002: Time wounds all healers

Welcome back to the second instalment of these chronicles, the first one was about SelfLeaders, this one is about an organisation setting out on that path.

Profile: Surgery Ward @ ANS (Angereds Närsjukhus)

Location: Gothenburg, Sweden

Operations: specialist ward for surgery.

Notable as: they are bravely setting out on a journey to turn hierarchies into networks.

Time wounds all healers

New Public Management is an idea that has transformed a range of sectors in a range of OECD countries. There is an elder care organisation (Buurtzorg) in the Netherlands that stand out from this trend. A nurse started it in 2008 and it has since stacked up a 60% national market share. It gives patients only 108 hours of face time with nurses, compared to a national industry average of 168 – yet patients frequently rank it as the number one health care provider in the country and always in the top ten. It’s overall cost structure is just under the national average and it’s overheads are 9% compared to an average of 25%. It has been the best employer five out of the last six years in the “greater than 1,000 person” category. Its patients spend 1/3 less time in convalesce after hospitalisation if they are in Buurtzorg care. It is not then strange that they frequently get visits from delegations from across the globe.

They are not just beating trends in terms of performance. Their organisational structure is curious. They simply don’t allow for authority; no one can tell another person what to do and expect them to do it on that that basis.

That is to say, given Herbert Simon’s definition (google him!), there is no authority. What would have been the HQ is a support function staff of 30. These 30 people are not there to control, but to serve the value-generating frontline workers. This minimal back office deals with issues relating to scaling and harnessing benefits of scale: e.g facilitating information flows between teams via ICT, collective purchasing and starting new teams. Teams themselves (700 of them in total, comprising 8000 nurses) have no formal leaders, instead nurses take turns to chair meetings. These autonomous teams set their schedule, accept new clients, recruit new members, evaluate team member’s performance based on their own criteria, innovate, set their own education targets – all based on their own budget process. All decisions take into account the special circumstances of patients who love the opportunity to understand and relate to these crucial aspects of their lives. The quotes from both nurses and patients made my heart ache. That a professional relationship can be so close is somehow incredibly beautiful.

It arose because nurses did not want to be measured minute by minute. These same ideas are now about to slowly be infused into ANS in Gothenburg.

Why this may just work

The organisation is run by Nicklas Oscarsson, a terrific fellow.

He, and a crack team of fellow metamodern consultants, are starting a process of facilitating a shift in mindset from one of entrenched power relations to fluid dialogue. What makes this so cool is that the project is both incredibly difficult (as we are operating without a roadmap or best practices), but remain viable because of Nicklas commitment to the ideals of co-creation and three advantageous modifiers of what would have otherwise been terrible odds.

  1. The hospital is new and organisationally it has not found stable patterns yet.
  2. The budget is relatively open for one more year (so there is less zero-sum equations).
  3. An in-house consultant has infused the strategy with green DNA that is well aligned with a co-creative modus operandi.

For organisational science nerds: they are a young organisation that retains a lot of red, is professionally steeped in amber traditions and are dominated by a larger system of orange, while slowly pushing into green (all at the same time). A great mesh of many meem’s competing for relevance, often leading to a red sensibility.

They are now trying to go a bit teal, I can’t wait to explore just how shall this story end?

I am curious to say the least.

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