On examples of self-organising teams (part 6)

What is the point of the organisation? Leicester and O’Hara state that “organisation is a means of getting things done. But it is also a way of living together. The purpose of any organisational form is to provide a means of collective agency”. This is insightful for two reasons: not only do we see that form should follow function, in terms of purpose, but also that the success of the form is the extent to which it facilitates and enables the group or team to be successful in this endeavour. There are many such ways that organisations have historically been structured and managed to achieve purpose. In recent times, we have seen challenges to the dominant hierarchical organisational paradigm. This blog series explores this in more detail, with a focus on self-managing teams. 

There are several approaches to the implementation of self-managing teams as a response to more traditional organisational structures. More well known international examples include the following:

  • Reinventing Organisations, an approach to reaching self-managing teams, developed by Frederick Laloux, whereby colours are used as shorthand for different organisational models in which self managing organisations are known as ’Teal’.   
  • Holacracy, a way of applying self managing teams across a whole organisation developed by Brian Robertson. It is described by the former CTO of Yammer, Adam Pisoni, as “the first fully formed alternative to Command & Control that real companies are using successfully”. Companies such as Medium and Zappos are using this approach. 
  • Buurtzorg, the Dutch system of healthcare established by RSA  Jos de Block, which puts control in the hands of the nurses delivering care and enables them to make decisions and do what is right for the person they are with at the time. This is a big shift away from the ‘factory model’ of care which sees people delivering services based on speed and outputs not quality and relationships.  

In the UK health and care sector examples are emerging, including the following, which are summarised to provide some tangible examples of the theory and framework of the first articles in this series.

SK Nurses, Cambridgeshire

Sophie Howson brought the Buurtzorg model to her manager Kathryn Caley’s attention while she was working as a district nurse within the NHS. Sophie, a highly regarded Queens Nurse and Kathryn, who has worked in a range of senior NHS operational management positions are ‘NHS people’ and it took quite something for them to do something different. Eventually they realised it would be impossible to achieve this within the NHS. With professional code of conduct demanding one thing and bureaucracy of the system another, the no longer felt the patient was at the centre of care –so in 2016 the set up their social enterprise, SK Nurses. Since then they have identified a GP practice to partner with (Gantar Medical Practices) and have had ongoing discussions with the CCG, Cambridgeshire County Council & local hospital.

Ideally, they would get some transformation funding from the CCG, but the current climate is very risk averse and while supportive, they are unlikely to be able to contribute financially. Sophie and Kathryn still hope to secure contract in 2018 with funding from the Cambridgeshire County Council & Addenbrookes Hospital. If they are able to unlock a contract, they are ready to go and have plans to scale – although there is still much work to be done to develop the necessary IT infrastructure needed to do so. Starting with a team of 4 nurses covering a population of 5,000 they plan to grow to 8 nurses covering 10,000 within 9 months. Within two years they aim to have four teams covering the whole area for Gantar with population of 40-50k. If they can’t make it happen in Cambridgeshire by end of 2018 they will look elsewhere. 

What makes this unique?

  • This is quite a ‘pure’ Buurtzorg project
  • They haven’t managed to win a contract so have been unable to deliver any services
  • Has significant funding lined up from Social Finance (if they can get a contract 
  • Developed plans to grow and spread this model 

Here, Brighton

Here is a purpose driven organisation inspired by a set of beliefs which are framed around six commitments that help them live their core purpose of ‘Care unbound – to create more possibilities for care in every moment’. It was founded in 2008 as Brighton and Hove Integrated Care Service (BICS) to make a meaningful contribution to help Brighton and Hove achieve its healthcare outcomes. Set up as a social enterprise and membership organisation owned by GPs, practice managers, nurses and staff, its work was guided by three principles: to do least harm first through intervention; extend the skills of others; only use specialist skills where they are needed.

Since 2008 they have helped redesign in excess of 200 clinical pathways, including those for neurology, ENT, gynaecology, dermatology, MSK, mental health, dementia and many others. Over the last nine years by supporting collaboration, learning and training to expand skills in primary care in Brighton and Hove they have brought an additional £10m into general practice that wouldn’t have been available otherwise.

In 2014 it refocused its core purpose on supporting a shift in the view of care from ‘what’s the matter? to ‘what matters to you?’  Here now has 250+ staff and turnover of £60-70 million. For much of the time they have been commissioned through tender process and bulk contracts. The commissioning landscape is constantly evolving over the last three years. Key strands of work include Sussex MSK Partnership , Brighton & Hove Wellbeing Service, Extended Hours Service

What makes this unique?

  • Large organisation that has re-positioned its self around a new purpose 
  • Driven by purpose – this is at the core of everything they do 
  • Self-management has ebbed and flowed but purpose and wholeness equally important 
  • Wholeness has been the strongest aspect of their transformation 
  • Social Enterprise, owned by members who play an active role

Cornerstone, Scotland

Cornerstone is one of the largest social care organisations in Scotland delivering care to 2,700 people each year. On the back of eight years of austerity “Cornerstone was delivering on contracts but not its charitable mission” and for CEO Edel Harris something had to give. In 2016 with the full support of her board and funding from Scottish Enterprise, Edel embarked on a three-month learning journey in the Netherlands, learning from Buurtzorg and other Dutch social care providers that were implementing self-managing principles. The break was eye-opining and when Edel returned Cornerstone started moving towards a ‘local branch’ structure made up of self-managing Local Care and Support Teams of up-skilled social care practitioners devolving autonomy and accountability to the frontline.  

They now have 31 Local Care and Support Teams that have transitioned to self-management – training on self-management is provided and everyone is trained in customer services. This way of working has reduced overheads by 40% which is essential to delivering this model at scale. Going forwards they plan to phase the whole organisation to 110 self-managing teams and carry out evaluation which has been funded by Big Lottery, Scottish Government; Carnegie Trust. One of the main factors for success was working with Health and Social Care Partnerships who are willing to relinquish some power and to take some risks in testing alternatives to traditional commissioning. 

One of the first pieces of advice that Edel would give to other care providers looking to emulate their success – “just do it, and the regulators will engage and pay attention”. Cornerstone benefited from the openness of Buurtzorg founder Jos De Block and amongst others and they are trying to emulate that by offering study visits to organisations from a range of sectors who are keen to learn from their success. 

What makes this unique?

  • Have managed to transition of 1/3rd of organisation in two years
  • CEO invested 3 months in learning about different models such as Buurtzorg
  • CEO managed to get full support of the board to make changes following research trip 
  • Managed to keep all contracts through transition 
  • Now have high number of organisations that want to learn from them

Wellbeing teams, NorthEast England

Helen Sanderson has been immersed in the development of person-centred practices in the UK over the last twenty years, having previously worked at the Department of Health as an expert advisor on person-centred approaches and is an author of over 20 books on person-centred thinking, planning, community and personalisation. In 2016 Helen founded Wellbeing Teams, which is inspired by Buurtzorg but they have a very different team composition using a model called Support Sequence which is focussed on self-care, digital tech, social prescribing, then paid support. Staff are using tech such as Slack & Loomio to communicate and make decisions. Each team has two wellbeing leaders that self-manage and sense check each other’s work, removing the need to have a coach. 

Wellbeing Teams have built strategic partnerships with one charity, Making Sense, which supports with digital expertise, and another, Community Circles, which helps activate people’s personal relationship networks to support them to achieve their personal outcomes and reduce social isolation. This way of working enables Wellbeing Teams to achieve better outcomes for people without having to jump directly to paid support. They have six active teams up and running across five local authorities and others in the pipeline. The first teams are delivering support at home to older people, and they are expanding to support young people and families, people with learning disabilities, and working with GP practices. the aspiration is to go from 6 teams to 600 in three years. Current teams are funded through Individual Service Funds, so the allocation they would have been given can be rolled up to be used flexibly with patients. Helen claims that ‘commissioning is fundamentally broken’ and the long-term aspiration is to bypass the commissioners and develop a model based on personalised budgets. 

Wellbeing Teams also provide learning and development to care provider organisations who would like to learn about the principles of Wellbeing Teams and how they can apply them in the way they work. Their Future Leaders programme allows people who believe that social care needs to be reinvented to take an online course that can be completed while in full time work and can open up employment opportunities in the sector, including Wellbeing Teams where three people have now been employed following the course.  The course can be taken anywhere in the world with people communicating using online tools such as slack and zoom.  Wellbeing Teams have a radical and innovative approach to recruitment, tackling the challenges of recruiting and retaining staff head on by recruiting 80% of staff from outside the sector but ensuring instead that employees have shared values. 

What makes this unique?

  • Helen Sanderson is a very credible CEO with a vision to really transform how social care
  • Radical approach to recruitment with 80% staff recruited from outside the sector
  • Designed easy to access online course to develop skills to be a Wellbeing Leader 
  • Working with a range of partners to deliver effective care – including with Community Circles 
  • Collaborating with others in the sector who are shifting to be more values led and implementing self-management principles

Bay Care group, Torbay

Set up by Katrina Green in 2010, Bay Care Group provides domiciliary care throughout Torbay and surrounding areas. Katrina has spent her whole working life in the social care sector and in response to poor job satisfaction and low retention of staff, she took the bold decision to give more autonomy to her staff and put carers in charge of their work, before she was made aware of the Buurtzorg model. During the summer of 2018 Katrina presented her vision to imbed self-managing teams to Bay Cares 112 staff. Carers were beginning to get used to having more autonomy in their work so the major change was that they now had to self-organise their teams rather than waiting for direction. Staff took to this immediately and quickly outlined the areas they wanted to champion. All staff were asked to choose at least one clinical skill that they wanted training in, which they were then supported with. While there were some initial teething problems, staff generally worked well together to develop rotas and work through problems. 

Each team has a coach to support them, most of whom were previous team leaders, others were nominated by their peers. As well as a coach each team has a compliance officer (who work across 2-3 teams) and all teams have access to slack to enable fluid communication between teams and the coach/compliance officers have visibility of this which is really important so that they can step in when needed. Initially there were a higher number of complaints as teams got used to this new way of working but after six weeks there was a 40% reduction of calls from both staff and individuals. 

Bay Care have outstanding rating with CQC and say the Inspectorate are really engaged with the way they are innovating. They expect that working in this way will enhance their assessment as it is focused on achieving the best outcomes for patients. Bay care now have four active teams across Torbay that are self-managing and they have ambition to grow this across the organisation once they feel the model has been fully embedded across existing teams. Katrina also leads a Care Managers Network that has 420 members across the South West – she is confident there is an appetite for others to adopt self-managing principles and is working with others (including Fellows: Nick Parker, Next Stage Organisation Consultant & John Bryant, Head of Integration & Development, Torbay & South Devon NHS Trust) to help drive this movement across the region. 

What makes this unique?

  • Katrina is clearly a well driven social entrepreneur that happy to ‘move fast & fix things’
  • Managed to set up the first few teams with limited support 
  • Well positioned to inspire/support wider roll out with other organisations across the south west 

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