Finding Purpose and Skin in the Game: Helen Sanderson on Transformational Health and Social Care

Helen Sanderson FRSA talks to us about ‘Wellbeing Teams’ - an RSA Transform-supported initiative aiming to radically change the way health and social care is delivered.

Helen has over twenty years’ experience developing person-centred practices in the UK under her belt, including as an advisor to the Department of Health and co-author of the Department’s first guidelines on person-centred planning.

Could you tell us about what encouraged you to set up Wellbeing Teams and your personal journey getting to this point?

My Dad died at 53 and as I was approaching my 50th birthday I asked myself, “If, like my Dad, I only had three years left to live, would I still want to do the work that I am doing now?”.

At the time I was working as a consultant with HSA, a small international health and care consultancy team, supporting major health and care organisations through different ways of thinking and working. I hoped I was having a positive influence in some way, but the question lingered. Would I be happy to keep doing the work I was doing, if I had just a few more years left? 

Doing Seth Godin’s altMBA course, and reading two books in particular helped me to answer that question. Atul Gawande’s Being Mortal challenges the way we support older people and think about end of life care, and Frederic Laloux’s Reinventing Organisations, recommended to me by fellow altMBA student Susan Basterfield, introduced me to how organisations are evolving and how they could work better in the future.

I wanted to see the change that Gawande and Laloux’s books addressed in the organisations I was supporting. To get first hand experience of self-management, I gave up my role as CEO at HSA and as a team we learned about self-management in practice.

As a consultant I learned that when it is someone else’s organisation, where you are not responsible for their finances, their registration with the Care Quality Commission (CQC) or reputation, naturally, there is only so far you can go. After learning about self-management with HSA, I wanted to ‘get skin in the game’, to test and learn what could be possible, and ended up forming a new provider organisation. This is how Wellbeing Teams started.

Self-management seem to be gaining more and more traction in health and care. What makes the Wellbeing Teams approach unique and what has aided your success?

I think we are starting to see more of an appetite for self-management due to the success of similar organisations abroad such as Buurtzorg, which is a self-managed organisation of 12,000 nurses based in the Netherlands.

We’re also seeing some influential organisations noticing and supporting self-management and it was an honour to be selected as one of Nesta’s New Radicals last year.

I don’t think there is any one factor that makes Wellbeing Teams unique, but we have a combination of principles and practices that we live by as an organisation that make us different.  

To name just a few, we are committed to values-based recruitment which means that we look at the whole person and whether their values align with ours when we’re hiring rather than just what’s on their CV. The social care sector is struggling to recruit and retain staff, so we intentionally recruit from outside the sector to appeal to a wider pool of people.

Boredom and loneliness have both been shown to have a severe impact on people’s health and wellbeing, so our care has a community focus. We support people to connect to what is happening in their wider community, based on a social prescribing model, or we create new opportunities to do more of what matters to them.

And of course, a commitment to self-management is essential to the Wellbeing Teams model. Teams don’t have traditional managers and are instead supported to make decisions and resolve challenges themselves.

The roles that the manager would have taken from scheduling, to recruitment, to marketing and communications (which we call storytelling) are shared by team members, based on their strengths. Working in this way keeps day-to-day decisions closer to the people we support, keeping us lean and agile.

As an early-adopter of the self-management model, what have been your biggest accomplishments and what have you learnt along the way?

If we’re focussing on self-management specifically then I would say that biggest learning is the power of the weekly meeting.

I became an accredited practitioner of the organisational style called holacracy and we used and adapted their process for tactical meetings to develop the Wellbeing Teams weekly meeting format.

They follow a simple structure, and this includes a check-in, a minute of mindfulness, looking at metrics together, reviewing the support we provide people through a ‘Living Well at Home’ board, and then raising and addressing tensions. Meeting facilitators are coached to use the process and they’re provided with formative and summative feedback on the meetings they facilitate.

We’ve actually just gone through our first inspection with CQC and the inspector sat in on the meeting. We were delighted that they specifically pointed to the meetings as an “innovative approach” where “Wellbeing Workers took ownership of identifying and taking responsibility for solutions to improve care provision…challenging each other in a respectful, constructive manner to ensure good outcomes for people using the service”.

I think that these team meetings are where you really see self-management in action and it was great to have this recognised by CQC.

What changes would you like to see in the wider health and care ecosystem to support Wellbeing Teams’ mission?  

The change to the wider sector that would best support Wellbeing Teams and other organisations like ours would be brave, place-based commissioning.

We need commissioners who are committed to exploring different ways of commissioning homecare that moves away from the hourly rate and time and task.

From our learning, delivering home care in Wigan and Oxfordshire, I think there are radical ways that home care could be transformed – by integrating reablement, health, home care and community connecting (social prescribing).  Our newest teams are working in partnership with Thurrock Council, Health and Public Health, where we are testing out some of these ideas.

What makes Thurrock’s commissioning different is their commitment to asset-based approaches and a focus on community which really resonates with our model. Others are recognising innovation in commissioning - just a few days ago a report from TLAP identified Thurrock and Wigan as a leading innovate local authority exploring new ways of working in social care.

What advice would you give to other organisations wanting to develop ‘next-stage’ principles and move towards self-management?

My advice would be to learn from doing. This could be getting clarity on roles and what you can expect from each other, developing team agreements, introducing Confirmation Practices, or introducing new meeting structures like the one I described earlier.

Invest in learning and connect with other people who are interested in next-stage principles and self-management. There are excellent videos from Fredrick LaLoux, and blogs by Corporate Rebels, as well as an online course that we’re offering at Wellbeing Teams with support from the RSA on self-management in action due to start in April 2019.

What can RSA Fellows and other readers do to support Wellbeing Teams and where can they learn more about your work?

There are lots of ways you can get involved and support our work.

If you’d like to learn more about self-management in action Wellbeing Teams’ course is due to start next month. It’s a five-week online course that gives you a good overview of self-management from our experience and three other self-managing health and social care organisations. You can find out more about the course here.

I also post a weekly two-minute film about what we are trying and learning on LinkedIn, if you want to connect with me there, and we are working with the RSA to create other opportunities to learn with us later in the year.

Wellbeing Teams is being supported by RSA Transform to develop self-managed health and care teams in the UK.

If you have any questions about our work in next-stage health and care, you can email us at [email protected].

Find out more about the RSA-supported course on self-management in action delivered by Wellbeing Teams.