Reimagining Care: The Human-Centered Promise of Self-Managed Organizations

Origins of the Inquiry

This paper was inspired by a deep curiosity about how human-centered organizational models can transform healthcare delivery. During my doctoral research, I was drawn to a fundamental question: What happens when we treat care not as a technical service, but as a relationship built on trust, dignity, and shared purpose? This question led me to Buurtzorg, a Dutch homecare organization that has revolutionized nursing through its self-managed philosophy. Buurtzorg—meaning “neighborhood care”—has become a global symbol of how autonomy and compassion can coexist with efficiency.

In the early stages of my research, I was struck by the stark contrast between conventional bureaucratic healthcare systems and Buurtzorg’s decentralized model. Traditional systems often rely on rigid hierarchies, standardized metrics, and top-down control—structures that can inadvertently erode the very empathy and connection that caregiving requires. Buurtzorg, in contrast, empowers small, self-governing teams of nurses to take full responsibility for patient care, coordination, and even budgeting. This shift from control to trust became the intellectual seed of my inquiry.

The Spark of Buurtzorg India

My engagement with Buurtzorg deepened when I encountered its adaptation in India. Buurtzorg India represented an ambitious experiment—could a model born in the Netherlands thrive within the vastly different cultural, institutional, and socio-economic landscape of Indian healthcare? This question became the driving force behind my study.

Buurtzorg India nurses were not just employees; they were the carriers of a new philosophy of work. Through field interviews and immersive observation, I discovered how autonomy transformed their approach to care. Nurses spoke about the joy of making decisions close to the patient, the freedom to organize their schedules, and the sense of personal accountability that came with trust. They described how this autonomy rekindled their intrinsic motivation—replacing feelings of burnout and fatigue with renewed professional pride.

These conversations revealed that self-management was not merely an organizational structure; it was a lived experience of empowerment. Yet, the translation of this philosophy from Dutch to Indian culture was not seamless. It required constant negotiation with local expectations, regulatory constraints, and deeply rooted hierarchical norms. This cross-cultural interplay became a rich site of learning.

Bridging Contexts: The Cross-Cultural Dialogue

Conducting this research across two vastly different contexts—Europe and South Asia—was both a methodological and philosophical challenge. The Dutch context of Buurtzorg was grounded in egalitarianism, high trust, and institutional stability. The Indian context, on the other hand, was characterized by resource constraints, complex power relations, and a deep social reverence for authority.

Bridging these worlds meant asking nuanced questions: What does autonomy mean in a collectivist culture? Can self-management thrive in an environment shaped by deference and hierarchy? How do nurses negotiate freedom within systems that often undervalue care work?

Through interviews, focus groups, and reflective dialogues, I began to see how Indian nurses reinterpreted Buurtzorg’s principles in their own idiom. Autonomy did not always translate into complete independence; instead, it manifested as relational accountability—being free to decide, yet deeply responsible to one’s team and community. Trust, in this sense, became both a personal ethic and a collective commitment.

The Emotional Journey of Research

Writing this paper was not merely an intellectual endeavor—it was an emotional journey. Listening to nurses’ stories was profoundly moving. Many spoke about how, for the first time in their careers, they felt truly “seen” and “heard.” They described moments when patients became partners rather than passive recipients of care. These narratives reminded me that healthcare is, at its core, a deeply human enterprise.

As a researcher, I often found myself reflecting on my own assumptions about management and motivation. The Buurtzorg nurses challenged conventional notions of efficiency by showing that compassion itself can be a form of productivity. Their experiences illustrated that when people are trusted, they not only perform better—they care better.

This realization reshaped the very questions I was asking. The inquiry was no longer just about “organizational design” but about the moral architecture of work. How do systems enable or inhibit human flourishing? What does it mean to manage when people are motivated by meaning rather than control? These questions stayed with me long after the data collection ended.

Methodological Reflections

The process of conducting interviews across cultural and linguistic boundaries brought its own set of challenges. I had to remain sensitive to subtle expressions of emotion, hierarchy, and resistance that might not be immediately visible in transcripts. Many conversations unfolded in local dialects, requiring both translation and cultural interpretation. Rather than treating these differences as barriers, I viewed them as windows into understanding how global ideas of self-management take root in local soil.

I also realized that studying Buurtzorg India was not simply a case study—it was an encounter between worlds of thought. Dutch pragmatism met Indian relationality; Western organizational logic met Eastern notions of duty and interdependence. The resulting synthesis was neither purely Dutch nor purely Indian—it was something emergent, a new way of imagining care work that transcended geography.

Insights and Implications

The findings of this study revealed several crucial insights. First, autonomy and trust are not abstract ideals—they are organizational resources that can be cultivated. When teams are given the freedom to make decisions, they develop deeper ownership and adaptability. This becomes especially critical in healthcare, where patient needs are dynamic and context-specific.

Second, self-management reshapes motivation. In traditional bureaucracies, extrinsic rewards and supervision dominate. In contrast, the Buurtzorg model activates intrinsic motivation by aligning work with professional values—compassion, competence, and community. Nurses described feeling “reconnected” to the purpose that drew them into healthcare in the first place.

Third, decentralization fosters learning. Without the fear of punitive oversight, teams innovate continuously—experimenting with care processes, building patient relationships, and sharing feedback openly. These micro-level innovations accumulate into macro-level transformation.

Finally, the study illuminated the moral dimension of organizational design. Structures are not neutral—they embody assumptions about human nature. Buurtzorg’s model assumes that people are inherently capable, trustworthy, and motivated by purpose. This belief becomes self-fulfilling when supported by enabling systems.

Reimagining Healthcare as a Community

Perhaps the most profound realization from this journey was that healthcare, when organized around trust and dignity, becomes more than a system—it becomes a community. Patients, families, and nurses form webs of mutual care that transcend transactional exchanges. This reconceptualization holds immense promise for countries like India, where healthcare systems often struggle with resource scarcity and fragmentation.

Self-managed models like Buurtzorg do not merely fill service gaps; they transform the very ethos of care. By embedding responsibility at the level of local teams, they restore humanity to healthcare. They show that efficiency and empathy are not opposites but interdependent.

Conclusion: A Journey of Head and Heart

Writing this paper was a process of integration—of theory and practice, intellect and emotion, structure and spirit. It reaffirmed my belief that management research must not lose sight of its human core. As organizations worldwide grapple with burnout, inequality, and alienation, the lessons from Buurtzorg remind us that compassion is not a luxury; it is a strategic necessity.

This work ultimately represents an invitation—to scholars, policymakers, and practitioners—to imagine healthcare not as an industry but as a living community built on trust, dignity, and shared purpose. The Buurtzorg story, and its Indian adaptation, show that when we organize for humanity, efficiency follows naturally. The journey continues, guided by the conviction that the most sustainable systems are those that honor the human spirit at their heart.