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Serendipity and the Art of NHS Management

Annabelle Burns discusses her visit to Buurtzorg and how it left her inspired and excited to embed new ways of working.

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It’s always reassuring when you discover that your niggling concerns or ideas about a new way forward have already been documented and theorised by others into a handy ‘how-to’ guide. This is exactly how I felt when I discovered the IHI Joy in Work framework which has been invaluable in guiding my thinking and planning around staff engagement and wellbeing in our team. (Watch Annabelle’s recent Q Zoom on ‘Promoting Enjoyment and Wellbeing at Work‘).

It’s also how I felt when I was privileged to be part of an NHS Elect Leadership course that took us to visit the self-managing organisation Buurtzorg, although the seeds and ideas that were planted on that trip are taking a little longer to germinate.

Visiting Buurtzorg

The self-management ethos and Buurtzorg’s leadership structures seemed to provide so many of the answers to questions I was grappling with in my NHS-based therapy team in London. I was inspired and excited and returned to work telling everyone about my trip but translating these values and practices into my own team has proved much more of a challenge. Yes, we have a team of competent professionals who are skilled and able to manage complex decisions. Yes, we have a strong child-and family-centred ethos and we already work in a small, locally-based team. Yes, we would love to reduce bureaucracy, spend more time face to face with families, make our care more efficient and more effective, more relevant and more functional. But we work within the monolithic NHS and Local Authority structures where there are hierarchies, and KPIs, directives and policies, commissioners and inspectors. How do we make a fundamental structural change from the bottom up in the context of this everyday reality?

How do we make a fundamental structural change from the bottom up in the context of this everyday reality?

Discovering the Q community has been another serendipitous moment in my management journey. Through the host of thoughtful professionals, books, podcasts, blogs and videos Q has connected me to I have been re-inspired that a self-managing future is possible. A recent Q-curated conversation with fellow ponderers and practitioners has encouraged me to consider again whether self-management may be the answer to the problems and questions my team is currently grappling with. I am ready to take the first steps toward exploring self-management for our team, and in doing so to consider how other AHPs and NHS-based teams can learn from these methods and ideas too.

It’s heartening to know that across the public sector there are pockets of thinking and practice that are building on and learning from self-managed organisations. There is much to learn from one another’s experience, as well as a growing list of recommended books and websites to read and reflect on. Through my own brief connections, I have already been given some invaluable top tips: start small, allow others to opt-in, go where the energy is, take the time you need. So, with all this in mind, if you work in the public sector or you are an AHP, and if the ideas of self-management spark interest or are already guiding your management practice I’d love to hear from you. Please do get in touch and join me on the exciting journey ahead. (My e-mail:

Annabelle’s self-management inspiration

We asked Annabelle for a few helpful resources on ways of working and self-management, here are some of her top picks:

An intro to Brave New Work; an initiative to find better ways for working

Meet like-minded people and learn new ideas

Learn more about Buurtzorg, the healthcare organisation pioneering self-management

Do you have any recommendations for great resources in self-management and new ways of working, Q community? Share them in the comments.

Join the Reimagining Health and Care SIG to get involved and stay up to date on their activity.


  1. Guest

    Yes, I found :)

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