The growing shortage of GPs and cuts in funding following the removal of the Minimum Practice Income Guarantee in 2014 provoked a big increase in workload at General Practices across the country.
The problem was compounded at Jubilee Street Practice in East London due to an above average healthcare demand from an increasingly deprived population. It seemed impossible to effectively run under a traditional, hierarchical structure, so the partners set out to explore alternative working models.
They recognised the need to release management resources by creating autonomous problem solving and decision making across all areas of the organisation and enable better patient services by a healthy and fulfilled workforce.
Inspired by the emergence of Teal corporate structures explored in Frederick Laloux’s Reinventing Organisations and Robertson’s Holacracy, the Partners invited organisational change consultant Nadia Laabs and I to help the practice reinvent ways of working in line with their mission and empower all staff.
What is teal?
A number of forward-thinking, global companies across a range of sectors (including Netherlands healthcare provider Buurtzorg, French brass foundry Favi, US tomato processing company Morning Star, and Californian outdoor apparel manufacturer Patagonia) operate outside of traditional, top-down management practices.
Driven by purpose, personal fulfilment, and growth, they are primed to drive innovation and navigate an increasingly complex economic environment. Teal organisations operate around three broad principles:
- Evolutionary Purpose
Starting with why, the focus is on making meaning and creating a positive impact. Buurtzorg’s purpose is not to make sure all their elderly patients get immunised on time, but to help them live a complete and independent life. For Patagonia, it’s about far more than clothing. They are on a mission to: “Build the best product, cause no unnecessary harm, use business to inspire, and implement solutions to the environmental crisis.”
- Self-Management
Transparent governance empowers all to be accountable, distributing power through self-managed teams at every level of the organisation, not just a few top executives. Even large enterprises can operate effectively in this way by maximising peer relationships and collective leadership.
- Wholeness
A consistent set of practices inviting employees to ditch the professional mask and bring all of who they are to work. The work environment promotes self-expression, idea sharing, energy and creative thinking.
Turning teal
Late last year, a staff survey at Jubilee Street revealed that employee fulfilment, joy, and processes had seen a significant boost since the previous year. However, there was still room for improvement for both patients and staff, with stress, workload, morale, attitude, and transparency particular areas of concern.
The partners signed a declaration agreeing to test the principles of Wholeness, Self-Management and Evolutionary Purpose as the governance and operating system. Holacracy and Laloux’s Reinventing Organisations concepts would serve as a guide, but ways of working would be tailored to suit the practice’s unique vision. We were then brought in to help develop, pilot, and figure out exactly what this new way of working meant for Jubilee Street Practice.
United front
A common mission is vital to foster cross-functional collaboration and empowerment, and it should act as a guiding star for decision making. The entire practice worked together to name the new way of working ‘Circles’, embodying the inclusive nature of our change programme.
We then drafted a vision statement (our enduring blue-sky goal), a more comprehensive purpose statement (defining our reason for being), and a detailed Constitution outlining our objectives, structure, and ground rules.
The Jubilee Street Practice Vision Statement is:
“A healthy and well-cared for population by a healthy and fulfilled workforce.”
Prototype and test
To kick off we launched five, completely self-managed, pilot Circles to test new ways of idea generation and decision making. One Circle consists of multi-disciplinary staff including administrators, GPs, and nurses, all working together to serve one service (e.g. Palliative Care; Human Resources; Patient Registration, or Diabetes).
Our five pilot Circles drafted a Charter, outlining its unique Purpose, Domain, Roles, Objectives, Budget, and Accountabilities, and practiced working as an autonomous team, with all decisions made without input from management.
Circle roll-out
We scrapped formal, individual job descriptions and created over 80 Circles, each responsible for its own governance within a given scope. Circles and the roles within them are not fixed and can be added, removed, or adapted in response to the changing needs of the organisation.
In this way, the static hierarchy of the pyramid gives way to fluid natural hierarchy, where influence flows to those with the most expertise, passion, and interest. Freed from the rigidity and sluggishness of a command and control structure, Jubilee Street Practice could be more responsive and energised.
Each member of staff self-nominated to join five or more Circles with a giant, flexible Circles structure displayed in the practice to promote transparency, understanding, and collaboration. As with the Pilot, each Circle also completed a Charter to clarify responsibilities.
Ongoing training backed by one-to-one coaching
Throughout the transformation, we ran workshops to share experiences and challenges, and to help staff adopt the Teal principles. Key highlights included ways to promote a freedom-based workplace, identifying personal strengths and areas for development, the launch of a peer-to-peer coaching system to drive professional development beyond the annual review, and creative problem solving and team decision making.
This may all sound simple enough, but changing processes and behaviour takes time and practice. Some needed additional support to take responsibility, while others struggle to let go.
It is particularly challenging to ensure everyone finds their voice in every situation, which can vary hugely depending on their nature, the context, and other members of the Circle.
Backing this all up with simple yet effective internal communications and maintaining momentum is no mean feat. It is also important to remember that this cannot be seen as a recipe card for Teal. There is no one-size-fits-all and what Teal looks like will differ hugely between organisations.
Organisational structure, processes, and culture must be designed around your people and your evolutionary purpose.
So what?
For a real sense of the impact on individual employees you would have to go and see for yourself, but here are a few of my highlights:
- Staff are primed and pumped to get things done at all levels of the organisation. They’re stepping up to volunteer for tasks that excite them, from editing the quarterly newsletter to prescribing governance, simply because they have been given permission and greater ownership.
- We’ve successfully boosted transparency and understanding of each other’s roles, interests, and values. Plus, the restructure offered the perfect opportunity to spot gaps and opportunities for improvement.
- There’s been a big increase in six staff engagement scores, including satisfaction and stress, despite raised responsibility, a significant shift in mindset, and complex problem solving. We’ve also seen improvement in transparency, retention, and recruitment.
- We’re saving a whopping 80 hours of management time and £5,600 each month (now being reinvested in quality initiatives) through direct work delegation to autonomous Circles that now better serve functions such as QOF Management, IT, HR, social media, risk assessment, premises, finance. and health and safety. Time saved has sliced the former Practice Manager’s role by three days per week and she’s been busy sparking NHS interest in Circles across the country
Running as a Teal organisation may seem daunting to many leaders, but it is also a strong and effective response to our increasingly VUCA (Volatile, Uncertain, Complex, and Ambiguous) world.
It certainly seems vital for General Practices. By empowering staff at Jubilee Street Practice under a model of collective leadership, management resource is being freed up to think of new and creative ways to deliver better and more sustainable care. Patients are already starting to reap the rewards through improved communication, better processes, more streamlined appointments, and happier staff.