Table 2 Comparison of key aspects of the case studies

Communication and technology

Technology is the product, but it is also a key feature enabling efficient inter-personnel communications, keeping track on the success of work, and practicing extra-curricular activities, while also constituting a major part of the social purpose and identity of the organisation.

Communication technology helps in organising around the primary process, the purpose.

Advanced, customised technology frees nurses from rote tasks, allowing them to concentrate on the nursing and face-to-face interaction with the clients.

Social vs. technical skills

Focus on recruiting a workforce with the best technical skills available. However, a “culture check” is performed at the time of recruitment, and is related to the aim of maintaining the organisational culture. Reaktor requires its employees to have social skills, and the lack of them can override technical expertise.

Buurtzorg hires technically qualified nurses. Yet, social skills and a certain social inclination are key to being able to flourish in a self-organised team. Many nurses have left the organisation over the years over issues related to social skills. In average, informants attest that it will take about a year to learn the social skills needed at Buurtzorg.

Family / organisational units

Reaktor operates through self-organised teams but their members can fluidly be changed within the organisation. Reaktorians as a whole share a common culture which allows them to relate to others, even though in a large organisation not everyone knows one another. In teams, the atmosphere is informal and members feel like they can be their true selves amongst colleagues. Reaktor does not consider itself a family-like organisation, but boundaries between the working life and private life are fluid. There is however a clear emphasis, even a requirement to have hobbies and life beyond Reaktor. The risk of burn outs, and problems of too much dedication to work are recognised and a healthy work-life balance is seen as a countermeasure to this.

Buurtzorg operates through self-organised teams that are geographically defined. Teams stay together as long as they don’t exceed 12 members. After that, a general rule is that they should split into two smaller teams. A team has power over all the practical issues related to their teams functioning, and members have strong commitment towards the team and the team members. Buurtzorg has also organisation wide events and communication, but usually members identify very strongly with their own team and their clients. Clients are promised that they will only have a small number of people visiting their homes, so that a family-like relationship can develop between the clients and the nurses. At Buurtzorg commitment to the client overrides most personal life interests, and work-life balance is a chronic issue: for instance taking a vacation is difficult to arrange, because the clients need constant care by the people who have committed to taking care of them.

Progress, development and growth

Reaktor has grown rapidly based on its good reputation as a working place, and good quality work. Growth requires special attention due to aims of maintaining the communal organisational culture, but on the other hand is seen as an enabler of progress through more interesting and challenging projects. Reaktor’s development directions evolve organically through the interests and capabilities of its members. Reaktor maintains a low threshold for trying out and testing new opportunities and directions. Those that have potential are continued and can develop to becoming key areas of activity.

Buurtzorg has grown very fast as a result of its model being attractive to nurses. Growth is not a goal as such, but it has made it easier to deal with other social entities in the system. Development and progress relate to the way Buurtzorg is able to change the discourse on home care and elderly care on a societal level.