Buurtzorg: The Dutch Company That Proved You Might Not Need Managers

Most companies assume that growth requires more management. More employees lead to more supervisors, more departments, more meetings, more reporting, more layers of approval and, eventually, a much thicker organizational chart. Buurtzorg, a Dutch home-care company founded in 2006, took almost the opposite approach.

Its basic idea is deceptively simple: skilled professionals probably know how to do their jobs better than layers of managers do.

Instead of building a conventional hierarchy, Buurtzorg organizes its nurses into small, largely self-managing neighborhood teams. These teams decide how to divide their work, organize schedules, coordinate care and solve day-to-day problems themselves. There are coaches available when teams need help, but they do not function as traditional bosses. The central office exists mostly to support the teams rather than direct them.

That sounds like the kind of management experiment that might work beautifully in a tiny startup and collapse the moment the organization becomes large. Yet Buurtzorg grew from a handful of nurses into an organization employing more than 14,000 professionals, while attracting international attention from healthcare systems, management researchers and companies interested in self-management.

What makes the model interesting is not simply that Buurtzorg removed managers. It changed what management actually means.

Founder Jos de Blok had worked as a community nurse and had seen Dutch home healthcare become increasingly fragmented and bureaucratic. In an effort to improve efficiency, many organizations began dividing care into discrete tasks. One person might administer medication, another might help with bathing, another might handle paperwork, while managers and planners coordinated the pieces from above. On paper, this could look highly efficient. In practice, patients often saw a rotating cast of caregivers, while nurses lost much of the professional autonomy that had made the work meaningful.

Buurtzorg was designed as a direct response to that system.

Its teams are small enough to remain genuinely human. A typical group is responsible for a limited number of patients in a local area, which allows nurses to know the people they care for rather than simply complete isolated tasks. The team collectively handles many responsibilities that would normally belong to management, including scheduling, coordination, recruitment and internal problem-solving.

This is where the model is often misunderstood. Buurtzorg is not a company where employees simply do whatever they want. Autonomy comes with responsibility. Decisions are pushed closer to the people who actually understand the work, but those people are also expected to manage the consequences of those decisions.

The company’s central structure is intentionally lean. Administrative functions exist, but they are designed to remove friction rather than create it. Technology plays an important role here. Buurtzorg developed its own internal digital platform to help teams share information, manage patient records, organize schedules and monitor outcomes without requiring a large administrative bureaucracy.

That distinction matters. In many modern companies, technology is used to monitor workers more closely. At Buurtzorg, technology is used partly to make supervision less necessary.

There is another aspect of the company that makes its philosophy unusually compelling. Buurtzorg does not define success simply as providing more hours of care. Its nurses actively try to help patients become as independent as possible. They work with families, neighbors, doctors and other professionals to build a support network around the patient. In some cases, success means that the patient eventually needs less professional care.

That creates an unusual tension from a conventional business perspective. A service company normally has a financial incentive to sell more service. Buurtzorg’s model is partly built around reducing the client’s dependence on the organization itself.

The fact that this approach scaled is perhaps the most interesting part of the story.

Large organizations usually become large by making their internal units larger and adding more layers of coordination. Buurtzorg largely did the opposite. It grew by replicating small teams. Instead of building one enormous machine, it created hundreds of relatively autonomous units operating under a common philosophy.

That allowed the organization itself to become very large while much of the daily work remained local, personal and manageable.

The model has attracted considerable study because of its results. Buurtzorg has been associated with high levels of employee and patient satisfaction, relatively low staff turnover and strong professional engagement. Researchers and public institutions have also examined whether the model can reduce costs by lowering administrative overhead and helping patients regain independence more quickly. The results are not universally identical across every study, and it would be simplistic to present Buurtzorg as a magical formula for every organization. Healthcare systems differ, labor markets differ and not every profession can operate with the same level of autonomy.

But that is not really the most important lesson.

The interesting question Buurtzorg raises is whether many organizations have far more management than the work itself actually requires.

Every approval creates friction. Every unnecessary report consumes time. Every decision that must travel upward and then back downward adds delay. Businesses often respond to these problems by adding more software, more process and more oversight. Buurtzorg attacks the problem from the opposite direction: what if fewer decisions required permission in the first place?

That makes trust more than a cultural value. It makes trust part of the operating system of the company.

The phrase “company without managers” is catchy, but it is also slightly misleading. Management functions still exist inside Buurtzorg. Scheduling still happens. Conflicts still have to be resolved. Performance still matters. People still need direction and information. The difference is that many of those functions are distributed across the team instead of concentrated in a permanent managerial layer.

Responsibility did not disappear. It moved.

That is probably why the model is harder to copy than it first appears. Removing managers is easy. Building an organization in which people have the information, skills, discipline and confidence to manage themselves is much harder.

Still, Buurtzorg offers a powerful reminder that hierarchy is not the same thing as organization. A company can be disciplined without being heavily controlled, structured without being bureaucratic and large without turning every employee into a tiny component in a managerial machine.

The most useful question Buurtzorg leaves behind may be a simple one: how much of the structure inside a company exists because the work truly requires it, and how much exists simply because that is how companies have always been built?

Sometimes the most radical business innovation is not adding another system.

It is discovering that you never needed one.