Helen Sanderson from HSA on reinventing home care

Lisa: So Helen, two years ago began a journey. Could you tell us a little bit about what prompted that decision, what inspired you?

Helen: Yes, it was as you say about about two years ago. I just finished a course called the Altmba, the alternative MBA that Seth Godin designs and had been incredibly inspiring. I’d met lots of new people on that and one of the people that I met is a woman called Susan Basterfield and we clicked straightaway. We share a passion for working out loud and we started connecting over Zoom once a fortnight after the course.

As it got towards Christmas and I knew that Susan was a really big reader like me, I asked her to recommend a few books for me to read over the holiday season. She recommended three and one of them was “Reinventing Organizations” by Frederic Laloux and as I read it, I started to shake. It was one of those moments where you’re reading something and somebody can articulate the thoughts and feelings that you had but not been able to organize or frame in the way that they did. So I was utterly inspired and enthralled about the concept of Teal and the whole evolution of organizations and could recognize that as a team we were operating in the green space as a sort of homely culture and I wanted to move to Teal.

But I knew it couldn’t be just my decision and so before I even finished the book, I was starting to talk to the team about it on Slack. I was asking if they’d like to read it along with me. I sent copies of the book to the team members who wanted to do that, and the team members who were interested but didn’t really want to get into a book at that stage, I found clips on YouTube and different things that explained the same concept.

Our next full team meeting, so we have whole days together, was in March, so from February to March I asked people to read it. We had coaching sessions about what we thought it might mean to us and on that team day in March, we looked at whether there was a cultural alignment between Teal and how we were operating, what some of the practicalities might mean, and we then that day made the decision that we were going to go on that journey. So it started back then, that was right at the beginning.

Lisa: I’ve heard you say before that you were a little bit almost smug about “how hard can it be to become a self-managing team?” What were the starting points and what were some of the milestones along the journey?

Helen: That’s such an awful thing for me to say, but I did! I read the book and thought, okay, there are three elements to being a Teal organization, certainly how Laloux describes it. It would be bringing the whole person to work, the evolutionary purpose, and self-management.

Now I think we were already a great team. A lot of our work had been working in person-centered ways, thinking about person-centered teams. So I kind of thought in my head, “Well, this is like being a person-centered team but just going a bit further.” We already brought the whole person to work. We all had one-page profiles that describe what people appreciated about us, what matters to us, and how best to support us. We had team agreements about how we work together as a team. We knew each other personally very well. We paid a lot of attention to work-home balance.

So the whole “person to work” thing, we got that. The “why” stuff, our purpose - well, we’ve all watched Simon Sinek’s “Start with Why.” We had a really clear purpose and I thought that was already nailed. So really, you know, how hard could the self-management stuff be?

But it meant me giving up my role and power as CEO and it meant that we needed to step up to each other and step up to accountability in a completely different way. And what I learned was we were more interested in being polite and lovely to each other and getting on well than we were about holding each other to account. So that was a really big learning curve for us.

So we started by looking at our accountabilities, being really clear in a Google document about our different roles and what we could hold each other to account for. And we introduced tactical meetings. My fibrands were particularly excited about digging deeper into this and we started a journey of becoming Holacracy practitioners. I got Susan Busterfield, who is a Holacracy practitioner, to support us to go through that process.

So we had a call every two weeks and the fibrands would have an hour Zoom call with Susan. We’d do homework in between and we got to a stage where we were competent but not signed off. You have to do an online test which is really, really hard with a very high pass rate plus a test that you had to do as well. So five of us did that. So we were confident enough in using Holacracy as a process within HSA and using the tactical meetings.

We started to introduce weekly tactical meetings and they are such a different style of meeting. So again, we’ve done a lot of work on meetings and making them really positive and productive, but the whole thing in tactical meetings of raising tensions and the way of addressing them - it felt brutal at the beginning. So asking people what they need and figuring that out - it was a bit like folding your arms the wrong way all the time. It felt awkward and a bit strange and it took quite a bit of getting used to.

We’ve just finished a team meeting today and I’ve been talking about this, and it is simply the way that we work now. It feels normal and ordinary and easy, but at the beginning that was really a big job for us - stepping up to be accountable to each other and giving each other feedback in a different way, and being prepared to say to each other, “We’ve committed to this and this isn’t happening and how are we gonna figure it out?”

Lisa: Was there anything you did to help with giving feedback to each other in different ways? Or how else did you evolve from that culture of being polite to a culture of being honest and straight with each other?

Helen: We’d already done some work on the best ways to give each other feedback and that again came from the Altmba because the whole process of the Altmba is that you are giving the other people in your groups feedback on their work three times a week to five people.

So I tried to finish the course with this awful realization that I had given strangers on this course that I had been doing - it’s an online course so you do it as well as working full-time - but I’d been giving this group of strangers more feedback than I’m giving my team in a year. And that was awful and shocking to me.

So the team and I did some work about looking at why we found it difficult to give each other feedback and one of the potential reasons is we didn’t know how each person preferred to get feedback. So we did an exercise together where we looked at what are the best ways to give each other feedback and the best time and things like that.

I know if you Google “best ways to give people feedback” there’s a standard way of doing it, but on the basis of being person-centered, you can’t assume the same for everybody. So I wanted to learn more about the nuances of that.

But actually I read another book that was almost as powerful as reading Laloux’s book, which is called “An Everyone Culture” and it talks about being deliberately developmental organizations. That was the first time that I read about immunity to change maps and I invited another member of our team, Emily, to help me do my immunity change map. That meant asking members of the team about “If I could change anything about myself, what would be the biggest thing that could make the most positive difference to them for me to change?”

And I got a greater sense of awareness that actually I was finding it difficult to give people feedback and that wasn’t encouraging other people to give me feedback and I was struggling to model it. And what was underneath that - some of it was that I was worried that I couldn’t give it very well and that sometimes I may come across more abruptly than I want to, and I didn’t want to damage relationships by giving feedback badly.

So I was so much part of the problem and I had to start changing my behavior and be bolder about giving people feedback and ask for forgiveness when I did that in a way that might have been more brusque than I’d like it to be. So I think the biggest lesson for me is I had to change how I was working if I was serious about us stepping up and being more accountable to each other.

And the other thing was we had developed adult relationships but sometimes we’d slip into parent-child with me being the parent and being mom. And I had to get much better at spotting when that was happening and call it out when I recognized it. And I had to keep saying to people, “Actually, that’s not my decision. I’m not the CEO anymore. How can you take that forward without me being involved in it?”

And we even developed on Slack, you can have different symbols, so there’s a swirl in green, some tealy green color, and I’d use that on Slack to indicate when I’m going “Actually, this is a different way of me behaving as not the CEO.”

And I’m really honestly sad I think I stepped back too much. I think I got confused by what not being a CEO anymore and still being able to operate as a leader. I think in a self-managed team, it calls us all to step into leadership roles and I think I stepped back a bit too far. I’m better at that now. But a lot of it was me learning to behave differently and me being more aware about my behavior and when I was stepping into a mom role or stepping back too far or being shy about giving people feedback myself.

Lisa: That’s fascinating. I think the two things that I’m hearing from you: the first was that you took a real risk, wanting to model a feedback culture by inviting feedback from everyone as a kind of starting point so that you could then also start giving it more. And then the second thing about embracing or finding what leadership looks like in a self-management team and finding the balance between stepping back but not abdicating. I think you’ve captured that beautifully. How did you step back from your formal role as CEO but still show up as a leader?

Helen: I think that was a tension that I struggled with in the beginning and I’m getting better at now. The other really big difference was the transparency of information. So now every team member on a monthly basis has exactly the same financial information that I as CEO had and still have, so that everybody knows how much money is in the bank, how much money we’re owed, how many days everybody did. We all know what each other earns on a monthly basis.

So I think the transparency of information was also a really big shift. And part of not being mum is me not being the only person worried about money all the time - I’m the only person who knew what’s in our bank balance. And I’m sure that the team isn’t lying awake at night worrying about money, but it does feel completely different when we all know when our bank balance, the organization’s bank balance, is healthier than at other times.

So that was the other critical thing - that we were clear about accountability and what we could hold each other to account for, we changed the ways that we met together so that we could address tensions and demonstrate our Holacracy practice in a really different way, and we have complete transparency of information and know how we can make decisions about money in a different way too.

Lisa: The transparency about money thing is something that I know people often really struggle with when transitioning to a self-managing organization. How did you do that? Was it all at once, did you do it little by little, did you discuss it? What was the process of doing that?

Helen: Well, the issue about who earns what was always very clear because we have a sort of flat structure with a day rate, and the amount that you earn is dependent on how many days you do. So that wasn’t a big deal at all and we were already sharing how many days people did.

But what was different was sharing “this is what is in our bank, this is what we’re owed” and that kind of information. So we just did it from the first month and sent it out to everybody.

What we found difficult was using the advice process. So I must say, as a process that hasn’t really worked for us. We still use it now, but only for financial decision making. And we had a governance meeting today to agree something.

So the other thing that we - the two things that we haven’t done that a lot of other people transitioning to self-management have done is we’re not using the advice process except for money, and we are not, we didn’t adopt the Holacracy Constitution. And the reason we didn’t adopt the Holacracy Constitution, although the other key things in Holacracy we are doing, was because it’s so hard to read and understand. And it’s so hard to read and understand they even have an easy read version of it, and I just think that’s completely at odds with a self-management approach.

And I have had this conversation with the people who are in the UK, who were the people who introduced me to Holacracy and I did their introductory session. So rather than taking somebody else’s constitution, we are essentially growing our constitution through governance. So we’re growing together what our policies, procedures, ways of operating together are, organically. And that feels much, much more comfortable.

And it felt a bit like the purpose of the Holacracy Constitution was to hold the CEO to account in not taking up the power of the CEO again. Because that was me, that didn’t feel like a big deal. So it felt different in some way than for other organizations, but that was an issue because I was so utterly committed to doing this.

So at the beginning, it was decisions about money that people found difficult to do. And I think it’s because it coincided with a quite a difficult financial period in the context of health and social care and therefore in the context of our income as an organization. That we’re all a bit too scared to spend money because we knew money was really scarce.

So we made some decisions, saying “Look, here’s a level of spending that everybody can do without getting permission from anybody else.” But if it was a bit higher than that, come back and ask. But people were still nervous about doing it. So we looked at why that was and decided that we’d have a committee of three, or a team of three of us who would agree or not on spending. That was me, because I have the longest history managing money in the organization, not because I’m CEO, another team member Rob who used to be an accountant, and then the third team member changed on a rotating basis. So everybody got the opportunity to be part of that group.

And what we agreed was if somebody posted a request for money, it was almost like having to do it as a mini business case. It wasn’t just like “I want this money”, but “If we invest this money here, here are the consequences of this and the benefits and here’s why I think it’s good for our financial future” - not just “Can I spend this on this?” And then the three of us would have three or four days to get in touch with each other, make a decision, and then give that decision back to the person who’d asked for money. And that’s working better for us.

So we’ve had to tweak and think differently about how we make decisions about money and how we use the advice process. But I think at the moment we’re finding that our accountability structure is robust enough that we don’t - and if we want to ask advice from other people, we would tend to use the tactical meeting for that.

Lisa: I wanted to talk about how it’s been for you moving from CEO to a member, albeit a leader, but a member of a self-managed team. If you were talking to a fellow CEO, what advice would you share with them or what insights would you share with them in terms of what they have to give up and also what you sort of get back?

Helen: What a great question. So I do a regular podcast with Susan Busterfield who’s supporting a really large organization, Wellways in Australia, to make this transition. And I’m also in conversation with Dan Harrison who’s doing the same in Cornerstone, an organization in Scotland. So two other women who have made and are making the transition from CEO to self-management as well.

And I think the biggest challenge for me is the one that we’ve just spoken about, which is how do you give up your formal power, support everybody else to manage that as well as you managing it, but not give up your moral leadership and showing up as a leader? So that’s been the tension that I grappled with and, as I said, I stepped back a bit too far. And it may be that that is necessary to help people understand and comprehend a different role.

So an example would be if you’re in a meeting but you’re usually chairing, you know, making sure that there’s other people taking responsibility for chairing and doing other things, but you still making contributions but not everything being deferred to you all the time. So it is about when that’s happening, recognizing it and calling it out really, and saying “No, I’m not CEO anymore and that means that that isn’t my decision anymore and that decision is held over here and how can I support you to go over there to enable that decision to be made” - without it feeling like a massive abdication and without it feeling like there’s suddenly only anarchy.

So I think that’s the attention and constant vigilance is required. And I did slip a couple of times. And when you do that, say “Okay, I just spotted myself behaving like the CEO again.”

So let me give you an example. One of our tactical meetings that I have - so Adam is our fantastic comms/marketing person and Adam doesn’t take part in our tactical meetings because, to be honest, in some ways we just hadn’t thought about it because he lives in a different country in a different time zone and that just wasn’t on our radar. And it suddenly became really obvious to me in a couple of conversations with Adam that it would utterly make sense for him to be there.

So I said to him in a private communication, “Oh Adam, please will you come and join us in our tactical meetings, then we’ll be able to nail some of these issues that we keep coming up as difficult.” So I invited him and I said our next tactical meeting is on Wednesday at midday. And then I realized what I’d done.

So two days later, I spotted this. I said, “Adam, it’s not my decision to invite you to the tactical meeting. So what I’m going to do is at the next tactical meeting, I’ll raise that as an issue and propose it to the team, see what they think. And if they’re in agreement, you’ll be invited to attend the next tactical meeting.”

So I didn’t choose to say to team members “I acted as a CEO again and I shouldn’t have. This is what I’d done.” But I said “That’s not my decision. So I’m bringing it to you now. What do you think?”

So it’s so easy to - I’ve been doing this for 18 years with HSA said. So these are habits that are quite hard to break. So it’s the personal vigilance for saying “I’m not CEO anymore, that’s acting like a CEO,” recognize that you’ve done that, ask forgiveness if that’s what’s required if that impacts other people, and carry on.

And in the same way, when people email me and say “Will you just check this, Helen?” I say “Actually, that’s not my role anymore.” Because they can’t change their behavior unless I’m changing mine.

And I think if I’m really honest, and if some of my team members were stood with me here, they’d say “Do you know what, you’re a bit blunt about that at the beginning, Helen.” And I hold my hands up around that as well. It was hard. I still occasionally slip into that. I hold up hands when I’ve got that wrong.

Lisa: I really love the idea of it’s almost like working out loud and making mistakes out loud, sharing those and asking for forgiveness and I think that’s really helpful in the transition period of just marking out “Oh okay, I slipped a bit there, let’s share that and learn from it” and make that sort of learning journey visible. And then it invites everyone else to do the same as well.

Helen: That’s exactly what I was trying to do. And I was talking to a colleague of mine who is a commissioner who was saying in one of these organizations that has moved to self-management, he was speaking to a manager who’d left. And the manager left because he thought there was a leadership vacuum.

And actually one of our team did the same. About timing, probably two of our colleagues who left after we’d been exploring self-management - I think if you were asking them directly and they were able to be honest with themselves, they would say “We came into this team because we wanted Helen’s leadership and we wanted to work with her. And when she stepped back and the invitation was for us to be self-managing, that wasn’t the psychological contract that I’d come into this team for. And that wasn’t what I wanted anymore. And eventually I needed to leave because that wasn’t why I signed up for.”

Before, I was everybody’s safety net and now we are each other’s safety net. But that takes more emotional labor to create that safety net and hold it together ourselves than just one person doing it in a formal role. So you’ve got to be up for that and recognize that that’s different.

And I think any organization that’s already established that’s choosing to move to self-management, recognizing that - and that’s why, so we’re in the process of setting up some well-being teams, and you can never chief you people across from an existing organization to well-being teams. People have to voluntarily choose to come into this role, I think. And it has to be thrown right through in recruitment.

So we’re recruiting at the moment and everything that we’re doing has to say two things: we’re looking for people who can deliver compassionate care, and we’re looking for people who are up for self-management, who want to take responsibility for their own work I’m working together seriously. And you can’t have one without the other if you’re going to be part of a well-being team.

Lisa: That’s a really interesting idea. I know a self-managing organization whose employees wrote a “scaring them away” letter they call it, which was a letter that they would give to candidates interviewing for a role kind of saying “You know, you have to do things yourself around here, you can’t wait for someone else to do it for you. Things might be a bit messy or not as complete or formalized as other organizations at various different points” - because they found that you are looking for a very particular kind of individual who’s up for that and it’s challenging.

And that’s one of the kind of interesting paradoxes about self-management as well, which they say a lot in the “An Everyone Culture” book - that it’s painful sometimes, it’s hard work, it’s not easy, but the trade-off is that it’s incredibly rewarding and fulfilling and you learn so much that it kind of makes makes it worth it in the end.

Helen: Worth it in the end - you asked me a question about the transition to CEO and I told you the hard bits. The good bit is I feel utterly liberated. I feel joyful in a different way than I did. I loved my job before and it’s a bit like not knowing you could possibly be even more joyful, but it’s given me a different headspace around development and ideas. And that’s why well-being teams exist now, is because I gained that freedom by giving up being a CEO. And I wouldn’t go back for the world.

Lisa: Something that I want to talk about as well is these well-being teams that you’re setting up, because I know this is inspired very much by Buurtzorg and the self-managing neighborhood nursing teams that they have. So can you say something about these well-being teams that you’re setting up and what the vision is?

Helen: Yes, I’d be really delighted to. And just like this came because I read Frederic Laloux’s book, I’m likewise so inspired by Buurtzorg, but it was because we moved to self-management and I had experienced it from the inside as well as then having the headspace to take on a quite a significant project that is now utterly consuming me in a great way.

So we learned about Buurtzorg, and the satisfaction of people they serve, people and patients, is incredibly high. They regularly win “Best Place to Work” and their back office costs against an industry standard of 25% are 8%. So you know in the UK health and social care field, that’s the Holy Grail, isn’t it? Satisfied staff, satisfied people supported, and cheaper.

So we equally got very excited about it. And of course they’re operating in a completely different environment, it’s an insurance-based system, they don’t have CQC. And CQC and the regulations demand a registered manager. So how do you fit being a registered manager in with self-management? And the whole of the thrust of UK policy and the Care Act is around outcome-based provision as well. So how do we do that and how do we do that in the context of personal budgets? And then, you know, how do we do it in a way that delivers really amazing choice and control for people directing their own supports?

So that’s a hefty challenge that has occupied me for 18 months now. So I spent a while researching it, you know, reading everything I could about Buurtzorg, talking to people who’ve done similar things, working with Susan Busterfield around it as well. And also going back to our own work around person-centered teams around concepts and the practices. We’ve done a lot of work in home care too.

So persuaded three or four places who eventually tested this out with different teams in England so that we could see and from practice, almost like in a lean startup minimal viable product way, start learning by doing rather than learn by imagining what it could look like. And we failed a lot, we learned a lot about what not to do as well as what to do. And part of what we were looking at is the only reason this is worth doing is if we could create something that could happen at scale. And I think scale is either about creating an organization as big as Buurtzorg, or it’s about exploring different ways of doing like social franchising. And initially we thought the social franchising might be the way forward, but I’ve come much more to believe that actually creating an organization is a more powerful way of making sure the values and the ethos and that we go as far as we can.

So to cut a long story short, I am changing how I work. Although HSA is still alive and kicking and doing really well, most of my time from the end of this month will be setting up a new provider called Well-being Teams and becoming the registered manager myself with CQC except me, and so that we can see how far we can go in taking forward well-beings, not just in home care but across health and social care as well.

So they’re very similar to the Buurtzorg model, no more than twelve people, neighborhood-based, self-managing or self-organizing, but Buurtzorg has one coach. We have two coaches because we are intentionally welcoming people who have no care experience into well-being teams because we think well-being teams sit at the intersection of compassionate caring and customer service. Because that’s the sort of ethos that we want to have - customer first and empowering people, have as much choice and control as possible.

So if you’re coming to us and you’ve got experience of care, we say welcome, you’ve got some unlearning to do. And if you’re coming to us with no experience for care, so in the service that we were working with in Devon, one of the team members Kelly, she was a head waitress, and another team member Shire, he was the kitchen porter. So we welcome people who have no experience of care and we’re saying we’ll teach you what you need to learn.

So this is new for all of us. There are two coaches. There’s a team coach who has the responsibility for supporting self-management and team well-being. We are so serious about the well-being in well-being teams being both for team members and the people we serve, and we use Five Ways to Well-being and lots of approaches around that. And we have a practice coach and her role is to support team members to get through the care certificate and support them to deliver compassionate care.

Because the difference with nurses and Buurtzorg - Buurtzorg are mainly nurses who have a professional qualification and know how to do the job. What’s different for them is how they organized themselves. With well-being workers, we’re recruiting people who may have no experience delivering care, so we need to teach them to do the job and deliver compassionate care as well as supporting a different way of working using Holacracy.

And the other big difference is we have Community Circles in well-being right at the center. So every team has a community circle connector who works with volunteers and friends and family around the individuals. So we’re wrapping around friends, family, community assets around the person seamlessly with paid support as well.

Lisa: Wow, that’s just fantastic. I feel like I just got goosebumps because I think what - where my mind went was you read so much nowadays about automation and AI and robots coming to steal all the jobs and stuff like that. And I think something that I’ve always thought is that there’s still such a valuable human role to play in care. And so the fact that you’re welcoming people who don’t have care experience and coaching them in that role and instead of seeing it also as customer service, that crossover between customer service and care, I think that’s wonderful and I feel like that’s just really inspiring for the future in terms of what’s possible. I’m really blown away by that.

Helen: Thank you. And we want to be the most tech-savvy teams in care too. So we’re going paperless from the word go. All of our team communication is on Slack and we use Zoom for lots of meetings as well. And everybody is issued with a smartphone or equivalent and all the paperwork is done through an app.

And we use something called the support sequence. So when we are meeting somebody for the first time, so traditional home care organizations would then call that an assessment, we call it an initial conversation. What we want to do is figure out with the person what their priorities are, what matters to them, what their priorities for change are. And to use the language of the Care Act, that would be their outcomes. And then design the service together.

So we start with what in health and social care is called self-care, but what it really means is how can we support you to be as competent as possible in either managing your long-term condition or living at home? And let’s think about that. We never use the term “self-care” directly with people.

But then we look at assistive technology. But our understanding of assistive technology is all things digital. So one possibility might be that if the person lives a long way away from a son or daughter - so say you live in London and your son lives in Scotland - so we might be looking at ways, if we’re supporting you to have an evening meal on a Sunday night for example, what we would like to figure out together with you is how can we, if setting up a Zoom call or a Skype call with your son while we figure out the food and make dinner for you… So in the same kind of time that would usually be allocated, you can be spending 20 minutes chatting to your son once a week or once a fortnight or whatever works for both of you, and getting the meal - that’s part of the service that we’re there to provide.

So we’re thinking about tech in terms of relationships and community and the family staying in touch with each other through WhatsApp groups and things like that, not your traditional ways that we think about tech in terms of monitoring safety and safety alarms.

So we do self-care, we do tech, we do friends, family, and community through Community Circles, and then we look at paid support. So we think we shouldn’t be providing paid support if we can do the job for you because we want to make your hours, your money go as far as possible and get as much for it as possible.

And then you choose your own team. Now choosing your own team isn’t heard of in home care. But we genuinely have ways where you choose, out of the 12 team members, the three or four that you want to support you, through one-page profiles and through mini introduction films as well.

So the whole team is supported by what we call the well-being support team which are the two coaches, the community circle connector, and me. Our job is to create the environment that enabled the welding teams to flourish. So we sit underneath and around the team rather than at the top in a very traditional hierarchical way.

Lisa: And currently you have six teams and the vision is to have 600 of that, right?

Helen: Six hundred! We’re about to recruit our first team. So we work with four different teams that have been helping us test and learn, but we haven’t been using practice coaches in the other teams and that’s part of what we learned - we really need to have in place. So the full model with practice coaches will be in Wigan and we go to recruitment in the next six weeks. And we’re learning and building on our recruitment process, a value-based recruitment process, but we’ve already won awards for, which we’re quite delighted about.

But we know that the recruitment is the critical, almost do-or-die about whether this can work or not. Can we get the right people? We’re really hopeful that we can. We start recruiting very, very soon and getting the teams in place as soon as possible. We’re starting with six in Wigan, but our ambition has to be scale. So our question is how do we go from six to six hundred in under three years?

Lisa: And what are your thoughts so far on that? Do you have any early ideas?

Helen: Well, this is the scariest and most ambitious thing I’ve ever, ever done, particularly personally taking the role of a registered manager. So I know we’re about to go on a huge learning curve. And somebody said to me, “What if it fails?” And I said, “This can’t fail well because we have to be adamant we have to go fail, fail, fail, fail. Every failure is learning, every failure is getting better, every failure is another thing to test and learn.”

So taking everybody with us on that journey is going to be powerful, scary, incredible, but the biggest learning journey I’m sure I’ve ever been on. If we are successful - so one of the other differences is we are creating a career path for people, which is again not typically present in home care, and people have weekly team meetings, which doesn’t happen in home care. They feel part of teams, which doesn’t happen in home care, and have 20% of their time off rota to fulfill their roles and be quiet team meetings and to meet with everybody once a month.

So what I’m hoping - but if anything is possible - if we can create a different experience for our colleagues and that we do that well, other people will want to join us. So my hope is in the same way that Buurtzorg gets probably about 100 CVs every week from people asking to join them, that we grow and spread by word of mouth. So that’s that’s the ultimate, that I’m hoping that if we’re successful, other people want to come work with us and that will grow organically that way, and we’ll invite other well-being leaders to come and do the role that I’m doing as well.

And my win of the week has happened today. I’ve been speaking to senior people in CQC who are responsible for looking at new models and regulation, and their feedback to me is that they’re enthusiastic about this, that they can see that well-being teams are a new model of care and figuring out how self-managed teams can demonstrate “well-led” to CQC and can ultimately be rated as outstanding if they demonstrate that wrong. Now that feels like a huge step forward, not just for us but for self-management as a way of delivering health and social care within our regulated framework.

Lisa: I mean, this is a big, big undertaking. It’s going to be a huge learning curve. And in the same way that HSA is sort of the source for Buurtzorg and holding the space for that, now the source for these well-being teams, what motivates you personally? Why is this so important to you?

Helen: I’m just taking a breath. The honest answer to that is - I was 52 years ago. My dad died when he was 53 and I think you never know, you don’t know how long you’ve got left. And I think getting to 50 made me think about that in a new way.

So I said that I read the book “Reinventing Organizations” and that was really powerful. I also read “Being Mortal” by Atul Gawande at the same time. And it made me think if I could change anything, if I could contribute to any change - I think our biggest need is how we see older people, how we think about older age, how we treat each other as we get older and how we die well.

So I kind of asked myself, “If I only had three years to live, do I want to spend the next three years doing what I’m doing now as a trainer and consultant?” And I hope I have made some difference in the work that I’ve done, but I wanted to be bolder. I wanted to see if I could go further. And I think that’s part of the ethos behind Altmba, you know - how great could I be?

So this is an evolution. I think of me deciding that I think consultancy - I think some consultants, and I hope we did and do, make a big difference, but there’s something very different about messing with other people’s projects as a consultant. I’m working through them and I think I’d say that a bit more disrespectfully than that I mean. But that you can never - there are always boundaries to how far you can make change as a consultant because it’s not your business. So it’s not your organization and it’s not your finance that you’re risking and it’s not your reputation as an organization that you’re risking.

So I think that I can only test out these ideas as far as possible by taking responsibility for the money, you know, the reputation, the registration with CQC and all of that. So that’s why - it’s because I want to be as bold as I can and I want to see how far we can go with this. And I don’t want to assume that I’ve got 30 more years of work or 20 more years of work. I want to behave as if this was the last contribution I could make, it’s this.