Beyond the Self-Management Hype

In case you haven’t noticed, some people have got very excited about the possibility of self-management transforming our public services. Well, that is, they were getting excited two years ago. That’s when Jos de Blok received his RSA Albert Medal for his work as founder of Buurtzorg, a new model of community health care. It’s also around the same time that Frederic Laloux’s book Reinventing Organizations was being referenced by publications from the New Statesman to Harvard Business Review. I even got caught up in the excitement with my own Guardian blog. Since then, the rubber has hit the road and the real work of prototyping and implementation has started. The current view, I think it’s fair to say, is that the going is tough.

In case the self-management hype has passed you by, in essence it’s about organisations that are achieving very impressive results for staff well-being, efficiency and quality of outputs through giving staff radical levels of autonomy. The vast majority of these have been in the private sector, but there are a few public sector examples: most famously Buurtzorg social care in Holland and the Chief Information Officer in Washington. There are quite a number of UK social purpose organisations with reputations for high levels of staff autonomy such as mySociety and Highland Home Carers. The focus of many people’s attention is, however, on Brendan Martin and his colleagues at Public World, who are the official UK partner of Buurtzorg and are currently working on a number of test sites across the UK to see if Buurtzorg can work in Britain.

When I met Brendan to explore how it was going his first comment was “we’re only a few months in so it’s far too early to tell”. However, there are some emerging challenges which, although come exclusively from the NHS, we think may be broadly applicable.

1. Maintaining focus on patient needs

Buurtzorg works in Holland because everything is done to free up the community nurses to focus on the individual needs of their patients, build relationships with them and co-create practical solutions. Brendan explains that “community nurses working in Britain have so much else to think about on top of their patients, such as performance targets and the demands of their organisations, that it’s often hard to give as much attention to the patient as they would like”.

2. Working inside the UK health system

Obviously Buurtzorg is not something that can simply be lifted from Holland and installed in the UK social care system. Yet there is a real danger that in adapting Buurtzorg we lose what it is that made Buurtzorg achieve such remarkable results. According to Brendan, “we need to show through practical application how the Buurtzorg approach can work here; but it could work much better if the existing system was able to support its core principles”.

3. Staff attrition

Self-management is not for everyone. When Zappos implemented the Holacracy system around 18% of their staff chose to quit. The level for Dutch organisations that Buurtzorg has supported to adopt its approach has been as high as 30%, and this is thought to be largely a function of the gap between the previous organisational top-down culture and systems, and the requirements for self-management. Brendan is concerned that, with staff shortages in district nursing and home care already at critical levels, some might be dissuaded by the challenges of transition from making changes for the longer term benefit of service quality.

4. Difficult to change existing leadership styles

According to Brendan, “people find self management much easier to understand cognitively than they do to practically implement”. The challenge appears to be at least partly related to the psychological bias many professionals have towards taking charge and leading from the top, which Brendan says “takes serious self reflection to become aware of and move beyond”. Self-management also requires a clear framework of what an organisation expects of its teams and individual employees, and how it supports them. A tension that requires active learning.

The two big questions on many self management observers’ lips right now are: Can UK public service organisations be transitioned into a Buurtzorg style, or does it need to be done outside existing organisations? And what other services may be ripe for the Buurtzorg treatment?

In terms of question one, our sense is that it will be hard to get the outstanding results Buurtzorg achieved in Holland inside an NHS organisation anytime soon. Instead what we might get are grades of self-management which different organisations can sustain. In terms of question two, our analysis is that any services that depend on autonomous specialists could benefit from self-management. An obvious example would be children’s social care. Catch 22 based in Crewe are not exactly self-managed but are highly decentralised and achieve outstanding value for money. Another example is community learning and other elements of further education provision where the cuts have been especially hard, forcing them to radically rethink provision options.

Whatever the case, the self-management experiment is underway and already providing some practical insights for how we might be able to give staff more control over public services.