Nijmegen School of Management
Bachelor Business Administration
Academic year 2023-2024
Organisation Theory
MAN-MOR001
Assignment for week 03 - Organizational Design
Organigram
Buurtzorg operates as a self-managing business model characterized by a flat and decentralized
organizational structure. In the following, I have attempted to outline their organizational
framework (Gray et al., 2015)
Figure 1: Diagram showing Buurtzorg’s flat organizational structure.
As outlined in Gray et al.'s (2015) article, nurses hold the responsibility for their patients' care.
These nurses form self-managing teams, typically comprising up to 12 members, leveraging a
comprehensive IT system. This system aids in patient scheduling, nursing assessments
documentation, and billing, facilitating seamless information exchange among different selfmanaging nursing teams. Additionally, coaches are available to support these nursing teams,
assisting in problem-solving. Notably, the article underscores that the nurses do not report to the
coaches, reinforcing Buurtzorg's flat organizational structure. Finally, a small back office handles
administrative duties (Gray et al., 2015).
Buurtzorg’s approach to the six fundamental problems of organizing.
Task Division
Martella's analysis (2019) explains two organizational approaches: the top-down (bureaucratic) and
the bottom-up (self-managing) regarding task division. Buurtzorg exemplifies a decentralized
structure where nurses hold responsibility and authority for task division (Gray et al., 2015). Here,
nurses actively contribute to organizing and distributing tasks, deviating from strict top-down
directives (De Blok, 2014). Furthermore, nurses can propose changes, fostering a bottom-up
approach. Therefore, Buurtzorg's task division closely aligns with Martella's principles of a selfmanaging organization (Martella, 2019).
Task Allocation
Martella's insights (2019) highlight the differing approaches to task allocation: bureaucratic
organizations favor a top-down method, whereas self-managing entities opt for a bottom-up
approach. Nurses at Buurtzorg possess significant authority to delegate tasks based on individual
strengths and interests within their teams (Gray et al., 2015). As a result, Buurtzorg's task allocation
resonates with Martella's principles of a self-managing organization (Martella, 2019).
Rewarding Desired Behaviour
Martella's insights (2019) distinguish between approaches to employee motivation: bureaucratic
organizations lean toward monetary rewards and career progression, whereas self-managing entities
prioritize intrinsic motivation through increased work autonomy (Gray et al., 2015). Buurtzorg's
system focuses extensively on intrinsic motivation beyond monetary rewards. Nurses are motivated
by the autonomy in patient care and manage their education budgets accordingly (De Blok, 2014).
This aligns closely with self-management principles (Martella, 2019).
Addressing Free Riding
Martella's research (2019) distinguishes between bureaucratic organizations where managers
monitor tasks and self-managing setups where colleagues hold each other accountable. Buurtzorg
relies on mutual accountability and peer monitoring, emphasizing teamwork and collaboration to
address free riding (De Blok, 2014). This showcases Buurtzorg's adherence to principles of selfmanagement.
Providing Direction
Martella (2019) explains that in bureaucratic organizations, employees often lack comprehensive
information due to heavy standardization of tasks that don't necessitate insight into the
organization's overarching goals. In contrast, Martella (2019) highlights transparency as a key
principle in self-managing organizations, where all employees have access to key information
facilitating decision-making. Buurtzorg places a significant emphasis on transparency, granting
employees access to organizational objectives (De Blok, 2014), aligning with Martella's (2019)
principles of a self-managing organization.
Ensuring Coordination
Finally, according to Martella (2019), bureaucratic organizations rely on standardized tasks for
coordination, minimizing the necessity for active coordination. Conversely, self-managing
organizations prioritize ongoing communication and open dialogue for coordination, often utilizing
extensive IT systems. In Buurtzorg, coordination occurs within decentralized teams that regularly
exchange information and experiences through IT platforms, facilitating seamless collaboration (De
Blok, 2014). Evidently, Buurtzorg's approach closely aligns with Martella's (2019) principles of a
self-managing team.
Humanity over Bureaucracy
Clearly Defined Division of Labour
Division of labour involves assigning tasks based on specialization (Clegg et al., 2021). Buurtzorg
operates with self-managing teams of nurses responsible for a broad spectrum of tasks without
strictly defined roles (De Blok, 2014). Consequently, there's a departure from strict labour division
found in bureaucracies.
Hierarchical Structure of Offices
This principle pertains to a structure where lower offices report to higher ones, implying a top-down
flow of decisions (Clegg et al., 2021). Buurtzorg, unlike typical bureaucracies, employs a flat
organizational hierarchy, notably seen in the self-managing nurse teams seeking guidance from
coaches but not reporting to them (De Blok, 2014; Gray et al., 2015).
Written Guidelines for Prescribing Performance Criteria
Bureaucracies rely on formalized written rules for task execution to ensure consistency (Clegg et
al., 2021). Buurtzorg, on the contrary, emphasizes nurse autonomy, requiring adaptation of
approaches based on individual patient needs (De Blok, 2014).
Recruitment to Offices Based on Specialization and Expertise
Bureaucracies prioritize meritocracy in recruitment (Clegg et al., 2021). Similarly, Buurtzorg
employs nurses based on competence, aligning with bureaucratic principles.
Duties and Authority Attached to Positions, Not Persons
Bureaucracies tie authority to positions within the organization (Clegg et al., 2021). Buurtzorg's
decision-making process involves collective input, deviating from bureaucratic authority structures
(Gray et al., 2015).
Office Holding as a Career or Vocation
Bureaucracies have a structured career progression system (Clegg et al., 2021). Buurtzorg lacks a
clear career path, emphasizing individual growth through self-development and continuous learning
(Gray et al., 2015).
In summary, Buurtzorg markedly deviates from the traditional bureaucratic organizational structure
across all six principles. Hence, it prioritizes humanity over bureaucracy.
Contingency Factors
Environmental Stability
Operating in the healthcare sector, Buurtzorg faces a highly dynamic and evolving healthcare
landscape. Founder Jos de Blok emphasizes the complexity of the current healthcare system,
characterized by rigid structures that impede effective patient care and nurse-patient relationships,
ultimately impacting care quality (De Blok, 2014). Buurtzorg's environmental stability is notably
low due to intense competition within the sector, despite potential differences in approaches to
client engagement.
Technological complexity
Buurtzorg utilizes a single IT system to aid nurses and facilitate information sharing. With the
utilization of an IT platform and an online e-learning platform, Buurtzorg has a moderate level of
technological complexity (De Blok, 2014).
A polar contrast to Buurtzorg's dynamics is Coca-Cola, a company operating in a relatively lowcompetition environment with stable demand and limited product changes. Given their differing
industries and contexts, adopting Buurtzorg's organizational structure would be considerably
challenging for Coca-Cola. Buurtzorg's strength lies in personalizing care for each patient, an
approach unfeasible for mass production companies like Coca-Cola, which aim for uniform
products rather than tailored offerings.
References
Clegg, S. R., Pitsis, T. S., & Mount, M. (2021). Managing and Organizations (6th ed.). SAGE.
De Blok, J. (2014). Buurtzorg Organisational Structure. In RSA. https://www.buurtzorg.com/aboutus/our-organisation/
Gray, B., Sarnak, D., & Burgers, J. (2015). Home Care by Self-Governing Nursing Teams: The
Netherlands’ Buurtzorg Model. Commonwealthfund.org. https://doi.org/10.26099/6CESQ139
Martela, F. (2019). What makes self-managing organizations novel? Comparing how Weberian
bureaucracy, Mintzberg’s adhocracy, and self-organizing solve six fundamental problems of
organizing. Journal of Organization Design, 8(1). https://doi.org/10.1186/s41469-019-0062-9