TICC: Transforming Integrated Care into the Community Annual Conference

The Dutch Buurtzorg model of holistic neighbourhood care is going
global across 2 seas region
Come and meet the partners - Hear the stories about their pilots and get full understanding of all principles and values underpinning the Buurtzorg Model

TICC is organising its annual event during AgeingFit on January 30th, 2019 in Lille, France from 2.00 pm to 5.00 pm. 

Testimonial - Buurtzorg Concepts BVWhat is the Buurtzorg’s model of holistic care? “Keep it small, keep it simple “ - Core topics: Self-management, coaching, building trusting relationships, IT system supporting holistic care, patient and team satisfaction.

Testimonial from Public World: Buurtzorg story - haring of our lessons learnt in the UK about how to adopt the Buurtzorg model in a different national context and in existing organizations. Reflect on roadmap over pilot sites in UK  successes, challenges before heading to testimonials from delivery partners  

TICC goals and roadmap on pilots in each country each country: successes and challenges
Testimonial by Kent CC & Kent CHFT: One pilot Extramural, Social and Nursing Care Team – “Look after patients, stay in budget, have fun, transforming community care”. 

Testimonial by Medway Community Centre: One pilot Nursing Care team – “Getting back to nursing – the Buurtzorg effect”

Testimonial by Soignons Humains3 extra mural teams, Nursing Care Teams – “starts from the patient perspective, and works outwards to create solutions that enable improved independence and quality of life. The Model empowers patients and encourages self-reliance” – focus on Organizational Innovation by Integrating Simplification. Insights on Flemish partners pilots by Zorgbedrijf Antwerpen and Emmaüs Elderly Care and others French pilots by VIVAT and La Vie Active

What is AgeingFit?
AgeingFit is the first European event entirely dedicated to innovation in the senior care market. For its 3rd edition, on January 29th and 30th, 2019 in Lille, AgeingFit will bring together all the actors who develop, commercialise, use and finance innovations of the sector.
More information about the event:
The Buurtzorg model, a new organizational model of homebased care and services has had a significant impact in the Netherlands, for over 10 years now. It relies on self-managing teams of 12 carers and nurses, based at a neighbourhood level and handling each aspect of care, ensuring their financial sustainability.
Over 2017 and 2018, all partners have come together to best understand the Buurtzorg Model, “Keep it small, keep it simple” to strive for organizational  transformation on Integrated Care into the Community either by creating new teams , extra mural nursing care teams or transforming existing home care service teams.
The Buurtzorg model starts from the patient perspective, and works outwards to create solutions that enable improved independence and quality of life. The Model empowers patients and encourages self-reliance. The teams actively work with volunteers and with the community to involve them in supporting patients and the focus is on preventative measures. The Model empowers patients and encourages self-reliance. The teams are also self-managing.
Buurtzorg organized several workshops on its model, and came to visit organizations and teams over the 3 countries to best share on core values and topics which could help all partners to best assess what it takes to strive for organizational transformation such as Organizational Innovation by Integrating Simplification and key role of coaches for self-managed team, simplification and innovation through digital transformation, but also using OMAHA patient’s assessment tool to make "the invisible visible", supporting holistic care..
Each country has yet started, academic partners HZ University and GHICL will be conducting evaluation on partners pilots to provide data and help building the blueprint learning on barriers and solutions found to deliver on the Buurtzorg model and its implementation of Buurtzorg over 3 countries, multiple sites and organisations.

The Transforming Integrated Care in the Community project partners across the UK, France and Belgium attended a one day Masterclass with Buurtzorg's founder and CEO Jos de Blok.
The workshop focused on organisational change and the importance of putting service users at the centre so that meaningful improvements and lasting changes are made. Starting with the patient first means processes can be made simpler, compared to starting with complex organisational structures. 
Throughout 2017 and 2018, Buurtzorg and Public World jointly organized several workshops on the model, and came to visit organizations and teams over the 3 countries to share the essentials of the both the care and organizational aspects of the model and topics which would help all partners to best assess what it takes to  transform their organizations.
Core topics included: better holistic care through relationships not time and tasks, organizational innovation through relentless simplification, what it means to be part of a self-managing team, the key role of coaches, the role  of digital transformation, the use of the OMAHA patient assessment methodology, and more.
The year was concluded with Public World’s event in London for care professionals and leaders to share early experiences from their pilots and interrogate Jos de Blok on how to successfully adopt Buurtzorg’s way of working.
Meet the Eden Neighbourhood Care Team - Kent CC & Kent CHFT
We are pleased to introduce you to our first Buurtzorg-style team.  
The Eden Neighbourhood Care Team started on Monday November 5th, 2018 and are based in Edenbridge. The team is made up of nurses and care workers, who will be joined shortly by an Occupational Therapist. 
The Eden team has been busy over the last few weeks, completing training to support them to be self-managing and making key decisions about how they will work to meet the needs of the local community. The team has been supported by their coach, and will continue to be as they develop. 
Alongside our team we also have a Coach in place. The role of the coach is very different to a manager, they are there to support and act as a facilitator for the team. In Kent our Coach is Peter Brook. As the team coach Peter has attended training with Buurtzorg in Holland and will continue further training here in the UK.
Meet the Elms Team from Medway Community Healthcare with Buurtzorg Founder & CEO Jos de Blok

“The proof is there in the patients’ experiences – we recently supported a diabetic patient’s wife to do his insulin injections each day. We trained her and left her with a ‘cheat sheet’ and our direct phone numbers if she ran into any difficulties. As a result, he feels more independent, they are proud to be self-managing his condition and they don’t have to worry about a daily nurse appointment. For us, it freed up time to focus on those who need us to see them most. This way of nursing isn’t revolutionary – it’s common (compassionate) sense.”

At MCH, we manage and deliver community nursing across Medway, in Kent. This covers various disciplines including continence, tissue viability, wound therapy, palliative care and more. We work across a population of almost 250,000, across five regional teams and an out of hour’s service. Too often we find that process and locally-set parameters for services stymie us and tie us up. It’s common to leave someone’s house thinking that we could have done a little bit more, if only we were ‘allowed’. We’ve been desperate for some time to get back to ‘proper’ nursing – when we have time and freedom to know our patients; to understand what they have and what they need; and to create the communities and connections around them to enable independence. That’s why we’ve adopted the Buurtzorg model as part of a wider European research project, named TICC (Transforming Integrated Care in the Community).
The Buurtzorg model starts from the patient perspective, and works outwards to create solutions that enable improved independence and quality of life. I’m loath to use the word ‘holistic’ because - much like ‘journey’ – it has a tendency to sound trite and contrived. But in this case, the idea that we consider the whole person is entirely accurate. The Model empowers patients and encourages self-reliance.
The teams actively work with volunteers and with the community to involve them in supporting patients and the focus is on preventative measures. Perhaps most controversially for ‘old school’ methodologists, the teams are also self-managing. They have the authority to make decisions about caseload, recruitment, office, suppliers, roles, budgets, coaching etc all in line with an agreed framework but outside of the traditional NHS hierarchy.
So what, exactly does all this mean for the patient in practice? Well, for example, in recent year’s community nurses aren’t supposed to cut patients’ toenails when it’s needed. Even if the patient in question is elderly, the guidance is to leave it and refer them instead to a podiatry team (or advise that a carer or family member should do it). Under Buurtzorg, the nurse would instead sit down for a chat and find out everything the patient is concerned about or struggling with. One of the principles is ‘coffee then care’ – we talk to the patient and find out how they’re doing, what they need, and how we can help them to feel better. If that means a quick toenail trim while we’re there, so be it.
For us at MCH, the pilot began in September and is initially being adopted across a small patch in Hoo in Medway. The aim is that within a couple of years it’s the standard model for our community nursing, and additional community services across our communities.
Tina Cooper, Laraba Anet and Nicola Walter are three of the newly recruited Neighbourhood Nurses in our TICC pilot and say just two months in, it’s already changing lives: Laraba says: “It is fantastic being able to provide genuinely person-centred care. Having the opportunity and time to get to know our patients, as well as time to care for them, incorporating all of their needs, not just their immediate health is refreshing. Nicola adds, “Work is enjoyable again and we look forward to seeing our patients and providing what they need.
In the course of 2018 we improved our understanding of what Buurtzorg is all about and how it works.  Initially Zorgbedrijf Antwerpen set everything in place to start up a team of family care workers (‘zorgkundigen’) on a campus-setting.
On this campus Zorgbedrijf Antwerpen has a service- and activity centre for senior citizens, service flats and a nursing home. All the services are close together and all the people living or coming to the campus are – by definition – customers of Zorgbedrijf Antwerpen.

By learning more about the Buurtzorg model of which one of the focal points is working and reaching out in a neighborhood, we found out that:
  • A campus-setting wasn’t the most ideal setting in which we could test the model to its fullest
  • If we would only work with family care workers (‘zorgkundigen’) the pilot team would be much like our existing teams.
  • There were already a number of good practices and smaller tests running within Zorgbedrijf Antwerpen, from which we drew some valuable lessons learned that could help to implement and support the pilot team.
So, in the second half of 2018 the decision was made to start with a mixed team (family care and  household support) in a neighbourhood around one of our service centres and not on one of our campuses (which is considered to be too artificial). At this moment the team is being briefed about what is expected from them and the support setting (coach and back office) is put in place so they can start in February 2019.”

The goal of our pilots is “shiny happy people with KISS”. 
At this point, we are running two different pilot sites: one with an existing team in residential care and a second with a newly composed team in home care. 
The first pilot site is in Ten Kerselaere (Heist-op-den-Berg) in two houses for people living with dementia.
Ten years ago we made the transformation towards small scale and normalized living. The focus is on living like you live at home. As a consequence our vision, architecture and organizational model was changed leading also to more responsibility for team members and changed staff profile.
Due to experienced problems with workload, work-life balance on the one hand and the love for care and the wish to have more time for the resident, one team asked if they could re-think their current way of working. Management provided the team the freedom and the opportunity to write their own story. The team is taken responsibility to prepare, realize, evaluate and change their current way of working.
The training session provided by Buurtzorg in autumn 2018 provided the necessary insights, input, and ideas to transform the existed team towards a self-steering team. Changes are introduced step-by-step as requested by the team.
The first tests were performed in December 2018. These tests were evaluated in January 2019. Since mid-January the first changes are implemented.

The second pilot is a newly composed home care team in De Peerle (Duffel).
This home care team provides holistic care for residents living in houses for assisted living and nuns of the monastery.  The team members were mainly recruited from existing staff in our residential care facility. The team started as a self-steering team from the first of January 2019. At this moment the team consists of 5 nurses and 1 coach.
A few milestones have been achieved by Soignons Humains
Three self-managed teams from Soignons Humains are now delivering holistic neighbourhood care in the Hauts-de-France Region in Lomme, Pévèle and Carembault according all principles and values underpinning the Buurtzorg Model.
All three teams have been busy over December, 2018 completing training to be self-managing using Organizational Innovation by Integrating Simplification.
In a self-managing organization, the team members are collectively responsible for the team result. Team decisions are made by consensus, with each team member also taking individual responsibility for the agreements made.
All teams have also been trained to use implementing, simplification and innovation through digital transformation, using OMAHA patient’s assessment tool to make "the invisible visible", supporting holistic care and more both for the patients and families.

Going Dutch? Presenting at the Service Design Conference! 
Delegates from Kent will be attending the Service Design in Government Conference in March 2019. As part of the conference Kent colleagues will deliver a workshop; «Going Dutch? Redesigning Community Nursing in Kent" with Buurtzorg Britain & Ireland.


About TICC: 
Systemic change in health and social care, providing services better suited to ageing population by addressing holistic needs. These changes will postpone the moment when residential of end of life care is needed, improve patient satisfaction and aid staff recruitment and retention.

Thomas Molloy
Senior Project Manager


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