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.