A self-managing neighbourhood care team
In West Suffolk we are implementing a new way of community care based on the Dutch Buurtzorg model.This way of working will represent a real cultural change to those who join the Test and Learn.
They will be a central part of testing this neighbourhood-based, holistic and person-centred care model which aims to wrap care not only around the patient but also their wider informal network. They will take a leadership role in exploring how the model can be adapted to the UK context and how it relates and interacts with the wider system.
They will also need to learn to work in a very different way.
The model is founded on the establishment of self-managing, non-hierarchical teams. The team will be made up of nurses and nurse assistants, based on a 70/30 split. Nursing and non-nursing tasks will be shared amongst the team.
The test team will be accountable to each other and to the people they support.
Coaches not managers will support the team, and the team is encouraged to take a solution focussed approach to all aspects of their work.
What values do we need to recruit to?
The success of the test and Learn is inextricably linked to the people who will lead the change. In the Netherlands, the Buurtzorg model was established by a small group of community nurses with a passion for this way of working, and has grown as a movement of like-minded individuals who are recruited by the Buurtzorg nurses themselves.
In establishing the model in West Suffolk, our aim has always been to start as close to the model as possible and to embrace the key principles of this way of working. The Buurtzorg team of nurses and nurse assistants must be at the centre of leading the change.
One of our biggest challenges has been how to find our first group of nurses who have the right values and behaviours to lead this way of working.
We started by analysing the Buurtzorg approach and identifying the values we would need to recruit to, to ensure that the team could embrace this way of working. These included:
– Compassionate and empathetic
– Solution driven
– High integrity
We knew that we needed to recruit a team, not just a number of individuals. We knew that a high performing team needed people who not only had compatible values and behaviours with the model, but also with each other.
We started with 6 weeks of engagement activities to socialise the model with existing staff within the wider system.
We also agreed that the model needed a different approach to recruitment.
We designed an assessment day with tasks and challenges to help us to identify the individuals who would be suited to this way of working and who had the rapport to make an effective team. There were four key elements to the day:
1. Supporting the candidates
Our aim for the day was to get the best out of the candidates. We were aware that many would not have taken part in such an involved assessment process before and were keen to ensure that they were comfortable and able to behave as naturally as possible given the circumstances.
We appointed a neutral, facilitator who was there to support the candidates throughout the process, rather than the assessors. The facilitator and the candidates started the assessment day with a joint lunch and a getting to know you session away from the assessors.
This initial session seemed to have very a positive impact on the dynamics of the group at the start of the more formal stage of the assessment.
2. Interactive group exercise
We started the assessment process with an interactive group activity aimed at testing out the values of the candidates to assess how they work in and respond to a team environment.
The team were given a ‘wilderness survival’ challenge which asked them to initially identify individually how they might tackle a series of challenges and then to come together as a group to reach consensus on each of the posed challenges.
The activity was purposely focused around a non-clinical problem. This ensured that candidates had to rely on their critical thinking, communication and collaboration skills to reach consensus, rather than their clinical knowledge.
For the assessors the task was an invaluable opportunity to see how the team would work together. It was clear where their strengths were, as well as where there might be areas for potential challenge or areas for development. In fact, as observers we were able to see the test team take shape before our very eyes!
The candidates undertook individual situational tests to examine their personal approach to specific scenarios. The scenarios were designed to explore:
– Person-centred thinking
– Care planning, including co-production with the patients
– Clinical governance
4. Reverse interview
We were keen for the candidates to make an active choice to join the Test and Learn and so finished the assessment day with an opportunity for the assessors, who were representatives of the partner organisations, to be interviewed by the candidates about the role and model.
This was a really lively session and could have gone on much longer and offered a great opportunity for the candidates to start to ‘own’ the model and understand their leadership role within it.
The assessment day was a really positive experience and we have now recruited three members of the team. This is slightly fewer than we had hoped for, but finding our first group of nurses was always likely to be a challenge. This is a very different way of working and those who lead the change will be pioneers.
In many ways the team has been self-selecting with the engagement and recruitment process encouraging, as well discouraging applications. Testing a radical new way of working will not be for everyone and it is critically important that we get the right team.
With the first three members of the team in place we can now support them to grow their team with like-minded individuals; taking a peer-to-peer approach to growth, which is so inherent to the way Buurtzorg has developed in the Netherlands.
By the Autumn we are aiming to have half the team in place and then to grow them to full capacity (8fte/12 people) over the first four months of the test. This is purposeful; self-management will be new to most and growing the team slowly will support them to embrace this way of working in a more managed environment.
Alongside this, our next step is to establish the induction process to support the team in this new way of working.
For further information about the project, please contact us at firstname.lastname@example.org.