Mentaal Beter: Self-management In The Country of Psychologists
The implementation of distributed and agile governance is never immediate in a company. In the particular case of Mentaal Beter, the organisational change was not a matter for executives, managers and employees, but for mental health professionals.
A challenge that Martin de Heer, CEO of NL Mentalcare Group, took up in the Netherlands.
Between health and business
With a degree in hospital psychiatric care and an MBA in business management and administration, Martin de Heer began by creating small structures with psychologists, in a rather informal way, with the idea of implementing working methods different from large health structures. This has spun off somewhat and merged with the franchise network of Mentaal Beter in 2009. The network now has around 1000 professionals serving the mental disorders of children, adolescents and adults in 110 practices and clinics. 35,000 patients followed each year, a claimed satisfaction rate of 8.5/10 (above the national average), and an overall turnover of 80 million euros. A real business, where profitability rates take a place that fits the healthcare sector; Martin de Heer speaks of customers rather than patients. The difference with a traditional company lies mainly in the fact that the “employees” here are psychologists, psychiatrists, psychotherapists… Who have their own professional standards and ways of communicating.
Expansion creates the need for organization
At the beginning of the adventure, it was not difficult to innovate in terms of management, due to the small size of the network. As things have grown, things have been organized in a fairly horizontal way: about 200 practitioners, each discipline having its referent practitioner in contact with the board of directors. But the whole thing needed to be federated, it was necessary to generate involvement… Leadership, but one that is adapted to their professions and practitioners.
Discovering Frédéric Laloux’s writings, the directors decided to build something that corresponded to his vision of the organization, according to three essential principles: to be oneself, to rely on a self-organizing structure and to have a purpose.
Determine your “why”
Above all, no rush on this point: it will take a year of reflection and exchanges to define the reasons for and modalities of empowerment. Martin de Heer has seen many other companies engage in holacracy or self-management in the broad sense. But without addressing this question of “why”, stakeholders can miss the meaning of holacratic implementation. The risk, in this case, is that employees do not feel comfortable in the system, which becomes just a structure, a method, with emptiness inside.
The purpose of Mentaal Beter was to give practitioners the means, the “empowerment” so that they could follow their intuition to implement the best practices in their field, in their region, and become all the more responsible in the practice of their discipline.
The “psychologists”, a population on its own
The implementation of holacracy proved to be complicated, because at first the method did not correspond to the mentality of the established group of professionals. Psychologists and psychiatrists are endowed with a deep critical, analytical, questioning attitude and are at the same time not really change-minded. The first meetings were stormy, especially when the Holacracy facilitator cut off a team member who start to speak at a moment not fitting in the meeting. “You talk to me like I’m a four-year-old child! Who do you think you are?” heard Martin de Heer from a psychiatrist to whom the Holacracy rules were explained. These rules were intrinsically problematic, because it was out of the question for these people to see the holacratic constitution as a sacred book! The new generation on the other hand was fairly enthusiastic and they embraced the new governance.
The Mentaal Beter network is being facilitated by a Shared Service Center. This former headquarter has skillfully moved towards something hybrid, combining two ways of working: teams are defined with roles and responsibilities, and the work is done in Scrum. And the principles of holacratic meetings are being used for defining the roles.
More and more training, growth comes at a cost
The progressive training of the teams has also been a remedy for the difficulties of youth. Training in the principles of self-organization first, but also in management, coaching to rethink one’s own organization… Essential, but time-consuming, with a significant financial impact: in addition to the cost of training, there is also the downtime and the resulting drop in revenue. However, the larger the structure, the more training it seems to require, a kind of reverse scale economy. To really understand the challenge one should also look at the context in which the company is working: healthcare is based upon a financial system where each minute is counted. So declarability is key and the challenge is containing the time-consuming roles in teams versus the autonomy of the team members.
Mentaal Beter’s workforce has grown by 30% per year in recent times to keep pace with customer growth. Newcomers who need to be trained, and who also require the restructuring of teams that cannot grow indefinitely. This permanent evolution requires regular updates of everyone, coaching…. In self-organization, growth has a high cost, but the results are there: professionals choose to work for Mentaal Beter because of the autonomy in the teams.
A real change in practices
For Martin de Heer, the relevance of the business model is constantly being questioned. Are all these efforts paying off?
There is always the economic imperative, to keep an eye on profitability. No way for him to hear: “Look, it’s just an experience. They tried something new. It doesn’t work.” So far, finances are doing rather well, which makes it all the more reason to be pleased with the changes in practices.
Self-organization, accountability in management… practitioners now think differently. Whereas they were previously satisfied with taking care of the installations and their working environment when they used them, they are now concerned with the functioning of infrastructures and their optimization. They feel that they really own and are in charge of the system.
Martin de Heer also finds them more involved with their patients, more creative, taking more initiative, “thinking more outside the books”. This is precisely the answer to the initial “why self-organization?”.
Support services (planning, stewardship…) also show more initiative, for the comfort of patients: better reception, better service… to the customer with the overall purpose
To strengthen the resilience of people dealing with mental health problems,
Be ready to welcome the younger generation
Mentaal Beter had to change, everyone had to change their way of looking at their work, a minimum requirement according to Martin de Heer if we consider the generation entering the job market.
Born with an iPhone in their hands, they are used to self-organize with clicks of the web tools (airbnb, Uber…), this new world of work is made for them.
Far from the culture of loyalty to the company, they prefer the culture of purpose, movement and life. Salary is not the most important issue for them either. The quality of the working environment, the company’s mission, its respect for the environment in its processes… those are key.
Employers who want to attract the talents of tomorrow, shape your governance, change hierarchic organization chart structures to dynamic circles and find a new balance between alignment and autonomy.
