Holacracy: An idea for long-term care?
Elizabeth Leis Newman
As a fan of titles, rules, and hierarchy (I would have made an excellent British subject), I greeted news of Zappo's new “holacracy,” with a measure of fascination and horror.
If you missed it, holacracy is a structure in a company that focuses on tasks, rather than management structure. The idea is by jettisoning titles and breaking down bureaucratic regulations, employees can focus on building a better organization. The goal is transparency and encouraging responsibility. Employees group into self-defined circles and then set rules of governance and workflow.
The advantage is that it breaks down barriers to an employee running with a great idea and getting stuff done. If you have ever spent time making sure you didn't damage egos of superiors, worrying about who to cc: on an email, or trying to sooth over hurt feelings related to a promotion, you can see why holacracy could free up time in your day. Arguably, most employees thrive when they have autonomy. One Holacracy.org blog post talks about the clarity that comes from holacracy, specifically the ability to focus on the work at hand.
But would it work for a long-term care facility or organization? Probably not. Unlike a company such as Zappos, which is rapidly expanding and reinventing the rules of business, there is a fairly rigid structure in place at most nursing homes. That's due to several factors, some external and some cultural. As an industry forced to be responsive to the federal government in order to survive, there are strict regulations in place that require documentation, not to mention the high level of turnover among employees and a need to keep reasonable resident to staff ratios. On the cultural side, while there is constant evolution, no one would accuse long-term care of being a progressive industry. It's also fair to note that most healthcare C-suite executives and managers aren't champing at the bit to kill off their titles.
Still, I think there are lessons that can be gleaned from the holacracy model, namely the idea of a laser focus on the work, which in this case we'll define as caring for residents. Good administrators, as Lori Porter has talked about, never require an employee to do anything they wouldn't do themselves. I know of a hospital administrator who made a point to answer a call light if he was walking the halls, which is how he discovered a patient was being served moldy Jell-O. (If you have a child who is looking for a science fair project, I'd suggest investigating how this is even possible.)
Similarly, many facilities are being encouraged to involve housekeeping, maintenance and other lower-level staff in being the “eyes and ears” of an organization. Organizations that encourage employees to launch projects and speak up, or who encourage work development groups similar to circles, will likely be the ones that can better adopt to a bundle payment model. Embracing holacracy may not work for your company, but ones that embrace new ideas will never go out of fashion.
Elizabeth Newman is Senior Editor at McKnight's, a title she dearly loves.