Buurtzorg’s case shows that sometimes we look for saving in the wrong place entirely. The real savings in home care comes not from shaving of 1 minute of changing a compression stocking. It comes from giving such great care that patients heal faster or become more autonomous, and so come out of care much more quickly, reducing care by hours, weeks or years, not minutes. And that the key to that is small, autonomous teams that aren’t prevented to give good care by well-meaning but flawed centrally-designed procedures, policies, bureaucracies… I’m convinced this applies to all of health care (think hospitals!), not just home care.
This morning, there was a 10 minute piece on this in the BBC’s flagship Today program, for which both Jos de Blok and me are interviewed (how cool is that? :)). Jos impressed me again with his simple common sense - he has a knack for making anything other that self-management sound gently absurd. (http://bbc.in/1FSCudX, starting minute 33).
The guardian article stimulated me to think about it more broadly, beyond home care and health care. The more I think about it, the more I’m excited by the prospect that new forms of thinking will bring the same kind of breakthroughs to many domains. Take teaching. The real savings don’t come from reducing costs for teachers. It will come from children no longer dropping out, from children feeling so whole, so valuable, so powerful (as they do in the ESBZ in Berlin I speak about in the book and many other innovative school that are popping up) that they don’t drop out, don’t fall on the wayside, don’t turn to crime to make a living or feel powerful.
Or take our flawed justice system. We know from experiences everywhere in the world that restorative justice systems work better for victims and for perpetrators. And they are radically cheaper to run, as the rates of incarceration go down dramatically as do the rate of reoffending. Imagine what we could do with all the money saved by closing prisons, and how much richer the lives of our communities would be.
Perhaps it will take a few more years for these ideas to be acceptable in a broader public discourse. I’m curious when a political will pick up on these ideas. In any case, I think Mark Thompson, who wrote the piece in the guardian, is onto a very powerful idea: what if we could increase public services rather than cut them, but adopting a different perspective on purpose and different management practices? He’s got me thinking about this a lot. I think indeed we are told a lie. Not lied to on purpose. But there is another way to deal with budget cuts that could, paradoxically, help us shift to better times.