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Self-organization is like pregnancy: a little can’t be done
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Self-organization is like pregnancy: a little can’t be done

Self-organizing or self-managing teams are the new holy grail in healthcare. But consider before you begin. Because it requires a cultural change, which requires a lot of dedication, perseverance and self-control.

In the healthcare sector and beyond, the Dutch company Buurtzorg is an inspiration. The home care organization with self-managing teams scores very high in employee satisfaction and has rapidly become the market leader. Many organizations want to follow this example.

The great popularity of self-organization or self-direction in healthcare is easily explained because it seems to be a way to save costs responsibly. After all, if professionals do tasks themselves more often, fewer managers are needed. That saves salary costs, is the reasoning in boardrooms.

Self-organization can be beneficial. Task-full teams that take their own responsibility relieve management and staff. Healthcare professionals who feel ownership treat clients better. After all, they are less likely to shift problems to colleagues. Doing things themselves also makes them feel better. At several organizations, I have seen healthcare professionals flourish because they gained more influence over their own work environment.

Hard to cultivate

Self-organization in healthcare is a fine aspiration, but it is difficult to cultivate. This certainly applies to existing organizations that have always worked according to a rigid hierarchy. It may be forgotten that Buurtzorg started with a clean slate ten years ago. Self-management is part of their identity. Interference from above with the teams is taboo. From the beginning, district nurses at Buurtzorg consciously chose a large degree of independence. Anyone who thinks you can simply copy their model is making a capital mistake. Because it is not a trick but requires a different way of thinking in the organization.

An existing healthcare organization must change significantly to make self-organization a success. It requires adjustments on the hard side (processes and systems), but also on the soft side. Not infrequently, a culture change is needed. Care organizations, especially large ones, are often characterized by tight control from above with protocols, registrations and instructions. Everything is focused on control. When a healthcare professional in such an organization is suddenly allowed to “figure it out for themselves,” it represents a landslide.

Setting a good example is therefore crucial. Directors and managers must actually be servant-leaders after they have handed over the tasks.

Michael Akudaman – IPM Partners

Self-organizing teams in healthcare

Working with self-organizing teams in healthcare takes time. Professionals always view management’s pursuit of self-organization with suspicion. They see it as a disguised cost-cutting measure or yet another change program. They distrust, rightly or wrongly, the genuine intentions to actually transfer responsibility.

Setting a good example is therefore crucial. Directors and managers must actually be servant-leaders after they have transferred tasks. They must support professionals in the decisions they make. Mistakes should not be punished. Professionals must be given time to learn from what doesn’t go well. And they should be allowed to come up with their own solutions to problems.

Not only management must sit on their hands and be servant-leaders. This also applies to support services. If you agree that healthcare professionals are going to be in charge of changing light bulbs, you have to actually leave that to them and not the facilities department. If you say they are allowed to schedule themselves, then central planning should implement their ideas. Of course as far as it fits within the agreed frameworks and regulations.

Resistance to self-organization

The examples I mention look simple on paper, but the practice is more unruly. After all, it takes years to get the culture turned around. There will also be resistance. Not all healthcare professionals are waiting for more responsibility. Certain managers see their existence threatened when care professionals take over part of their tasks. And support services employees feel insecure because they no longer serve management alone.

A final risk to self-organization is a changing of the guard. A fresh vision from above can undo all the hard work with the stroke of a pen. It is important to secure the ideas of self-organizing or self-directed teams in healthcare and ensure that future administrators go along with it. For this reason, I always advise those considering self-organization not to do it by halves. Managers, professionals and support staff must grasp the thinking and rally behind it; the same goes for future administrators.

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