Buurtzorg: the district nurses who want to be superfluousBMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3140 (Published 06 July 2017) Cite this as: BMJ 2017;358:j3140
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The piece about the Buurtzorg concept of social and nursing care in the community almost had me misty eyed with hope for the future. In truth there can be few challenges which are more important and pressing than resolving this issue in the UK. And resolve it we must or the logistic and financial impact will bulldoze every other resource hungry health agenda out of the way.
The Dutch approach has almost re-invented the concept of Mission command. The Prussian-pioneered mission-type tactics doctrine, combining centralized intent with decentralized execution subsidiarity. Promoting freedom, speed of action, and initiative, within defined constraints.
Crystallised by Moltke in the 19th century 1: A favourable situation will never be exploited if commanders wait for orders. The highest commander and the youngest soldier must be conscious of the fact that omission and inactivity are worse than resorting to the wrong expedient
The Key tenets of Mission command being
• Build cohesive teams through mutual trust
• Create shared understanding
• Provide a clear commander’s intent
• Exercise disciplined initiative
• Use mission orders
• Accept prudent risk.
There can be no greater accolade for De Bok et al who have achieved so much, than to have a number of nations try and copy him.
Sadly cynicism crept in when I read the statement within the article “Buurtzorg will need to fit into the UK system.” No doubt the person who said this is still trying to ram their DVD disc into a Beta max VCR in the hope it will work when it hasn’t done for the last 20 years. For this single statement encapsulates all that is wrong with the Royal National Shakespeare Health Service, because the notion that the UK system may need to fit in with Buurtzorg is not considered. It probably would be a bold paradigm shift, which, defines its aims of making the district nurse superfluous but in the process may also make some of the expensive parasitic hierarchy extinct.
1 Dupuy, T. N. (1977). A Genius for War: The German Army and General Staff, 1807-1945. London: Macdonald & Jane's. p. 116. ISBN 0133511146.
Competing interests: No competing interests