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Episode Transcript
Lisa: Zoe, perhaps if you could start by telling listeners a little bit about here and how it started and what the purpose of the organisation is.
Zoe: Yeah, sure. So here started in 2008. That makes us ten years old this year. We’re a healthcare social enterprise that’s owned by its own staff—general practice in Brighton and Hove, that’s GPs, practice nurses, and practice managers. And we started in 2008 as a response to a system that we felt was grossly unfair in healthcare, where the greatest amount to spend gets spent on a very small range of interventions and very little resources, as in the big picture as we saw it, were being spent in primary care where most people at most times in their life experience a need for care and a response to those needs.
Originally we started as a way of organizing ourselves in primary care to both do the right thing for the people that we served and address health inequalities and the unequal nurse that it seemed in healthcare spend, and make sure that we spend every pound that is spent in healthcare wisely.
It soon became clear to us that we needed to help integrate services across primary care general practice, secondary hospital services, mental health, and community services. And we developed a then quite radical model of delivery that put people in control of their healthcare journeys, organized care wrapped around a single set of pathways and even then, in a revolutionary way, a single clinical information system that was paperless.
We run a range of NHS services under NHS contract, so we’re sort of in the NHS family but not of the NHS family. So we’re not a hospital or a GP practice, although we do run some GP practices. We’re a different kind of breed. And our purpose has always been evolving, as I believe organizational purpose and in fact personal purpose evolves.
About two and a half years ago, we embarked on an 18-month journey inspired by a number of factors that we can talk about, but in particular inspired by Frederick Laloux’s book “Reinventing Organisations,” to really listen in to what was the purpose of the organisation now as it stands from the perspective of understanding that organisations are living systems, they’re not machines. And our purpose is really about what’s the deepest calling that an organisation can offer to the community that it serves.
During that process, we involved 300 people including citizens, including our staff, including partner staff that we work with, and landed on a purpose that we call “care unbound: creating more possibilities for care in every moment.” And everybody’s got their own interpretation of what that means. That’s what’s so great about working with purpose. But for me that means about reclaiming care out of the paradigm of something that we do to another in a kind of paternalistic way, to seeing clearly what’s needed, responding well, and taking action wisely, and shifting the way we think about care as being away from just a single medical intervention and single conversation into a much broader and deeper way of understanding what it really means to care for each other in an environment that fundamentally doesn’t really support people caring for each other.
Lisa: So I’m curious what it was about the book “Reinventing Organizations” that resonated with you or sparked with you such that you began this kind of 18-month journey to look at evolutionary purpose. It sounds like one of the breakthroughs that Laloux describes. What was it that spoke to you about the book?
Zoe: It was—I think the story of how I came to the book’s quite an interesting one in its own right, and it also tells a bit of an organizational story for ourselves.
This was about four years ago. We had got to a place as an organization where we had 125 people working in our organization. We had a very broad range of services. We’d just moved from one office to another. We’d been split up with four different sites in Brighton where we are based, and people kept telling me that they were feeling like they didn’t know what we were, what we were doing anymore. And some people who had been cofounders with me and a few others came to me and said, “It just doesn’t feel right. I feel that we’re disconnected from what we’re here to do,” and “I don’t really know what it is that we’re here to do.”
And to be honest, as an organization, I think we had lost our way. We’d started as eight of us on a very kind of values-driven organizational base that we’d worked really hard on articulating our organizational values. But we had along the way put in place the kind of bureaucracies that normal organizations have to do and that we still do that our regulators require. We’ve got the normal forty policies that were 40 pages each. We’ve got quite a—despite our shared leadership model that we’ve had since the very beginning, we’ve got quite a hierarchy going on. I think at one point I looked at this period and there were seven layers in some services between the founders and me as one of the leaders and people who were actually delivering the service.
And in my aspirations to make sure that those people at the front line who were delivering services were making the decisions about direction, spend, all of it, and all of those resource decisions wasn’t really happening. And I also was feeling really burnt out from winning many, many contracts. With our business model, we had been competing in the market in the healthcare market, which is an extraordinarily exhausting thing to do.
And a friend of mine, John Waters, said, “I think you need to read this book. I think you’ll really enjoy it.” And I actually didn’t read it. He came to me that summer and said, “Oh, I think you need to really enjoy this book.” And I said, “I’m too busy to read a book, John. I can’t be bothered.”
And then I started to listen and I started to reconnect and listen both to myself and what other people were saying to me. And for some reason, I picked up this book and took it on holiday to Wales over Christmas and I read the book. And I had—it was like it was like remembering all the things that I had previously known to be true but had somehow not been brave enough to implement.
So I come from a long tradition of believing in self-organizing principles. I was part of the group of people who—part of a wider group of people who gave birth to the Art of Hosting movement in Europe and internationally. I was really inspired by Margaret Wheatley’s work on meeting new sciences in my 20s. I was like, “Wow, this is a whole new way to work with people.”
But somehow or another along the way, even though I’d had this very in-depth experience of what it was like to operate in a really—to see the world through the lens of it’s a living ecosystem as opposed to command and control—somehow or another in creating an organization, it had got a lot of strengths in terms of a lot of strength around equality of opportunity and very values-driven, and yet we had created hierarchy along the way.
And so Laloux’s book then simply put all the things that I’d already known and in fact some things that we were already doing into context. It was framework-forming, and I was like, “Ah, that’s it. That’s it. We just need to focus ourselves on our ways of working as an organization to really then be able to, I suppose, repurpose ourselves and find our path again as an organization.”
And that’s not to say that along the way we weren’t doing some amazing things. We were doing some amazing things. We have done some amazing things that have served millions of citizens across Sussex and now many more millions. But there was a big thing missing, and Frederick’s book helped me to see what those missing parts were.
So I came back from Christmas and I bought about 60 of the books and we started an organizational inquiry. I may have started it amongst people that I thought would be interested, and then I worked on it at board level. And at board level, we just went, “Right, this is the direction we’re going to go in. We’re gonna try and experiment with: can we bring some of those three breakthroughs into our organizational life?” And we’ve been on that journey ever since.
It’s not a straightforward journey in our environment by any means, and it’s not complete. I also don’t believe it’s a destination. My initial thoughts about this, Lisa, were, “Oh well, all we need to do is just to do the three breakthroughs and then it’ll all be fine.” And actually, I now know that it’s a process in a practice, it’s not a destination.
Lisa: Well, what would you say have been some of the milestones or experiments in terms of wholeness and evolutionary purpose then? What have you been discovering and playing around with?
Zoe: Well, a big thing that we’ve been experimenting with that arrived to us as an organization and, in fact, arose within the organization quite organically was the role of a mindful practice in order to be able to see clearly and act wisely.
About the same time actually, we went to Meaning in Brighton, which is an amazing conference, which I’m sure—
Lisa: Yes, yes.
Zoe: And we took a group of 10 people—self-selected a group of 10 staff—partly because I wanted people to get a sense of, you know, what were other people doing in other sectors to create meaningful work environments and meaningful work. And there was a workshop run by Michelle and Joel Levey on mindfulness at work, and some people went to that workshop and some people went to something else.
Always as part of when we go out as a group to a learning event, then we debrief afterwards. And we were debriefing after this event and suddenly there’s kind of an extraordinary thing was happening in the room. There were about about 30 people there who I think we’d—we’d been on some other workshops too, maybe they’d been in Austria. People had been on at the same time. I can’t quite remember.
And suddenly, people were sort of confessing to having—it was like people were coming out and saying, “You know, I’ve got a bit of a mindfulness practice.” And so suddenly there was about ten people saying, “Yes, I have a mindfulness practice, and actually I find it really helpful. I find it really de-stressing in the day.” You know, there were sort of all sorts of stories coming up. And suddenly I was like, “Oh, this is very interesting.”
And I was inspired by Joel and Michelle Levey’s approach to bringing mindfulness into the workplace because, again, I’d been—I too had had, on and off in the last 20 years, a mindfulness practice in various stages of my life. I pay more attention to it than others. And I was really inspired by the very simple way in which they brought clarity to not only how useful that practice could be, but you know, how profound it was in improving relationships in the workplace and really improving focus and helping in decision-making.
So I was like, “Oh, this is really interesting.” You know, I saw an immediate way of connecting in people’s personal practice with how could we use it in an organisation. And I’m probably getting the story wrong because it’s all a bit of a long time ago, but—or the order of it wrong anyway—but we decided, as an organization, a small group of us thought, “Well, we’ve been experimenting with 8-week mindfulness courses that people were—we were subsidizing as part of our community well-being fund that we have for colleagues.”
And we started to think, “Well, actually, could we experiment with bringing mindfulness and understanding purpose together?” Because obviously one of the key things, one of the key aspects of mindfulness is insight—is being able to see what’s going on and understand it and then respond appropriately—which, for me, is part of the inquiry into purpose.
And we put—we simply put the two things together. I say simply, after a little bit of planning and the dedication of a number of key people. And we teamed up with Joel and Michelle Levey, and we ran a program called “Being Here.” And we ran a series of introductions to mindfulness and team meetings in mindful practice and mindful dialogue and a whole series of things.
And then we also ran two-day workshops using mindfulness practice to determine a purpose, both personally and team and organizationally. And then we also teamed up with Neo, what was then Neo Creative brand agency, to help us to then articulate the outcome of that into our organizational purpose.
And since then, the mindfulness is a significant part of our organizational life. We don’t make it mandatory, and we might start a meeting—in fact, every meeting that I’m in starts with a minute of bringing ourselves to each other in the room in a mindful way, or it may even begin with a couple of minutes of silence. And we have a number of very reflective practices throughout the organization.
Lisa: I’m wondering as well—and perhaps mindfulness comes into this because I know you mentioned mindful dialogues—but I’m curious about how you support people in the organization in terms of relationships, for example, or collaboration and cooperation. What sort of skills and practices and awareness has been important for that?
Zoe: Well, one of the things that we know about ourselves as an organization is that the vast majority of people who work with us operate out of a worldview that says that they really value equality and they really value being kind and supportive to each other. They really value the strengths that each other bring.
And what the downside of that means is that we have two things that go on. One is that we’re afraid to give each other feedback and potentially create conflict. And the other is that we have a tendency—there’s a tendency to misuse power of authority in a sort of unhelpful way. And that’s unsurprising for an organization like ourselves, and in fact, I think it’s unsurprising for most organizations to find conflict a bit challenging.
So since we first started, I’ve always—we brought various different training programs and support mechanisms for having good conversation. So in the early days, we use—we use most of things that we still use today actually, which is equipping people in how to give good feedback.
I’ve got this idea—I don’t want feedback to be something that we have to go into a quiet room to give each other. It’s a conversation. When somebody does something amazing, then you can give feedback. And then when somebody does something that is really annoying, you just need a way of really simply saying that in a really easy way.
And over the years, we’ve experimented with lots of different ways of doing that. What we are learning is that it’s a practice that needs regular practice. So we run groups, we run particular training groups around feedback, having difficult conversations. And then more recently, we call them “circus,” but they’re like—our organizational development team have been working with teams on real issues and equipping them with the skills to be able to solve those real issues in the moment, you know, alongside people as they happen. And we’re finding that that’s more effective than single training or going to have a day together on—although those things make a difference. Actually, the thing that really makes a difference is in-the-moment development.
Lisa: You bring up the circus team, and I wanted to talk about—because I know you’re part of the Enabling team, is that right?
Zoe: Yes, yes.
Lisa: I’d like to hear a bit about what is the design of the different teams and how does the circus team or the Enabling team, for example, support people and, yeah, I guess support the organization. How does that work?
Zoe: So all of our organization is organized into separate teams and separate business units. So it’s worth explaining that our service delivery model is one of integration and partnership with other providers. So for example, we deliver primary care mental health services, but we do that in partnership with three other organizations.
And one of the things that we do is that we create a single sense of team for those people working within that service. That particular service has got over 130 people working in it, and they think of themselves as Brighton and Hove Wellbeing Service. They don’t think of themselves as being here employees or Sussex Partnership Trust employees. They think of themselves as being part of this team.
And that was a very conscious decision we made 10 years ago, and that partly came out of what I observed in healthcare is that citizens don’t care who you work for, and what they expect is for you to be able to help them when they put their hand for help. But our organizational response seemed to me, and largely still is, one of passing the buck from one part of the system to another and nobody ever taking overall responsibility, and that people within those teams felt a very sort of tribal connection to the part of the service that they were working in.
So we’ve got this very strong ethos as an organization about single sense of identity within our service delivery teams. So the organisation’s made up of—obviously it’s changed over the years and gone up and gone down, but at the moment I think we’ve got six different service delivery teams.
And then there is a very small corporate team. That’s actually about the same size. It’s got different skill mix in it, too, when we started. That includes the usual things that you would expect in a corporate function, like finance and making sure people get paid on time and make sure the buildings are safe and looking after the human resources side of the business.
And then we have what we call an enabling team, which in other organizations would be called an executive team, all of whom are board members. And then we have a board that’s got two additional members on it.
And we invented circus about three or four years ago. And so the enabling team’s role is to create the conditions for people who are doing service delivery to be successful. And our role is to steward the organization’s purpose. Everybody’s job is to listen in to what the organization’s purpose is and whether we’re delivering it well enough. But I do think there is a special role to be played for the leadership and enabling team function in that role.
And then circus is a small—actually a very small team of mostly part-time people whose job it is to highlight areas of the three breakthroughs and play creatively with bringing them alive in the organization. So their role has evolved over the last four years, and at the moment, they’re working on both a series of practical tools and practices and working alongside people to develop those tools and practices in practice. And that’s everybody else’s job as well, and I think it is helpful to have a set of people who are a bit expert so that it’s not the blind leading the blind.
And we also have our financial stewardship. It’s a little bit different from most organizations. So our financial stewardship of the organization is distributed and held by a wide group of people across the organization. So although we have a finance director, his job is to support the wise decisions of that financial stewardship group.
And although the buck always stops at board level over some key things like health and safety, it is possible to distribute responsibility and action over key things like that. So we kind of—on the outside, we look a bit similar to most organizations, but on the inside, it’s got some fairly different but not totally unique organizational practices and ways of structuring ourselves that are more in line with an evolving teal organization.
Lisa: You have this beautiful phrase on the website about your role being to help tether the organization to purpose, for example. But how has your role evolved for you, and what have been and are some tensions in terms of this chief executive role and what that means in an organisation like here?
Zoe: Well, the first thing I should say about this is that we actually operate a shared leadership model in our organization. So there are three of us who really fulfil the role of chief executive. So that’s myself, Peter Devlin, and Jonathan Sargent.
And I was also really inspired by the work of Christina Baldwin and Lynne Arias over the Circle Way practice, which was at the foundation actually of the Art of Hosting, where leadership is shared and rotated on the basis that none of us know the answers and we’re better if we learn more faster if we’re with others.
So when we first started, we used to have the executive directors of the company. We have four other non-executive directors of the company, but we’re the company. There are seven company directors. We’re a company limited by shares, and we’re the executive directors that are appointed by the rest of the board. And we’ve always operated a shared leadership model.
So that means that Peter and Jonathan and I spend a lot of time together and have a very rich and deep relationship. What we discovered along the way was that the rest of the world found it difficult to cope with. So our external partners found it quite difficult to understand why they’d be talking to me at some points and Jonathan at another point. And in fact, to be honest, they still do. So we decided to invent the role of chief executive. That’s one part of the story.
The other part of the story is that I am the person who has always been—ever since I was a child—interested in purpose. I used to drive people mad by asking big wide questions. And I remember as a 12-year-old really feeling a deep sense of connection to: Well, what is it that I’m here to do?
So I’m the one amongst us who holds the practice of trying to listen in to the broader environment and myself and what’s going on within us as an organization to really define and sense into what’s the right direction for us to take right now. What’s needed right now? And it doesn’t mean that I’m the boss.
However, one of the things that I’ve found and I think is really tricky is that we operate in a paradigm where hierarchy is so ingrained in us. And I don’t know whether it’s in part to do with patriarchy or what it is to do with, but it’s a very fundamental part of who we are. And so people often look to me to say something wise or make some decision or something. And sometimes that’s comforting, and sometimes I think, “Well, that’s nice that people are interested,” but it’s not always the best answer to wait for me to make some pronouncement.
So I have a practice that I try to stick to, but Lisa, I’m not perfect, which is that I don’t make decisions. So we use an advice process in the organization, although in some parts of our organization it works better than others, where the simple rule is: the bigger the decision, the more people that—anybody can take a decision, but the bigger decisions need more people involved in helping me to make it.
And as an enabling team, we constantly seek to check out: What decisions are we making here, and are we the—who else needs to be involved in those conversations, and are we the right people to make those decisions?
And some of the other tensions are about the external environment in the city looking for hierarchy and finding hierarchy reassuring. So our regulators see hierarchy as good leadership. So we’ve been inspired by people like Helen Sanderson who’ve been challenging that mode. But in a way, what we’ve done is not be as brave as she’s been and tried to kind of create solutions that kind of fit the mold, but underneath they aren’t really like it. That’s been our strategy.
And more recently, we swapped roles, so I’m not currently the chief executive. I’m chief energizer of one part of our business that needs startup energy, and Peter has stepped into being chief executive of the organization. And of course, when that happens, there are some profound things that change. So Peter’s got a different take on what the role is and how to fulfill that role, which is natural.
And in the process, me and Peter and Jonathan then have to redefine and we discover how do we hold that role together. So I’m still it and I’m not it. Pete’s doing it and he’s also doing other things. So it’s not straightforward or it’s quite challenging, I’m saying.
Lisa: Yeah, definitely. I mean, I was talking to a social enterprise the other week who was saying they were struggling with a similar thing. That they had been awarded some funding by a body or other and had all of these—to use Laloux’s term—“red” kind of compliance regulations. And they were really feeling that tension of, you know, how can we possibly strive to be teal or whatever you want to call it? How can you do that when you have the complete antithesis in the external environment of having to meet these requirements and these expectations?
So it’s really challenging, and I think it’s really encouraging and inspiring to see examples like here and Helen Sanderson’s wellbeing teams and how you sort of navigate that. But what are your thoughts about the future and whether the rest of the world or these institutions—do you think they are going to evolve eventually? Or do you think there’s no hope? Are you an optimist or a pessimist?
Zoe: So I’m neither. I’ve stopped believing that I can save the world, and that’s very Margaret Wheatley, I guess.
Lisa: Yes, yes. She’s been a teacher for me for a very, very long time.
Zoe: Yeah, I’ve absolutely—I got burnt out by believing that it was all on my shoulders or the shoulders of my organization. For me, it’s not a helpful place to be in. But I absolutely believe that what we do in here and there are others really, really matters.
So one of the things that keeps me—perhaps not hopeful for the rest of the world, but keeps me hopeful for the people that come into contact with organizations like ourselves and keeps me hopeful about our ability to help people more and more and more in whatever way we can—is that creating an organization that is essentially a place where people can express themselves in a way that is both purposeful, is helping others, is contributing, is not further damaging the environment in which we live in, is really looking after the whole, feels to me to be the most important work that I can do right now.
When I think about how really harsh the environment is for people who’ve got mental health problems or whose lives have fallen off the rails, I think I just have to create a place where people who care for those people feel nourished and nurtured, that they can develop, that they’ve got conditions to create some creative solutions to finding some problems and resolving things that really might help other people.
And creating what Margaret Wheatley calls “islands of sanity” in this really challenging time feels to me to be really, really important. And I like to think that we’re playing—we’re a small island of sanity, and I don’t worry about what the rest of the world is doing, I’m afraid, and whether or not other organizations will follow.
I mean, it’s heartening to see that there are other workplaces that follow in the same direction. Somebody—it may even be you—told me that Mott MacDonald have been self-managing and self-organizing for 15 years now. It’s like people crawl out the woodwork—“Actually, we’ve been doing this for more years than you!”
I mean, that’s all heartening, but I’m like, let’s focus on what matters right now and what I’ve got presented to me in the here and now. Lots of people moan at me and say, “But Zoe, you should be sharing more and learning more.” And that’s probably all true, and it takes a lot of energy and effort to protect what we have. Protection of what’s uniquely ours to do is really a job in and of itself, let alone sharing it with lots of other people.
Lisa: As someone who has been on this journey with here for 10 years now and having explored lots of different practices and ideas from mindfulness and bringing in your expertise in Art of Hosting and your passion for purpose, what advice or insights would you give to other leaders like yourself or people who are trying to create their own island of sanity somewhere and ways of working that support human beings, I guess?
Zoe: Yes, there were some really important things that I think we—well, I’ve learnt along the way. One is about creating time to listen, reflect. Creating space, I think, is really, really needed.
I think when we went off—in the past, I would rush that stuff and try to introduce—first try to introduce self-management about—right, we’ve got an opportunity, let’s progress it. And we hit various brick walls along the way and quite a bit of resistance.
And what I’ve learned to do is continually take a step back, always really try to deeply listen to not just what’s said, but what’s not said, what’s the underlying message that feels incongruent and resonates as the right thing to do.
And also, I think I’ve developed some skills in being able to understand where people are at and work with that, so removing judgment about some of that.
I mean, I operate in an organization that is just full of people who love the green worldview of equality of opportunity. And often that means that they like to talk about things for a very, very long time, and they really love consensus. And there are some places where that’s really great, and there’s sometimes where we just get on with things.
And so I’ve learnt to practice just knowing where people are at and working with that in a way that moves things on just a little bit. Doesn’t have to move it on a great big whole host, but just a little bit.
The other thing that’s been really helpful is having a broader network of people all over the world who I feel connected to in many different ways, who are on a similar journey or who have some significant teaching and experience to offer. And connecting up with those people has been really, really helpful to me as an individual and to our broader organization actually.
And the other big thing that I have learnt is not to take the tools that are offered and implement them too quickly or too much in a structured way. Your organizational context is what matters, and work with that.
So I remember being very clear that we needed to build on the strengths of our organization already when we were thinking in the three breakthroughs, and then we could build on the rest of it. And I’ve seen a number of people say, “Well, you know, the toolkit says I’ve got to do all this, so let’s do all that.” And I’ve always been a little bit like, “Really?”
And also my thing that I always say to people whenever they ask me about how do you shift from normal paradigm to evolving paradigm is, well, I don’t know really. You have to feel your way into it. And I think it’s in the practice of doing something rather than talking about it that we really learn whether or not something works.
