The Buurtzorg model is widely known, it is a way to allow local groups to take ownership of those who need care in The Netherlands. This post is not about what the Buurtzorg model is and how it works, it is about what is behind it that makes it work - the hidden foundations to its success. Emulating the way they do things will never result in the right outcomes unless the fundamentals are followed.

This is the story behind the results every time we try to emulate success by copying.

I have just finished listening to Brendan Martin of Buurtzorg UK, and  his message was clear, the fundamentals of the way that managers and leaders think about and design the management of the work has to be part of this new way of working.

This is one approach that deals with the fundamentals in a way that allows leaders to remain connected and lead the new approach. And it positions them to see for themselves the changes they have to make to their understanding of the frameworks they have created that are the current rules, procedures, behaviours and culture.

Typically:

1. Firstly, the group of people who are tasked with experimenting with the approach, they separate themselves from the rules and procedures of the current organisation.
   
2. Allow that team to develop along a set of new set of experimentation principles.
3. Managers protect the team from the current system whilst they are undertaking the experiment. Those managers also engage with the team and resolve problems to clear the way for that team to move forward.
   
4. The team do real work in a new way, focused on what matters to the person, and doing whatever is necessary to achieve what is needed.
   
5. Once a the team has undertaken and learned enough, they summarise their learning directly to senior managers.
   
6. Once this has been accepted as the new way forward, others from the current service are rolled-in to the new team, so that new entrants become immersed in the new team, by their colleagues.
   
7. Managers and leaders need to co-create the fundamentals of the new service to support the new emergent service. They cerate and support the emerging service.
   

The role of leaders is key, in that they must realise that it is their current mindset and behaviours that create the current system. If they wish to change that system, they need to be at the forefront of the change.

Experience has demonstrated to us all that the choice of how to design this change is key to sustained change.

Taking a group of 24 senior public sector managers through the start of the journey of integrating a new Digital front end, redefining the Customer Service department where all calls come in, and redesigning services to become person centred and effective happened today.
Some services will see a radical online presence. Those with transactional and standard workflows. Conversely the person support services, like housing, that often deal with complex issues will become more relationship driven. The session was two hours, the purpose was: - For each service manager to take ownership of the end to end design of their service, including the demands that come into CS. - The design and integration of the Digital system into their services, by taking responsibility for its design, and to ensure that the design is optimised for that service in the best way possible.
The session was more of a workshop with questions and discussions, rather than a presentation. the key to it was the feedback from those managers who are already on this journey and what they are learning and doing differently over the past few months.
The session was designed both as a summary of the work I had been doing with them to Understand their demand. Understand being the first step before valuating and deciding on where and how the change shoul dbe and happen. The follow on is to then catch up with each Service Manager and take them through a direct experience themselves through Understanding.

1. The session started with 30 min background to traditional management and how our current management paradigm and beliefs are ultimately flawed for this type of organisation.

2. A brief overview of the debacle what was public sector CRM, and pitfalls of Digital First, surrendering to consultants and trends, etc.

3. Go through the method we used to analyse the calls coming into Customer Services. https://www.improconsult.co.uk/service-design-example8.html

4. Go through a summary of each service according to value and failure and waste. (pic at the top)

5. Agree to follow up with each service manager to work with them to understand and create the design.
The feedback afterwards was positive, despite the fact that I had to show some shocking evidence of our staff and manager relationships.

For the past 18 months I have been helping to develop and guide a group of internal service designers in a large organisation of several thousand. It is fascinating how the emphasis changes where I have to truly understand ont only the problems and characteristics of the organisation and their managers, but I need to actually support each of the 5 internals individually and according to their individual situations.
Helping someone else means that I have to clearly help them to develop in the way that suits them, and in a way that helps them to become rounded and competent designers.
What I had to do is to formulate the way that I work into a methodology that was accessable by others. So I had to start thinking and writing. I had to work with each of them and understand their gaps, and requirements for support.
One outcome was that I reinforced my own learning. I also created a document that was a guide to help us focus on the things that really were the fundamental things to forus on. Each of them did not need to all work in the same way, but they needed similar fundamental principles and techniques.
After working with them for so long, I now leave them to develop together. Building on their individual strengths, and being confident in themselves to learn and move forward.

The way I did this was to work with them and their teams. So, initially I observed and gave suggestions and advice offline, one to one. For me this is critical because I can then spend the time understanding the true nature of the work they are doing, and creating a complete picture. I also observe the designer, and understand their relationship with their team. Also looking at their focus and framework of their methodology.
I also need to understand the purpose the strategic direction of the work. In one case, my invovlement resulted in the closure of a main stream of work, that had no hope of achieving a successful outcome.
Once I have done this, I can then start to do some work directly with the teams, and then the internal can observe and learn from my approach and behaviour.

One thing that I very rarely did, was to be critical about their work, or tell them. In such situations I had to carefully construct a logic, and discuss with them about alternative ways of achieving what they were doing. Sometimes I had to wait until the path forward was obvious, and maybe allow them to fail a little. Other times I stated a view, and it was always up to them if they then took on that view.

There is a team of front line health workers, fmor a County Council and the NHS, that are working in a radically different way to the rest of their colleagues. For 9 months now they have experimented with a trial where they take demands from the community, and deal with them in a very different way to the standard rules. The team took resposibility of the workflow, from end to end, and were allowed to make decisions on what and how they undertook activities. Their goal was to help that person to get them back to as normal state as possible - based on what the problems are to solve.
It is great to help them with a methodology, and see how their understanding of what they need to do differently emerges.

The effect that the team had on 32 individuals was striking:

• The number of assessments, down 64%
• No of people involved end to end, down 32%
• No of referrals, down 41%

At this point the Directors and everyone else assumed that the team had achieved this by spending more time and resources on those people, but this is what the figures were:

• Total number of hours spent on the cases, down 14%
• Face to face time as a percentage of total time,  from 46% to 60%

And to demonstrate that the team were focused on the right thing, they predicted that:

• The estimate of that demand returning into the system, from 71% to 0%

Naturally the Directors were stunned, and the Chief Exec said "This is how I want my health servoce to be like"

A great testament to the team and hteir approach. Lets wait to see in 2020 what they manage to achieve!

The team took 35 cases and used a methodology that was based on Systems Thinkig to design their service from a completely diffrerent perspective. They had a manager conneted to them to help them clear the barriers in their way, and to help them to ensure that decisions could be delegated safely.

Helping busy managers who end up rushing from situation to situation, fixing issues that all seem to be as important as the next. Working with those managers to create a prioritised plan for their service development. Taking into account the workflow, their staff, competencies, value created, and the role of the supervision.

The legacy that we leave... 

• A public sector that is very tired of change.
• And one that has been dragged from one initiative to another with no real collaboration.
• We are left with a fractured system, whose impact has been of those in society that need the most help,
• We kid ourselves that if Wigan is doing well, then that example proves that we are doing it, regardless of the fact that around 95% of local councils are hopelessly firefighting their way through austerity.
• We actually know what works, but we canot seem to expand on that success.

Working with local government with collaborate approaches that use systems thinking has allowed managers to redefine their services in ways that we have never done before. The outcomes have been that our citizens get the support they need to live meaningful lives in their communities, and the local area begins a journey to heal rifts and meld together.
By discarding traditinoal management approaches of departmental silo working, and a focus on cutting servies, it has been a privelidge to help managers to redefine their services to develop a services that does work to support those in need. We have understood for the first time the true customer journeys, end to end.

• We have understood how the current sysetm with its measures have driven front line staff to do and act in ways that are unhelpful.
  
• We have realised that to make real change, the manager needs to lead the change from the front with their staff.
• We need to organise ourselves to communicate and collaborate with other departments that affect the same customers that we have.
• We have to develop new ways of working that allow delegated decisions with a team, and view all of us as public sector officers as human; bringing our whole selves to work to do the best we can.

In 2019 it has been wonderful to see how many public sector managers really do want to design their services to do the right thing for citizens and communities. Although there are some islands of best practice around the country, the reality of local goverment falls to local managers who are responsible for services in their area. And it has been a privelidge to gather together those who want to move forward and avoif the short termism that so many succumb to simply cost cutting.

Workshops for chief executives and directors have been a great way to demonstrate how collaboration leads to shared learning across councils - and that reduces cost ands enhances competence in each organisation. It has been a pleasure to participate in several of them and to see the egos and historic mindset break down and produce real collaboration.
Real change in created when leaders decide actively to mvoe in a positive direction that is free from the old mindset. it is easy to start and that is the only thing that is needed - to start. It is a journey, and not a destination. It depends on leaders regornising their human-ness, and recognising that we are all learning, and we need to move forward.
It is great to see how the development of systems thinking moves on our approaches from salami slicing of annual budgets, and cutting services.
The continued movement of allowing our inward drive to improve and make the world a better place helps us to focus on sustained and real change, together with those we work with. It allows us to cut through the short term knee-jerk rlotitcally driven reactions, and focus on what is truly needed.

From the idealistic days of the 1970's we have ignored the true nature of the problems in our public services, and we have failed to address the causes of why we can never get our public sector to be efficient and effective at doing what it is there to do

It is a pleasure to work closely with councils who take up the mantle of using technology to help and support their services. Together we have worked to first learn abou thow their services and the public interact, and how the services are designed end to end. That hten becomes the starting point for designing Digital solutions that have then been given to suppliers to design somehting that works for that council, in the way that they want it to.
The way that we have done this is to work with each head of service in learning about the demands coming in to Customer Service, what the demand is, what matters to people who call in, is the demand a value or failure demand? Then, the head of service can then start to look at their service as a system, and together with their staff develop the right workflow.

We have partnered with agencies in Sweden and entered into dialogue with well respected thinkers and leader sin Sweden, who are wanting to take the public sector in Sweden further and higher. They recognise the challenges they face in the future with service delivery and funding.
I have been helping them to refocus their perceptions and designs from one of tradition and bureacracy, to one of collaboration and participation.

It is refreshing to help people in Sweden to learn from the mistakes that we int he UK have made in the public sector. I relish helping public sector leaders in Sweden to get some learning of what not to do! It is a pleasure to see in workshops that I have given how those leaders listen and take thoughtful stock of their situations.

Sweden is a small country that has the ability to easily have national discussions amongst its leaders of the public sector. It is refreshing to see how so many managers understand each other in the public sector, and are clear about the challenges they face. Unlike in the UK, their focus is on discussing the latest issues they face and those descussions are important, active and listened to. It is part of their way of collaborative descision-making.

One of the downsides of this decision-making process is that leaders in Sweden often discuss lots, and that might make them act later, or perhaps not at all. Consensus is all important in Sweden, and that consensus can act against decision-making.

However, in the UK, we seem to be quite the opposite; all action and little collaborative discussion. Our momentum forward appears to be born from the dreams that certain politicians have upon waking up from a nights sleep. Margaret Thatcher was a popular figure, and one of her popular characteristics was the ability to decide and act. And our conflictive political system seems to relish this style of leadership.