Do we need bosses? This CEO says we need to rethink workplace structures for young people and our mental health

What’s the secret to a more engaged, effective and happier workforce? Doing away with managers and allowing teams to self-organize.

So says Jos de Blok, the founder and CEO of Buurtzorg, an innovative Dutch nursing organization that employs more than 15,000 nurses offering community-based care services around the globe.

Many countries are facing a crisis in care due to ageing populations and staff shortages. A World Economic Forum white paper has found that investing in care could fill unmet demand for healthcare, boost social mobility and drive economic growth.

But the way care is organized needs to be transformed to increase productivity and capacity, said de Blok at a Davos 2022 session on the Jobs of Tomorrow.

“All over the world, only 20% of workers are engaged [with their work], and that’s a very big problem because it leads to less productivity but also less health.

“In my opinion, we need to create working conditions where people can adapt new ideas in a flexible way, they can learn all the time … and where the organizational structure leads to more effectiveness.”

In 2006, de Blok and three colleagues set about trying to simplify the healthcare system in the Netherlands, by empowering nurses to focus on helping clients with self-support and independence.

It scaled quickly from 1 to 870 self-organizing neighbourhood teams, across 24 countries.

Buurtzorg’s “onion model” puts clients at the centre. “The professional attunes to the client and their context, taking into account the living environment, the people around the client, a partner or relative at home, and on into the client’s informal network,” the company’s website says.

Teams of 12 people involve the client in developing solutions that suit them, which depend on each individual’s formal and informal networks. The teams decide themselves how to organize their work, share responsibilities and make decisions.

By changing the model of care, Buurtzorg achieved “a 50% reduction in hours of care, improved quality of care and raised work satisfaction for employees”, according to a 2012 case study by KPMG.

“We need to increase flexibility for workers by letting them decide how they want to learn and how they can contribute to the workplace,” says de Blok.

“If they feel ownership, they will be of more use to the company they’re working in. I believe that 40 or 50 years of top-down thinking has created a lot of damage for a lot of people. In Holland, we have two million people with depression problems. I think that’s a big problem all over the world, that we create depression by our working conditions. If we improve working conditions, people will be happier, more productive, more flexible.”

In 2016, before COVID-19 put even greater strain on the world’s healthcare systems, the World Health Organization (WHO) published its Global Strategy on Human Resources for Health: Workforce 2030.

There are expected to be around 40 million new health-sector jobs by 2030, the WHO estimated. Most of these will be in middle and high-income countries, but there will be a shortage of 18 million workers in lower-income countries, it said.

Buurtzorg’s method could increase productivity on a national level by 30%, says de Blok. This could help to address capacity issues, as well as offering a structure that’s more attractive to the workforce of the future.

“We have created a lot of bureaucracy, very complex systems, that teachers and healthcare workers have to administer. [But] you can use this time for productive services,” he says.

“All the MBAs are teaching the same thing, we have to think about strategic management, operational management and so on – and that’s not the world we live in today. Young people want jobs that are attractive and to feel there is meaning in their work. If you do that, then people are growing and productivity is growing.

“In 20 to 30 years, we will have double the number of over-70s in many countries, so if we don’t change the way of working, we won’t have the people to serve them.

“If you look at demographics in a lot of different countries, it’s all the same. The scarcity of healthcare workers is already there, the frustration with the systems is already there. We need to change systems to increase the flexibility of the capacity, and we need to create more attractive workplaces by giving more autonomy, freedom and more ownership to healthcare workers.”

Levels of staff satisfaction and commitment are consistently high among Buurtzorg nurses. This is partly because they are paid well, but there is more to it that that, says de Blok.

“Are we willing to reward [healthcare workers]? Are we willing to increase their salaries? What we’ve seen throughout the years is that salaries are under pressure. What we did is raise salaries, and by raising salaries results increased.

“We have wrong assumptions about efficiency and effectiveness. By reducing the focus on efficiency, effectiveness grew and results grew.

“We have the highest-paid workers in the country, but we had a lot of comments from colleagues who said, ‘If you are raising salaries, then we are under pressure,’ and I said ‘No you can do the same, you only have to change the structure of your organization – less people in overhead roles, and more focusing on the primary process’.

“Throughout the last 50 years, we have disintegrated so much that the labour force has become less and less effective. Look at healthcare or education systems – all the different tasks have been cut into pieces, we are focusing on processes and tasks instead of results.

“So if you focus on outcomes and you integrate these different roles, it will become more attractive, more effective and we’ll need less people for more activities.”

Self-organizing team structures have their roots in agile software development practices, which follow the principles of the Agile Manifesto, published in 2001.

Critics say leaders often emerge in self-organizing teams, while project management software provider Wrike notes it’s harder for organizations with a strict hierarchy, such as banks.

But de Blok says only those who understand that this is a “different paradigm” will be successful – and trust and humanity are central.

“It’s very important that you realise it’s a different paradigm. It’s a culture, behaviour and a lot of elements together.

“Frederic Laloux wrote a book called Reinventing Organizations and he shows the way we think about organizations will change over time, it’s changing already because a lot of younger people feel very familiar with these ways of working.

“We build one company after another based on the same principles, putting trust and humanity at the centre, because that’s where it starts, not ‘we will make more profit if we do this and that’.

“People who don’t see it won’t be successful at changing. [But] if you’re concerned about how people are learning and working, and health is the focus, then you will change. The principles are very simple, but we’ve made the world so complex that it’s very difficult to think simple. That’s our biggest problem.”