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Social work entrepreneurship and Buurtzorg model



Kirjoittanut: Ariel Cohen - tiimistä SYNTRE.

Esseen tyyppi: Akateeminen essee / 3 esseepistettä.
Esseen arvioitu lukuaika on 11 minuuttia.

Social work entrepreneurship and the Buurtzorg model. 

Ariel Cohen

 

Introduction 

 

Social and health services are a range of public services provided by the government. Its intent is to provide help and support to groups or individuals in need of help and assistance. Social services are aimed at assisting disadvantaged, defenseless, and struggling people and families. Helping those who are poor, disabled, or ill is at the core of social services and welfare. Typically, children, parents, elderly and disabled people are the most significant social service recipients while health services conclude everyone.  

 

In Finland, it is mandatory for the government and municipalities to provide these services for their citizens and make sure they are working well. Although municipalities are the main provider of social services, there is room for private social service companies to sell their services to them. Since it is mandatory by law (Kansanterveyslaki 1972/66), if municipalities don’t have the resources to provide these services, they are obligated to buy them from the private sector. The share of enterprises and organizations in the production of social and health services has been steadily increasing during the 2000s. Private providers account for just over a quarter of all social and health services. (Sosiaali- ja terveysministeriö) 

 

With an aging population, the need for social and health services will continue to grow. To meet this demand, private services are also needed. The expertise of good quality has been seen as a sufficient means of survival in the sector. However, as competition intensifies, quality of service is seen as having a clear link with customer satisfaction and thus to the company’s performance. Services developed through expertise are often similar, especially in the social sector, which is heavily regulated by legislation. Therefore, the quality of the service is the key to where image differences can be created. (Lehtinen & Niinimäki 2005,14–24.) 

The most common private social services are sheltered housing for the elderly, home care for the elderly and disabled, institutional and family care for children and young people, and daycare for children. (Sosiaali- ja terveysministeriö). 

 

Why Finland needs more private social service entrepreneurs? 

 

Social services in Finland are in constant turbulence. The social climate and attitudes have hardened. Political decisions and cuts have led to disproportionate situations for the most vulnerable in society. Social workers support the most vulnerable groups in our society, who are hardest hit by changes and cuts. Professionals have also had their share of the cold snap, for example in the form of cuts in working conditions brought about by competitiveness agreements. Employees are drowning to work since there is not enough working power and salaries are really bad.  

The decreased birth rate has been much discussed, but its impact on labor starts to affect it mostly in the 2040s. Even before then, population aging and the growing demand for labor will cause major changes to our service system. It is estimated that the social assistance sector would need around 200 000 new workers over the next 15 years to replace those retiring and to meet the growing demand for services. At the same time, the number of people aged 75+ will increase by around 338 000 by 2035. It opens many new opportunities for entrepreneurs. (Työ- ja elinkeinoministeriö) 

This graph shows how the money is divided into social services and you can see clearly how big of a chunk elderly people take from that. It continues to rise to huge amount in the future.

 

(Sosiaali- ja terveysalan tilastollinen vuosikirja 2021) 

 

The unique aspect of social entrepreneurship is that it frequently works closely with the public sector. Companies sell their services to municipalities and partially directly to clients in the private sector, which supplements public services (Jaakkola 2019, 127.) The requirements of the clients who use their services and the state of the economy have an impact on private social entrepreneurs. The importance of municipal services is acknowledged by Finns, but the importance of services that facilitate daily life is rising, and private services are being employed to complement or supplant municipal ones. A continual stream of new services and products are also being developed. Entrepreneurs benefit from the ability to network and offer top-notch, adaptable services to various clients. Networking is crucial for quality and for the entrepreneur’s capacity to adapt to market developments. (Kainlauri 2007, pages 10–11) 

 

Social care clients now have more choices and services are more diversified. For professionals, privatization and self-employment offer the opportunity for professional independence and higher earnings. The entrepreneurial side is seen as interesting because you can work with your own conditions, try new things, and improve but it has backfired since social service experts usually lack good business skills. In addition to good business skills, entrepreneurs need a lot of knowledge about the environment, the needs of the clients, constantly changing legislation and the needs of municipalities. It is therefore not a surprise that new entrepreneurs might face challenges in the start-up phase.  

 

There are two ways of starting as an entrepreneur. First way If you want to provide round-the-clock services, for example, a home care unit, you need to apply for a permit from Valvira. The unit must be staffed by people with appropriate training and skills with necessary skills and knowledge. The person in charge is responsible for ensuring that the services meet the requirements. Processing time of the application will take about 2 months and will cost approximately 4500.  

Another way is to apply for a permit straightly from the municipality where you want to start the business. It applies to services that are not round the clock, for example, home visits for the elderly or disabled. (Valvira) 

There are many ways of making your company valuable and different from others, but here l will focus mainly on the revolutionary Buurtzog model, and how it changed this field of business.  

 

Buurtzog model 

 

As talked earlier, since the aging population is growing at a rapid speed, the private sector grows with it and there will be more competition in the market for private social services, but how do you actually make sure that you outperform every other company and give the best care out there? This is an obstacle that many companies stumble on, for them, it is all about how to maximize profit and forgetting the core values behind this work.  

What if home care was completely reorganized? What if it was done 35 % cheaper? But at the same time, the workers would be hugely enthusiastic about their work, and the quality of life and mental health of the clients would be improved. Sound too good to be true? This is the revolution that Buurtzorg is making in the Netherlands. (Martela 2015) 

Buurzorg was founded in 2007 in the Netherlands with a team of 4 nurses who got frustrated working in traditional home care, where the command and control screwed up the delivery of good care. Since that Buurzorg has been the fastest growing organization in the Netherlands, were already in 2015, was over 9500 nurses and revenue of over 300 million. In the same time, it has taken over 70 % of the sector. The main values of Buurzorg are self-direction and the freedom of the employees to do their work as they wish. In fact, Buurtzorg is so self-reliant that despite employing close to 10,000 people, there are no managers and only 45 employees work in the office. The rest of the company is structured around twelve-person, self-managed teams. Twelve caregivers are in charge of one area, and they decide how to organize the job, spend the money, discover clients, and plan other aspects of the work on their own. When necessary, coaches and players from other teams provide them assistance, but ultimately it is up to them to make all decisions. Nobody has the authority to command them to do any action. (Martela 2015) 

Employees value independence, and it has been proven when most of the employees shifted from other companies to Buurtzorg and got chosen to be the best workplace in the whole Netherlands, and has the highest average customer satisfaction in the whole country. At the same time, treatment is more effective than elsewhere. On average, clients are in treatment for shorter periods of time and the treatment is more focused on the needs of the client. 

Buurtzorg emphasizes the autonomy of its patients by using highly independent teams. In addition to caring for their customers, each team is in charge of everything else. Choosing which patients to serve, intake, planning, scheduling, leasing and furnishing their office, hiring, selecting which physicians and pharmacies to contact, individual and team training, and so on. The founder and CEO of Buurtzorg stated: “We’d had enough of managers determining how people should do their work. I was convinced that true professionals know when and how to apply their competencies, without the need for managers. […] At Buurtzorg we have no artificial hierarchy; all decisions are made after consultation. If we cannot optimally use our people’s talents, this is a significant waste. Our professionals come up with new ideas. They generate thousands of ideas every day.” (Verweij 2020) 

 

Used by Buurtzorg, the approach of decision-free solutions states that in order to fully maximize the company’s potential, you need to create transparent communication between experts and non-experts and you need to overcome decision-making without any old-fashioned hierarchy. As talked about earlier, teams consist of no more than 12 people who decides everyting by themselves, and with comprehensive IT-System, they are able to communicate with other teams and ask for necessary guidance and support. If you face any kind of new situation or problem with the patient, you can always seek help from others. This creates communication between the experts and the non-experts. This way you can maximize the quality of care and minimize costs. (Verweij 2020) 

 

Teams look out for themselves in almost every aspect, but they are not left completely alone. An essential element in the structure is the coaches provided by Buurtzorg, who provide guidance and keeps the teams to stay in the right track. These coaches are indispensable, but they have absolutely no decision-making power. Coaches are not responsible for the outcomes of teams and the final choices are made by the team, even if the coach knows a better solution. Most of the support the coach is giving is to ask insightful questions and reflect on the team’s results. There are many similarities with Proakatemia (Tampere University Of Applied Sciences), where the old-fashioned teachers are replaced with coaches, who don’t have decision-making power in the team. (Verweij 2020) 

 

When teams face any conflict, they use Nonviolent Communication, where the idea is to create a genuine human connection between parties in conflict for them to find a mutually agreeable solution. Compassion and empathy play a key role in a true understanding of others. If the team can’t solve a conflict, a coach or external facilitator is called to help. In rare cases, if the other person comes to the conclusion that the trust is broken and there is no chance for any mutual agreement, they can ask help from the CEO, to arrange a meeting with him. If even he fails, the team can ask him to put an end to the person’s contract because legally, he is the only one who can do so. (Reinventing Organizations Wiki). 

When Buurtzorg is using self-managed teams with flat hierarchy, where teamwork and culture are the keys, “it leaves no room for societal bias. Expertise has no color, is genderless, and without form, name or title”. (Verweij 2020). Buurtzorg may be the first organization in the world that might achieve superior performance without a lack of autonomy, trust issues, freedom, responsibility, racism, or discrimination.  

What if every company would do it? Would it work in every field of business? Might seem like a utopistic thought, but surely something to think about. What if giving employees autonomy, freedom, chance to influence the organization and creating transparent communication between employees and employers would improve every organization’s success? We surely don’t know, but at least it seems worth trying.  

 

Observations as a social worker 

 

I’ve worked with disabled and elderly people since 2015, in three different companies and in the private sector straightly with the customer. During these many years, I’ve done a lot of observations about that field of work and formed strong opinions about the pros and cons. This is my point of view, based on my own experiences working as a social worker. From a young age, I’ve always been interested in working with different people and offering my help and caring. Due to my good ability to empathize and being a genuine human being, l think I’ve done a good job in that. My dream was to continue to work in that field, but the issues with low salaries, getting into a better position, work conditions, and how organizations were managed did their part in choosing not to start a career there. I didn’t know about the possibility to start working as an entrepreneur and selling your services directly to municipalities or private persons.  

 

Starting from cons, since there are more of them. I won’t go into details about what companies I’m talking about so l won’t get fired. Here are my thoughts and gathered reviews from others who are working for the same company. l am talking about one of the biggest companies in this field of business. 

Pros 

Salaries are the worst possible out there, people are getting paid the bare minimum and the amount of rise that you get after 5 years of duty, is less than 1 €. There is no introduction to the work or the customers, so employees are going to customers without any knowledge about their conditions, and without proper introduction, they might face situations, where they didn’t prepare or simply do not have the knowledge to do. This might lead to dangerous situations. Employees are sent to customers arbitrarily, with the mindset to get the job done in one way or another. With no proper planning of shifts, you might have a situation where you need to visit 4 customers per day and use half of the day for transfers, and of course, you aren’t getting paid for the time you are traveling. Due to a lack of workers, they are taking almost everyone for the job, for example, it does not make sense to send an immigrant, without the ability to communicate in either English or Finnish, to an elderly or disabled person, who is having a hard time to say what do they need even in Finnish or send small women to lift up big men out of their beds. It just does not make sense but no one cares as long as the money comes in. There are constant changes in the supervisors, and the pressure of the work is too much for them. No communication between supervisors or employees. Employees might need to do tasks that are against the law without a proper degree because someone needs to do them. The fun part here is, that without a proper degree, you can’t get paid more, but you still might need to do the tasks. 

 

There is a constant lack of workers since the working environment is so bad. No one cares about the employees and the patients are seen as objects, just a way to earn more money. Salaries often might be paid wrongly and you need to pay attention to every pay slip. 

 

Cons 

The ability to choose your shifts is great. You can choose whatever shifts you want to since there is so much work available and no employees. For example, It works great as a part-time job for students.  

These are not just things from my point of view or only from my company. After consulting many social service employees, from different companies, they could agree with my thoughts and observations. Many things are going in the wrong direction and there are a lot of things to improve, like talked about earlier, the amount of social service needed in the future will grow a lot. Maybe this is the time for the leaders and politicians to look into the mirror and start to question what is more valuable. Good care of human beings or money. 

 

 

Conclusion 

 

The need for help is growing at a fast pace. Employees are fighting for better conditions and no changes are seen. Seems like there just isn’t enough money to support this system well enough and the results are seen. More and more employees are fleeing away and the number of applicants for schools is reduced. What happens to our society if we just can’t produce enough professionals to fill in the blanks? We need to change this system by giving people meaningful and good jobs and making sure the conditions are good enough for them to continue their valuable work. Buurtzorg is a good example of an alternative system that could work for us.  

 

References

 

Jaakkola, H. 2019. Valitse innostus. Voimakirja sosiaalialalle. PS- kustannus. Otavan Kirjapaino Oy. Keuruu. Read on 11.11.2022 

 

Kansanterveyslaki. 66/1972. Read on 20.11.2022 

https://www.finlex.fi/fi/laki/ajantasa/kumotut/1972/19720066

 

Kainlauri, A. 2007. Ideasta hyvinvointialan yrittäjäksi. WSOYpro: Helsinki. Read on 19.11.2022

 

Lehtinen, U. & Niinimäki, S. 2005. Asiantuntijapalvelut. Tuotteistaminen ja markkinoinnin suunnittelu. Helsinki: Werner Söderström Osakeyhtiö. Read on 20.11.2022

 

Martela, W. 2015. Buurtzorg ja Itseohjautuvan Työn Vallankumous: Miten Tarjota halvempaa, iloisempaa ja LAADUKKAAMPAA hoitoa? Read on 29.11.2022 

https://frankmartela.fi/2015/08/04/buurtzorg-ja-kotihoidon-itseohjautuva-vallankumous-miten-tarjota-halvempaa-iloisempaa-ja-laadukkaampaa-hoitoa/ 

 

Reinventing Organizations Wiki. Read on 29.11.2022 

https://reinventingorganizationswiki.com/pl/cases/buurtzorg/ 

 

STM. Yksityiset sosiaali- ja terveyspalvelut. Read on 17.11.2022 

https://stm.fi/yksityiset-sotepalvelut 

 

THL. 2021. Sosiaali- ja terveysalan tilastollinen vuosikirja. Read on 9.11.2022 

https://www.julkari.fi/bitstream/handle/10024/143537/SVT_SOSTERIVK%202021_sivu%2099%20korjattu_24.10.2022_s.pdf?sequence=13&isAllowed=y 

 

TEM. 2020. Sosiaali- ja terveysalan toimintaraportit. Read on 15.11.2022 

https://julkaisut.valtioneuvosto.fi/bitstream/handle/10024/161994/TEM_2020_01.pdf 

 

Valvira. 2020. Yksityisen sosiaalihuollon luvat. Read on 12.11.2022 

https://www.valvira.fi/sosiaalihuolto/yksityisen_sosiaalihuollon_luvat/ilmoituksenvarainen_toiminta 

 

Verweij. J. 2020. The outrageous success of “Buurtzorg” is easy to explain and hard to replicate — and there is still plenty of (spectacular) potential! Read on 19.11.2022 

https://www.linkedin.com/pulse/outrageous-success-buurtzorg-easy-explain-hard-still-jorn 

 

 

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