Self-organisation in the care of the elderly and the sick

On the organisation chart that Karin Koch-Haug calls up on the screen, the name of the manager is missing for many units. "These Spitex centres are run by the teams themselves," confirms the nursing specialist at the Schwamendingen centre of Spitex Zürich Limmat AG. Originally, the self-organized teams were intended as a one-time pilot test at the Schwamendingen center. The Dutch care provider "Buurtzorg" provided the model (see previous article). At the first information events on the pilot, it became clear that many employees wanted to participate in this project despite initial doubts and unanswered questions, recalls nursing specialist Heike Hustig, who had been involved in the pilot in Schwamendingen from the beginning. Since 2018, Spitex Zürich Limmat AG has been gradually converting all its Spitex centres to self-organised teams. This year, the last three centers are to follow. One of the triggers for the changeover was customer satisfaction, as Heike Hustig reports: "We wanted to increase continuity so that customers are always cared for by the same person, if possible." This is easier if the scheduling is done by the team responsible for it.

The freedom of the teams

Today, the teams decide almost all operational matters themselves. There are no longer any centre managers or team leaders for coordination. Thus, the teams of the Schwamendingen centre have divided "their neighbourhood" among themselves, whose care clients they now look after independently. This also clarifies the responsibilities for customer care. Management tasks such as planning (deployment and duty rosters) or finances (budget, workload) are distributed among individual roles (batches) in the team. These roles can be found in all teams; in addition, a team can create further roles. In the Schwamendingen centre, for example, one team member is responsible for applications. And of course, in the end, the team decides which person it wants to hire.

However, Spitex Zürich Limmat AG is not completely self-organized. There is still a central management for the entire company as well as a support center. This ensures important support functions such as finance, IT or real estate. These issues have to be solved centrally because they are complex or because of efficiency, as Christina Brunnschweiler, CEO of Spitex Zürich Limmat AG, explains. The legal requirements in Switzerland are more complex than in the Netherlands, she says, referring to the Buurtzorg model.

In addition to the basic infrastructure, the management also specifies the productivity (billable hours) and the quality standards. The individual Spitex centres are therefore controlled by objectives and framework conditions. Christina Brunnschweiler uses the image of a furnished apartment that is made available to the teams. However, the teams have to do their own housekeeping. They are supported by various coaches. The HR coach helps with personnel questions and takes over the pre-selection for recruitments. The project coach advises on structural issues and the quality manager supports the teams in quality assurance. Regarding her own role as CEO, Christina Brunnschweiler says: "We need an authority that provides orientation and sets the framework. I also act as an external contact person, for example for contracts and cost approvals.

A balance sheet

With the changeover, employees take responsibility for issues that are otherwise the responsibility of superiors. Even the birthday cards for customers and colleagues are now taken care of by a team member. This requires a sense of duty, emphasises Karin Koch-Haug. "That's why employees have also resigned. Some people just want to do their job and not take care of the business," she concludes. Nevertheless, the fluctuation has remained relatively low.

Many managers had to find a new role in the company. Some became coaches. For example, a former center director now works as a project coach. Other managers left the company. There were individual plans for the transition. Managers were informed early on so that most could adjust. In retrospect, Karin Koch-Haug says that the step-by-step introduction with a pilot center proved to be successful. A simultaneous conversion of the entire company to self-organisation was unrealistic because of the time required. "Despite great enthusiasm, we needed a period of adjustment," she explains. For example, management tasks were only gradually distributed from the old positions to the teams. For this, there was support from coaches, who also moderated the numerous meetings.

Insights for other companies

Spitex Zürich Limmat AG has chosen a pragmatic path and sought a balance between pure teaching of self-organization and the possibilities on site. This distinguishes it from a start-up that can build its organization from scratch. Various voices from the professional world confirm the path taken by Spitex Zürich Limmat AG by advising companies to find their own, tailor-made form of self-organisation. Last but not least, regulatory requirements can limit the possibilities of self-organisation. Here, other industries, such as IT or the media, have an advantage over the healthcare sector. The pragmatic approach of Spitex Zürich Limmat AG includes the gradual changeover, because the company first wanted to gain experience with the new form of organization. This was done entirely in the spirit of continuous improvement, which required a certain amount of effort in terms of communication and reflection. This approach has the advantage that the remaining branches of the company can take the pilot teams as a model and benefit from their know-how.

The example of Spitex Zürich Limmat AG also shows what the benefits of self-organization can be: an increase in customer satisfaction and greater motivation among employees. For the customers, the result was an increase in quality, as surveys and personal feedback show. Care customers now always have the same contact person and can reach them directly via a team telephone number. It is possible to respond to individual customer requests quickly and flexibly. "But satisfaction within the team has also increased," confirms Karin Koch-Haug. "We have much more scope for creativity. In addition, it strengthens team cohesion when we can recruit our own people, for example." Regardless of the effort involved in the changeover, neither Karin Koch-Haug nor Heike Hustig want to go back to the old structure.