In the face of constant budget cuts, ageing populations, and employees leaving their profession in droves, there is perhaps no greater need to reinvent organisations than in the health and social care sector.
Fortunately, there is a growing number of rebels who are doing just that. Here are some examples of inspiring stories I’ve come across from interviewing pioneers in this field for the Leadermorphosis podcast.
REBEL 1: BUURTZORG, NETHERLANDS
A Corporate Rebels favourite, Buurtzorg is surely one of the most successful examples of a healthcare company reimagined. More than 14,000 employees, no managers, outstanding patient and employee satisfaction metrics, overhead costs a third of their competitors’… It’s an impressive case study.
At the heart of their model is self-managing teams supported by coaches supported by minimal bureaucracy and an innovative IT system.
I spoke to three nurses who formed the first team in Houten about what makes Buurtzorg so special and how the experience compares to their former employer, a large, traditional healthcare company.
- Feedback and open communication is key. “If it’s not safe enough to talk with each other about problems or mistakes then you can get very big problems.”
- Focus on the health of teams. “When you have a good team and it feels safe, you always have a solution.”
- Leverage each team member’s unique strengths. “You find out things you didn’t think you could do. You get the best from yourself. You stimulate each other. If you can’t do it, someone else can. Together you are strong.”
- Watch out for burnout. “A lot of people feel too responsible, they cannot let it go.”
- Advice for leaders: “Let go and trust. Only coach.”
- Self-management isn’t for everyone. “I don’t think everybody is capable or wants to be like this. Some people want a boss. They feel safe. If they have to think for themselves, they don’t like it.”
REBEL 2: CORNERSTONE, SCOTLAND
One of the largest social care companies in Scotland, Cornerstone, is on a three-year transformation journey. Rather than wait for the sector to change in the face of yet more budget squeezing, CEO Edel Harris decided to take matters into her own hands.
After taking three months out of the business to research and visit innovative companies like Buurtzorg, she began making some changes, including losing nine layers of management and trimming down their 52 policies to just seven essentials.
Like Buurtzorg, Cornerstone is growing self-managing teams supported by coaches. Here are some highlights from our conversation.
- We made it voluntary at the start. “You can’t force people to work in this way. If they don’t want to, they won’t make a success of it.”
- Trust people on the frontlines. “So many businesses treat their colleagues almost as if they’ve had their brains removed… Now there’s a whole different culture emerging in the organisation where people feel free to make decisions and do the right thing and use their initiative and creativity.”
- Rethink support functions like Finance, IT and HR. “We invested in customer service training for them, the message being: their only job is to provide exceptional service to their teams and branches.”
- The Cornerstone Triangle: Competence (do you have the right experience, tools, training?), Clarity (do you know what you need to achieve and what the boundaries are?), Autonomy (do you have the freedom to do what you need to do?). “We do a lot of work through the whole organisation making sure everybody has the three parts of the triangle in place.”
REBEL 3: WELLBEING TEAMS, ENGLAND
Wellbeing Teams, inspired by Buurtzorg and founded by Helen Sanderson in 2016, now has eight self-managing teams across England supporting older people, people with long term conditions and people with learning disabilities and their families in the north, centre and south of England.
In 2019, Wellbeing Teams was the first self-managing organisation in social care to be inspected by CQC and even better, they were awarded the highest level in 3 out of 5 categories (less than 4% of organisations in this sector achieve this).
Here are some takeaways from my conversation with Helen in 2017:
- It’s tricky to find the midway point between stepping back and abdicating as a leader. “A self managed team calls us ALL to step up into leadership roles and I think I stepped back a bit too far.”
- Transparency of information is key. “On a monthly basis everyone has access to the same information as I did and do as CEO. It’s a big shift from me not being Mum and the only person worrying about money.”
- Open dialogue is vital. “We are clear about accountability…and we changed the ways we met together so we could address tensions and give each other feedback.”
- They’ve been very deliberate about recruitment. “We’re looking for people who 1) can deliver compassionate care, and 2) are up for self management.”
- Unlike Buurtzorg, Wellbeing Teams have two kinds of coaches. “One is a team coach (who supports self-management and team wellbeing), and the other is a practice coach (who supports team members through their care certificate and delivering compassionate care).”
- Leadership in self-management is rewarding! “I feel utterly liberated. I feel joyful in a different way. It’s given me a different headspace around development and ideas. And that’s why the Wellbeing Teams exist now because I gained that freedom by giving up being CEO and I wouldn’t go back for the world.”
REBEL 4: HERE, ENGLAND
Founded in 2008, Here is a not-for-profit social enterprise owned by GPs, practice managers, nurses and by their staff. At the core is the vision of person-centred care. I spoke to Chief Executive Zoe Nicholson for the podcast to learn more about them.
- Here is big on wholeness and has invested in mindfulness courses for colleagues for years. Zoe sees it as: “A mindful practice in order to see clearly and act wisely.”
- Feedback and having good conversations is important. “It’s a practice that needs regular practice. We run training groups around feedback and difficult conversations.”
- As Chief Executive, Zoe is part of what’s called the Enabling Team and three people share the role of Chief Executive. “The Enabling Team’s role is to create conditions for people doing service delivery to be successful. We steward the organisation’s purpose. It’s everyone’s job is to listen in, but it’s a special role for leadership.”
- Here also has a small organisational development team called Circus. “They highlight areas of the three breakthroughs [from Reinventing Organisations] and play creatively with bringing them alive in the organisation through working on a series of practical tools and practices and working alongside people to develop them.”
- Wholeness and purpose is at the heart of Here. “It’s about creating an organisation where people can express themselves in a way that is purposeful… really looking after the whole, is the most important work I can do right now.”
- Her advice for others on this journey? “How do you shift from one paradigm to another? I don’t know, you have to feel your way into it. It’s a process and it’s a practice, it’s not a destination.”
I hope to learn about and talk to more rebels in the health and social care sector. For now, these four are certainly inspiring enough. To listen to the full episodes of these conversations, and others, you can find the podcast here (also available on Apple podcast and your usual podcast apps).