The 7 Most Common Myths and Misunderstandings about Self-organising in Health and Social Care

1.   Self-management means no management​In traditional organisations the tasks of decision making, providing expert clinical advice, allocating work and resources and monitoring and assuring the work being done are often all part of the managers role. In a self-organising team these tasks still exist but are done in a different way. Teams that work successfully adopt processes to help them manage themselves and hold each other accountable. The process of peers holding each other to account about their practices and efficiency can be much more powerful and effective than traditional management methods. Common techniques teams use to help them do this are tactical meetings, integrated decision making, regular consideration of statistics and stories that enable the team to know where they are at and plans to continuously improve.

2.    There is no hierarchy​
There is no power hierarchy, no-one is given power over their team mate. Natural hierarchies do arise and are encouraged by building an environment that welcomes the whole person to work. Someone who is considered efficient and fair is an obvious choice to fill the role of organising the rota or can be the “expert” that supports others who want to develop the skills and aptitudes for this task. Similarly, a colleague who is an expert in a clinical aspect of work will naturally take a lead in discussions and developing practice in this area. She may even find she is asked for advice and input by other teams.

3.    Teams are left alone to get in with it
Teams are supported to self-organise by coaches or facilitators. Coaches and facilitators have no power in the team. Their role is to provide advice, information and support the team to make decisions and resolve issues. Depending on the type of team or organisation, some teams are also supported by business managers who handle contracts on their behalf or carry out other specialist functions.

4.  Teams act independently and do as they please
Teams taking decisions often use integrated decision making and the advice process. This ensures that they take advice from any experts and talk to anyone who may be impacted on by their decisions. The decision is the teams to make but they will be taking the decision having integrated any views and objections they encountered. Teams may also link with other teams to consider issues they have in common. For example, teams may send representatives to a meeting that they have empowered to make decisions about staff training. The meeting would be accountable for planning the programme and spending the budget on behalf of all the teams. Systems and processes based on holocracy or sociocracy are often used to connect teams and their decision making across larger organisations.

5.    There is no leadership​
There is distributed leadership. Many people taking different roles will be required to take decisions as defined by their role, instigate action, resolve problems and monitor quality and outcomes. Especially as an organisation establishes itself or makes the move to become self-organising leadership is key. Leaders need to create the spaces for the self-organising behavior they wish to encourage and keep inviting people to step up and take part. They need to have courage and hold a steady course as the organisation encounters its first problems and setbacks. They need to articulate the purpose and values frequently and clearly so that teams can make decisions and check they are in alignment. Leaders need to create the environment in which the teams can flourish. They need to collect and provide information to teams to make great decisions and to external regulators and stakeholders to assure them that the services provided are safe, effective and compassionate.

6.    Only highly skilled senior professional staff can work in this way​
Anyone in a health or care organisation can work in this way. We already have many of the skills and self-organise in non-work situations all the time. There are examples of the lowest paid, lowest grade staff working successfully together in self-organising teams. There are also examples of the highest paid, highly trained and educated staff who have not been able to work successfully in this environment. The approach is about working as part of a team. Being able to give and receive feedback, being accountable, being supportive, being humble, being proactive in identifying and solving problems and being trusting and trustworthy are all attributes of successful self-organising team colleagues.
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7.    There is a blueprint about how to do this
The teams and organisations working in this way are very generous. Both inside and outside health and social care they will share their experiences and knowledge with you.  There are lots of shoulders to stand on to see the way forward for your team or organisation.  This way of working is so successful because it enables every individual to contribute their best to their team. Similarly, it enables every team and organisation to offer what is most useful to the people and communities it supports. As a result, each organisation will be different. Indeed, each team made up of different team members and serving a different community in an organisation will be different. The thing that unifies them and serves to measure their success is that they can fulfill the organisations purpose for the people and communities they serve. There is no blueprint but there is a lot of knowledge and experience that you can use to plan your own journey.
 
Jane Pightling www.evolutonaryconnections.co.uk