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Amber · With caveats Home care · NL since 2006 ~14,000 employees, >70,000 clients

Buurtzorg

The model still works - the funding system does not pay for it

Buurtzorg remains the largest working example of self-organisation above 10,000 people: teams of up to twelve, no team leaders, about twenty coaches, a back office of around fifty. The cracks in 2026 are not in the model. They are in the tariff system, the succession and the transfer abroad.

Last reviewed: 16 September 2026

Why this status

A loss of roughly EUR 8-9m in long-term care in 2025, an intake stop in two regions since February 2026, a dynastic succession and failed subsidiaries abroad. Cite it, but never without the cracks.

What makes it a Beta case

Teams of ten to twelve nurses serve about fifty clients in a defined neighbourhood and do everything themselves: intake, planning, holidays, hiring, office rent, contact with doctors and hospitals. A team that outgrows twelve splits.
No team leaders and no middle management. About twenty regional coaches, each for forty to fifty teams, have no decision rights, no targets and no bonuses - they ask questions.
A back office of roughly fifty people in Almelo for the whole organisation. The intranet BuurtzorgWeb carries knowledge, peer advice and all team figures, openly and not anonymised.
One steering number: the share of billable hours, which teams calculate themselves. Monthly team rankings are public; there are no budgets, only a cash-flow projection of how many new teams the organisation can afford.

What is documented

Scale: about 14,000 employees (9,000 in nursing teams, 5,000 in domestic-help teams), more than 70,000 clients, client satisfaction 9.2 out of 10, turnover around EUR 400m (Kwaliteitsbeeld 2024; interviews 2024).
Fewer hours per client: 73 hours a year against a national 85, with about 30% of all district nurses and about 15% of care volume (Buurtzorg 2024/2026).
No re-centralisation is documented: no regional managers, no top-down budgets, coaching span unchanged. Central decisions exist (no freelancers from 2025, a central pay grade in 2022) but they set the frame, not the work.
Independent evaluation (KPMG/Plexus 2015): fewer hours per client and the best patient experience, but total system cost including hospital and nursing home only average.

Where it cracks

Money: a loss of about EUR 8m (Skipr, February 2026) to EUR 9m (Zorgvisie, March 2026) on long-term care in 2025; a gap of roughly EUR 10 per hour; intake stop for new long-term-care clients in Leiden and Salland; up to 8,500 clients affected if no tariff agreement is reached. Earlier losses: EUR 4.7m in 2016, more than EUR 7m in 2022.
The cause is structural: the model uses fewer but higher-qualified hours, and the hourly tariffs punish exactly that skill mix. A superior internal structure does not beat a hostile payment regime.
Succession is dynastic: Joost de Blok (son) has been co-director and designated successor since December 2023, Thijs de Blok (son) runs Buurtzorg International. Laloux himself describes Jos de Blok as the last instance in conflicts and the only person who ends contracts.
Transfer abroad failed: Buurtzorg Germany went insolvent in February 2022 (thirteen sites, only Munich survived), UK pilots were "absorbed back into their organisations", the US arm withdrew. The model is bound to the Dutch funding and training environment.
Evidence gaps: the scoping review by Hegedüs et al. (2022) finds no reliable cost-effectiveness data outside the Netherlands; the "Best Employer" title dates from 2011-2015 and has not been won since; current sickness-absence figures are not published.
Against the BetaCodex yardstick: no value-creation accounting per team, a fixed input target (60-65% billable hours) instead of relative outcome measures, and team size twelve against the recommended six to eight.

Verdict

Buurtzorg is still the case that shows self-organisation at scale is possible. It is no longer the case that shows it pays. That is not a failure of the model; the losses sit exactly where the tariff system prices hours instead of outcomes. But a case that needs a paragraph of explanation is not an opening case, and a succession that goes to the founder's sons is the Getz trap, not the Gore proof of person-independence.

For a talk

Beta works at ten thousand people - as long as the payer pays for outcomes and not for hours.

Sources

Website: buurtzorg.com