WeCare: The District Nurse and Self-Organising Home Care Teams – When Efficiency Meets Professional Discretion

In late 2016, Bas Smit, CEO of WeCare, a large Dutch regional care organisation providing home care, intramural nursing home care and extramural social care, had just returned from a high-level funding session organised by the Dutch Healthcare Authority. In addition to people from the care sector, the meeting included representatives from insurance companies, government agencies and healthcare providers—all there on a rainy afternoon to assess recent attempts by care providers to improve the quality and personalization of home care while cutting costs.

Although all agreed on the move towards more local embedding with increased responsibility for nurses in neighbourhood-based, self-organising teams, there had been debate on precisely how to embed the teams in the organisation and their neighbourhoods. While some had argued for self-managing teams, following Dutch care organisation Buurtzorg’s very successful approach (ref) with completely autonomous teams, Smit believed that WeCare’s embedded self-organising teams featuring district nurses improved possibilities for local coordination.

This case explores WeCare’s model of self-organisation and addresses key challenges in dealing with issues of innovation, costs and efficiency, quality of care and the job quality of care workers. This case shows the complex regulatory and financial environment in which an existing home care organisation aims to develop and adapt by introducing self-organising teams.