worked together with the first team.
“I started to work as a nurse again, and from the start we got so much attention all over the country. Nurses all over the country were asking, ‘can we do it here? Can we start something here?’ And then throughout a single year we had 10 places. That was 2007. We had 10 locations and every time the nurses, they cut our patients, they cut our referrals, they got close connections to the GPs and within a few months we were breaking even, so we didn’t have to invest so much. We had one loan from a bank, that was enough to cover the first year and then it more or less exploded because then it was 10-15 locations per month in 2008.”
The business began receiving more-and-more attention from the local newspapers and Dutch television. It had the highest quality scores and the lowest costs.
“We had very happy nurses,” he says. “From the second year we were profitable. We didn’t want investors.
“So we said, if we can do it with the money we get from the health insurance, then I think we are not pressed by any of other interests. We can build it together.
“So the nurses felt very responsible for the result also. If you can do it in a way that we can reduce costs within a few years when we have some more revenue and we have more profit then we can share some extra. That was the idea.”
Relation repair bonus
With the extra revenue the business was bringing in, de Blok developed a bonus scheme to reward the hard-work of the nurses that brought it to fruition.
“I called it ‘the relation repair bonus’. These nurses, they were so engaged that, once in a while, it was frustrating for their families. Their husbands came to me and said ‘it’s very good to see my wife so happy again but what I don’t like is I don’t see them anymore’. I think it was in 2009 that we had quite a good year. So we said, okay we’re going to give a bonus, and we are going to call it the ‘relation repair bonus’ and then I got pictures from Portugal, from Greece, from these nurses having a wonderful time. They were sitting in a restaurant and they’re saying ‘okay my husband is happy again'”.
There is not a single instance anywhere in the world of a free market health care system that actually works. Jos de Blok tells Renegade Inc. that if you design an organisation with a human being in mind, not a debt-driven organisation that is geared for profit, focusing on investor relations you can create a company or business that naturally attracts the top talent in the industry.
“By designing it that way, my idea was we would attract the best nurses, and if you’re working with the best nurses they attract other good nurses, because good nurses want to work with other good nurses. So that was one of my ideas, that we could build a network nationally,” he said. “My idea was if we make it so flexible that in every place in the country people can start it by themselves, then it can easily grow from 10, to 100, to 1000, to 10,000.”
“If you don’t start from another perspective now, if you don’t say ‘okay we have to change our services, so we have to change the way we organise ourselves’, or ‘we have to change the way we make strategies and policies’ and so on, then I think within 10-15 years, the old way of doing things won’t survive anymore because the new examples which are based on other principles will grow much faster and will be much more effective, which will attract the best people. So I think it’s possible we supported some organisations, we changed in quite a short time and it was an amazing result. On the financial side they did much better, the quality was much higher and they attracted new, talented people. So it’s not so difficult if you’re able to translate this new vision into behaviour and cultures and other ways of dealing with things.”
From our perspective, 95% of de Blok’s work is simplification, if you look at other organisations, around 80% of the time is spent complicating things. Tune into the rest of the episode above to find out how to strip-away the superficial niceties and build an organisation that values its staff and has better outputs, from the ground up.