Unleashing people potential

Learn more about the remarkable transformation of a 100+ year-old healthcare organisation towards a radically new setup fully relying on human potential.

Nurses do not need management, says the CEO of a famous vanguard company in the Netherlands. And still, most of the healthcare organisations employing nurses are terrifyingly bureaucratic relying on a vast amount of managing overhead. While the front end is as human as business services can be, the back end is as ossified as the skeletons of dinosaurs. Even in the business of providing care, organisational development has been and still is done based on an outdated assumption: the belief that an organisation can only be effective and efficient when it applies specialisation, standardisation, stratification and other concepts that were born in the production halls of the early 20th century.

Many companies within ambulant care in Switzerland have realised that they cannot leverage the true potential of their people without rethinking their organisation. Implement Consulting Group is proud of having supported the vanguard organisation within this industry that pioneered in introducing self-organisation. While many other companies have jumped on the bandwagon, the original remains unrivalled. In a multi-year transformation, the company reduced 90% of its management functions, got rid of a lot of bureaucratic structures and procedures and lifted decentral leadership and entrepreneurship to new heights.

Prior to the transformation, each of the ten sites of the 1,000+ employees organisation had its own management team, its own planning department and its own local administration consisting of 10-15 employees at each site. These employees managed the business in their region and did all the “office work”. Nurses were supposed to execute what had been defined in detail by dedicated managers and planners, ending up with schedules like this: 09:35: helping to shower; 09:45: wound care; 09:55: providing body care; 10:10: running to the next client. Moreover, each piece of information they received by patients had to be sent to the managerial brain sitting in the office. This weird practice contradicted with the real role of the nurses in the homes of their patients. Very often, they experienced moments asking for independent problem solving and decision-making – moments asking for a high degree of agility that nurses were not allowed to show.

The top management of this organisation was well aware of the downsides of these managerial practices further evolving with growth. For a long time, some of the directors eyed to the Netherlands and imagined how they might translate a spectacular organisational concept called Buurtzorg to Switzerland: the idea of getting rid of management, of enabling and stimulating decentral decisions, of turning nurses into entrepreneurs managing their local business. However, they were unsure whether this was to be called the future of work or just a modern fantasy.

Together, we entered a structured process of evaluating operating model options and exploring the potential of self-organisation. We did that by drafting the future and looking for evidence on critical hypotheses. During this process, the fantasy took on shape and became a clear vision: we built an operating model which was to be piloted at a large site. When presented to 100+ employees, the model was described in only five pages. We knew that it had to be further developed together with the people on site – the ones who are doing the “real” work. The standard answer to a lot of questions was: we do not know yet, but we will find out. And we found out. Together with the employees at the site involved, we detailed the model that became the radically new blueprint for the rest of the organisation.

What are the key features of the new model? As of today, the organisation has assigned 60 mixed teams to specific regions. They are held responsible for the performance and quality of all services and all patients within their region. The self-organising teams decide on what they do for patients, on who works when, and on who goes to which patient. They are asked to increase and decrease their capacity in order to reach goals. This includes decisions on hiring and firing. While the core business is managed by empowered nurses, all administrative tasks are done by a central service centre providing the teams with highly standardised and reliable services. This allowed the organisation to leverage the potential of decentral decision power and to profit from economies of scale by installing a powerful support platform.

We ended up with a model that Gary Hamel and Michele Zanini would call a “humanocracy”. We redefined decentral ownership by introducing business reasoning at all levels of the organisation. We introduced market mechanisms by allowing self-organising teams to ask for and offer capacity if needed to reach their goals. We installed a meritocracy by incentivising and rewarding exceptional performance. We strengthened the community by positioning peers as first contacts. We strived for openness by allowing every kind of partnership in the local context of business. We relied on experimentation by finding this model based on evidence gained in practice. And finally, we embraced paradox situations because we knew that they are the moments of truth requiring real decisions and allowing for refinement.

This organisation might have pioneered in reinventing its operations. Many other companies are still waiting on the sidelines. However, we are deeply convinced that the 2020s will lead to a new normal: companies operating with entirely new models fully relying on maximising human contribution both with regard to entrepreneurship and creativity and by introducing self-organisation at all levels. The revolution starts now. Who wants to join?

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