What would it be like if clinicians, administrators, clinical support staff, the people who come into contact with patients every day, were able to do great things for the people they serve in an environment where doing the right thing, every time, was made easy by the organisations for whom they work?
What if excellence was routine because of, rather than in spite of the organisation?

What do organisations need to do differently to let the fab stuff and the fab ideas done or created by their staff grow and flourish?

BICS was formed in 2008, as a not for profit organisation, owned by primary care. Its purpose has evolved from enabling people to access the right care, from the right people, first time, through the provision of referral management, to “Care Unbound, to create more possibilities for care in every moment”.

We have grown rapidly and provide a wide range of clinical services across the south east of England, in partnership with NHS Trust, third sector and like-minded commercial partners.

We change the paradigm of care from “What’s the matter?” to “What matters to you”.

As we have grown from being a couple of dozen people in a corner of someone else’s office to an organisation with a headcount of several hundred working across multiple sites, our biggest challenge has been to maintain the flexibility, fleetness of foot, creative energy, and commitment to great outcomes for our service users that has been a hallmark of our success. What did we need to do to stop us becoming just another large nhs organisation?

In early 2015 we came across Frederic Laloux and his book Reinventing Organisations. He has conducted research into organisations from all over the world, in a broad range of sectors, which have developed a new way of working that delivers great results, and creates an environment in which people truly enjoy doing their jobs. He has demonstrated that these organisations, coming from very different origins, and in a process of convergent evolution, have all developed a common set of practices and tools that serve as a roadmap for others who want their own organisations to succeed in a world of increasing volatility, uncertainty, complexity and ambivalence.

Readers of this site may be familiar with Buurtzorg, the phenomenally successful provider of community nursing services in the Netherlands, and one of Laloux’s major case studies. In BICS we have set out on a journey to embrace these practices, to join a growing global movement which seeks to transform the experience of work for all of us.

The transformation involves three interconnected themes:

• Evolutionary Purpose – connecting people to a clear and unambiguous sense of purpose in their work
• Wholeness – creating a work environment that allows people to bring their whole selves to work, and operating from a place of trust that people are fundamentally honest, well intentioned and capable of learning
• Self-Management – that people are at their most effective when they are in control of what they do and how they do it

At BICS we have committed resource and energy to exploring our purpose. In healthcare, it may at first sight seem obvious that purpose is clear and shared, but an NHS environment of top down targets and process performance indicators has steadily eroded purpose and driven a wedge between front line staff and corporate “leaders”.

We have also introduced a series of voluntary practices, around how we run our meetings, about how our physical workspaces are designed, and about workplace mindfulness. These practices daily influence and shape how we talk to each other and to the people for whom we care.

Lastly a number of our service teams have taken up self-management structures, stripped out their hierarchies, and taken full responsibility for managing their outcomes and their budgets. To support this we have introduced an “advice process” in which anyone can make a decision, the only rule being that they must seek the advice of everyone upon whom their decision may have an impact.

In future posts, some of our teams will contribute their own stories of what they have achieved and what it feels like to work in this new way.