NSM Focus | Self-organising teams in the healthcare sector: ‘What we needed was less system and more human interaction’

Philadelphia, a healthcare institution with thousands of clients, over seven thousand employees and more than five hundred locations throughout the Netherlands, has in past years gradually shifted to self-organising teams. A daunting task, with fantastic results, says Secretary of the Board of Directors Siem van den Broek.

foto Siem van den Broek‘What was our purpose again?’ This was the question that emerged in past years at different locations among Philadelphia staff, clients and their families. Are we still doing what we are meant to do: provide people with mental disabilities with the best care possible? A call from the Ministry of Health, Welfare and Sports (VWS) to take part in a pilot in less regulated healthcare further strengthened the organisation’s motivation to return to basics.

“Less system and more human interaction, that was precisely what we needed,” explains Van den Broek. “The healthcare sector is staggering under the weight of regulatory pressure. People tend to blame the government, but the rules we’re bound to by law are actually pretty basic. The tangle of protocols, guidelines, and accountability mechanisms arises in lower system layers, with the Dutch Healthcare Authority, the care administration offices, the Healthcare Inspectorate, and other institutions. Not to mention the extensive etiquette of local healthcare facilities, such as ‘put your cup in the dishwasher’, ‘Wednesday paper recycling day’, etc. By capturing everything in rules, we try to avoid directly holding each other accountable for our joint responsibilities.”

Freedom and responsibility

“The key is to once again engage in dialogue with one other – staff, clients, and their families – and to dare rely on people’s professional skills,” Van den Broek continues. “Our staff know better than anyone what’s important. So ‘less regulated’ doesn’t mean burning all protocols and checklists, but rather thinking for ourselves instead of blindly following instructions, taking responsibility instead of evading it, and exploring our autonomy instead of relinquishing it. This led us to self-organising teams.”

Van den Broek speaks of a shift in thinking, action, and organisation. “Step by step, we mapped all the work processes, activities and contributions of our staff, and we studied how clients move through the organisation. Who do they encounter? What are the challenges they face in the process? We then redistributed all tasks and processes among teams and departments. Wherever possible, we linked teams to the entire process of individual clients, so they could quickly and autonomously respond to new issues and opportunities. Part of the deal was to give people the trust and autonomy this requires.”

No well-defined tasks

The teams that were deemed ready for this step were the first to be invited to switch to self-organisation and inspire other teams. Like any other organisation dealing with change, Philadelphia had its own pioneers, sceptics and naysayers. Much was invested in training managers, who followed a programme in Psychology of Organisational Change at the Radboud Management Academy. This helped managers understand the underlying organisational principles and guide their teams towards increased professionalism, entrepreneurship and teamwork skills. All teams were offered and continue to be offered the necessary coaching and training. “This is crucial. After all, our staff no longer have well-defined tasks, but rather a range of action. Some really enjoy the space and freedom, while others feel nervous about it.”

Teams are free to set the pace for their own learning and development. More than half of our locations now work with self-organising teams, and the rest is expected to soon follow suit. We continue to coach everyone through the transition. And if people are really reluctant to get on board, we explore together whether Philadelphia is still the right fit for them.”

Is this the only way forward?

Philadelphia is witnessing an increase in employee responsibility and a drop in absenteeism. “Average sick leave is 7% in the healthcare sector and 4.5% at Philadelphia. Here is a beautiful example of how this works: at one of our locations, some team members came to dread night shifts. They wondered whether things could be organised differently. Their location manager asked what they needed to make it happen. The answer turned out to be money, to hire colleagues who enjoyed night shifts. In the end, the team members who only wanted to work day shifts gave up some of their salary to outsource their night shifts. The result: a better balance between work and private life and more work satisfaction.” JvdB