Innovations in domestic care

The increasing number of people in need of care and the simultaneous shortage of skilled nursing staff are posing challenges for outpatient nursing care in Germany. Against this backdrop, innovative organisational and working models for outpatient care that promise not only high-quality care but also improved working conditions are gaining in importance.

Between May 2019 and January 2023, up to four teams from Bosold Pflege GmbH in Leipzig worked under licence according to the Buurtzorg model – a work colleague and organisational model for outpatient care that was launched in the Netherlands in the mid-2000s.

On behalf of the Saxon State Ministry for Social Affairs and Social Cohesion, Prognos, in collaboration with Prof Dr Andreas Büscher (Osnabrück University of Applied Sciences), evaluated the feasibility and effectiveness of this model in Saxony.

How those in need of care and professional carers benefit

The evaluation results for the initial phase of Bosold Pflege’s Buurtzorg project indicate the following:

• Elements of the Buurtzorg model are feasible: The results show that elements of the Buurtzorg model are feasible under the specific conditions of the provider and the state. This includes, in particular, continuity of care, a focus on needs and the promotion of independence in nursing care.
• Successful start thanks to good support: The key prerequisites for the initial successful implementation of the Buurtzorg project were created by the intensive preparation and support of the team formation by the provider and a coach. The transfer of existing contracts and open communication also made things easier.
• Better quality of care and relationships: The result was a positive impact on the quality of care, evident in the increased independence of those in need of care and greater satisfaction among those receiving care and their relatives. In addition, the relationships between carers and those in need of care improved.
• Higher job satisfaction: An increase in job satisfaction was also reported, which was primarily associated with reduced time pressure in daily work. Accordingly, it is not surprising that the project met with interest from professional carers both internally and externally.

Lessons learned from implementing the Buurtzorg model

However, as the Buurtzorg teams grew, various challenges arose that could not be resolved in a sustainable manner and ultimately led to the dissolution of the teams by Bosold Pflege. The causes of these problems were manifold. The experience gained provides insights from which measures to avoid mistakes and best practices can be derived.

• Gradual implementation of self-organisation: The sponsor and the Buurtzorg teams sought comprehensive autonomy and self-organisation for the Buurtzorg teams. However, these teams were sometimes overburdened with additional organisational and administrative tasks. This could potentially have been prevented by a gradual implementation of autonomy and self-organisation.
• Communication as the key to success: Introducing a new colleague and organisational model requires intensive communication and the restructuring of hierarchical structures. Those involved must regularly take time to exchange ideas on an equal footing and solve problems. Communication and conflict resolution skills are essential for this. Coaches can provide support, provided they have sound experience.
• Integrating new members takes time and support: According to the evaluation results, time and financial resources were invested in the successful integration of new team members, but these did not always prove to be sufficient. Careful planning and comprehensive support in this process are essential to ensure long-term effectiveness and successful collaboration.
• Creation of remuneration requirements: The economic goals of Bosold Pflege could not be achieved through the Buurtzorg project. However, given the small number of cases, it should not be concluded that the model is fundamentally uneconomical. In addition, the performance-based orientation of the outpatient care system is in some cases incompatible with the Buurtzorg approach.

The Buurtzorg model at a glance

The Buurtzorg model is a concept of integrated outpatient nursing and other care from the Netherlands. In line with the motto “humanity over bureaucracy”, the focus is on the person in need of care. The central elements of the model are:

• Needs orientation and promotion of independence: Care is individually tailored to the needs of those in need of care. The aim is to promote their independence. The establishment of a broad local support network – for example, through the involvement of neighbourhood assistance – is central to this.
• Self-organised teams: The care teams are largely self-sufficient. This means that they are not subject to supervision by the responsible nurse. Consequently, the carers not only take on the care itself, but also administrative tasks and the organisation of their work, which leads to a high degree of personal responsibility. They are supported by a back office and experienced coaches.
• Sustainability: The model also aims to improve working conditions for professional carers, increase their satisfaction and thus strengthen their commitment to the profession.

Our approach

For the retrospective evaluation, the project team conducted literature and document analyses, expert discussions and (online) surveys, among other things. Nursing expert Andreas Büscher from Osnabrück University of Applied Sciences accompanied the Prognos team as a scientific advisor. At the end of the project, a final workshop was held with representatives of Bosold Pflege, former members of the Buurtzorg teams, health and nursing care insurance funds, (associations of) service providers, the Saxon Nursing Council, the Saxon Association of Towns and Municipalities and the client.

Links and downloads

To the study (PDF, in German)

Further information (Website sachsen.de, in German)

Project team: Gwendolyn Huschik, Laura Sulzer

Latest update: 12.01.2026