What difference could self-managed teams make to staff and patients?

By Helen Sanderson and Lisa Gill

Self-managing organisations are nothing new, however interest has increased in recent years as more people begin to experience the limits of traditional, hierarchical organisations. The way we’re working isn’t working – only 15% of employees worldwide are engaged, only 12% of employees in Europe say they’re always consulted before objectives are set for their work, and excess of bureaucracy costs the U.S. economy more than $3 trillion in lost economic output.

Jeffrey Pfeffer’s book Dying for a Paycheck presents some alarming statistics about work-related stress, including that the workplace is the fifth leading cause of death in the US.

If we look at the health and social care sector, Professor Michael West’s research has shown that 50% more staff in the NHS report debilitating levels of work stress compared to the general working population. Pfeffer says the answer to improving our workplaces is to develop two aspects: social support and autonomy. In our view, social support is about creating environments where we can bring our whole selves to work, and autonomy means a shift towards more self-managing teams and organisations.

What difference could self-managed teams make to clinicians and health staff?

We don’t yet have definitive research evidence on this, instead we will draw on leading healthcare examples from Buurtzorg in the Netherlands and Wellbeing Teams in the UK. Buurtzorg has over 14,000 employees (mainly nurses) and is described as having ‘sky high’ engagement. Client satisfaction is highest in their segment while employee satisfaction is through the roof.

(Image: The Buurtzorg Onion Model)

The motivation and passion of the nurses is hard to miss when they proudly explain how they run their own neighborhood. Having worked for other more traditional Dutch healthcare organisations before, the way of working of Buurtzorg has set them free.

"We feel more liberated, appreciated, and fully in control of how we can provide the best possible healthcare to our clients. Instead of having to work with lots of frustrating bureaucracy, we can now do what we love to do: delivering care to clients.” – Nel, nurse at Buurtzorg

Inspired by Buurtzorg, Wellbeing Teams support people, including those with experience of cancer, to live well and die well at home. They focus on both self-management and ‘bringing your whole self to work.’ One practical example of this is how we use One-Page Profiles to capture what people appreciate about you, what matters to you, and the best ways to support you at work. The image below, developed with nurses and clinicians working with people with cancer, illustrates ten ways One-Page Profiles can benefit colleagues.

The combination of self-management and bringing your whole self to work leads to higher psychology safety. Blame and shame cultures are common in healthcare with damaging effects on staff. In Wellbeing Teams there are specific strategies in place to make it easier for people to share when things go wrong, to learn from failure as well as success, and to talk about tensions. Teams learn a practical skill set from Compassionate Communication, to support them to identify their feelings, look at what this means that they need, and how to ask for and negotiate this, as well as how to have courageous conversations.

(Michelle, Jodie and Becky from Wellbeing Teams in Greater Manchester)

What difference could self-managed teams make to patients?

“Happy staff means happy patients” may sound trite but it has elements of truth. For example, Buurtzorg’s patient satisfaction scores are 30 percent above the national average. Wellbeing Teams was the first self-managing organisation to be inspected and rated by the UK regulators, the Care Quality Commission. They received the highest rating – Outstanding – overall, and this means that they were considered outstanding for being Well-Led, Caring and Responsive. In the public report, the inspectors wrote:

“People (patients) told us they were partners in their care and had control over what support they had. The service, without exception, respected people’s choices and found innovative and caring ways to support people...people said they knew their Wellbeing Workers well and that they went above and beyond what would normally be expected of them.” 

This could suggest that staff who have greater autonomy in their work (self-management) are empowered to enable patients to have greater choice and control in their lives and service.

The people (patients) supported by Wellbeing Teams also had One-Page Profiles, describing what people value and appreciate about them, what matters to them, and how they want to be supported and cared for. People were seen as individuals, and care is relationship- and strengths-based.

How to experiment with self-managed teams

There are a growing number of self-managing organisations around the world, many in the health and social care sector are featured on Helen’s podcast A Cup of Teal and Lisa’s podcast Leadermorphosis. However, every organisation is unique – there is no one-size-fits-all solution. In our next blog, we’ll share some tips for how you can experiment with self-managed teams and answer some common questions.

About the authors

Lisa Gill

Lisa Gill is an organisational self-management coach and facilitates leadership courses that train people in a more adult-adult, coaching style of leadership with Tuff Leadership Training. She is also the host of the Leadermorphosis podcast, for which she has interviewed thought leaders and practitioners from all over the world about the future of work. Lisa was included in the Thinkers50 Radar 2020 for her work with self-managed teams. Her facilitation also extends to the world of online participatory courses via the Better Work Together Academy.



Helen Sanderson is the founder of Wellbeing Teams, a new model for delivering care and support within communities, demonstrating how self-managed teams can work in health and care. Wellbeing Teams are one of Nesta’s 50 New Radicals, have been rated Outstanding by the UK's Care Quality Commission and have won The Guardian's Public Service Award in 2019. Helen is the author of over 20 books, as well as good practice guidance for the UK's Department of Education on Education Health and Care plans.

Last update: 
Friday 19 June 2020