Manage training and coaching
In every organization, there is a natural tension between the need for expertise and the need to let people on the front lines make decisions. When expertise is needed, the first reflex of most organizations is to create a core group of experts.
The risk, of course, is that over time two castes will emerge within the organization: a prestigious (often highly paid) group of central experts and a group of people doing operational work in the field without decision-making authority. At the contrary, , it is not logical that each of 600 teams develops expertise in all medical issues they might encounter.
With over 9,000 employees, Buurtzorg limited the head office staff to only 40 people. There are no typical staff roles (no CFO, Head of HR, etc.). Most headquarters employees are involved in administrative tasks (e.g. social security administration). In other terms, most typical staff tasks are simply assigned to teams.
In order to manage its competencies, Buurtzorg has developed mechanisms to leverage its decentralized expertise.
Find in-house expertise
Team nurses are encouraged to develop expertise and become points of contact beyond their team. Through Buurtzorg's intranet, nurses can easily identify and access colleagues with relevant expertise in a specific area.
On the Intranet, a section "frequently asked questions about...." allows everyone to find answers to their problems.
Create a task group
If competence is not yet developed internally, volunteer task forces of nurses are set up that, in addition to their work with patients, they investigate a new topic and build up expertise (for instance, how Buurtzorg should adapt in response to new legislation).
Call on external expertise
Although Step 1 and 2 answered most of the questions, the company realized that there were still questions for which the FAQs and working groups did not provide answers.
The group may decide to call in an independent expert a few days a month (as a consultant) who would answer the teams' questions on request.
If an expert is hired, he has no decision-making power over the teams and only acts as an advisor.