This is a series on Teal and Levels of Work. Here is the backstory for the series in case you are interested in the context. The purpose for the series is to explore the tenets of Teal through the lens of Levels of Work.
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Buurtzorg works with self-managed teams at Level II (S-II). These teams of 10-12 nurses handle the intake, scheduling and administration of their own patient load of approximately 50 patients. There is no “visible” manager assigned to hold them “to account” for performance.

When things go well, things go well. When things go adequately, no one rocks the boat. But, when things don’t go well, the mettle of a team is tested. And, Buurtzorg expects the team to handle its own issues, without the oversight of a “visible” manager.

So, what is going on here? Let me introduce you to Wilfred Bion. Bion was a psychiatrist, working for the British Army during World War II. His mandate was to take shell-shocked soldiers (current day PTSD) and return them to the battlefield to re-engage in combat. His background and academic training were suited to the task, but Bion had a problem. There were too many soldiers in this condition, the numbers overwhelmed the hospital resources.

Bion made a decision. There were too many PTSD soldiers to deal with 1-1, so he invented something called group therapy. He did not invent group therapy because he thought it a good idea. He invented it, because he had no other choice.

Working with soldiers in groups, with the purpose of returning them to battle, Bion observed the way the group worked, their interactions, dependencies and behavior to face the issues that landed them in the psych ward in the first place. Bion noticed two distinct behavior patterns, when the group appeared to be in “work” mode and when the group avoided work, or appeared to be in “non-work” mode. The distinctions were quite clear –

Work Mode – Non-work Mode
Rational – Irrational
Scientific – Un-scientific
Cooperative – Collusive
Controlled – Uncontrolled
Conscious – Unconscious

Groups moved from one state to the other state at will. Bion described this state as the group’s Basic Assumption Mental State or BAMS. Groups would move from Work to BAMS and back again. The movement from Work to BAMS occurred easily (unconscious), but the move from BAMS to work required very specific conscious behavior.

Working at the hospital, Bion attended meetings with other staff physicians, nurses and administrative personnel. The purpose of the meetings was to work together to solve problems and make decisions. Bion thought it peculiar that the hospital doctors and nurses displayed the same group behavior as the patients.

As part of military rigor, Bion was also required to attend meetings with upper echelons of military rank, to discuss strategies of war and resources of personnel, those going into battle, those recovering to return to battle. In those meetings, Bion was awestruck to discover the same behavior in military ranks, as the behavior in hospital personnel, mirrored in the patients. If it weren’t for the uniforms, you could not tell the difference between the generals, the doctors and the patients.

These behaviors would be readily observable in the (S-II) manager-less nurse teams at Buurtzorg. Take this tough problem – a team member, who after many opportunities (chances) is simply not a fit for the team. The most important cultural issue for every team is “who gets to be a member of our team?” This is the classic (though contrived) premise of the tv series Survivor. Faced with this decision, the team will either go into work or non-work (BAMS). Remembering that BAMS is an unconscious process, most teams automatically go there, observable in Fight-Flight-Freeze-Appease. They fight about it, blame each other (and the computer system). They flee, avoid, talk about the problem only in private (gossip at the water cooler). They freeze, make no moves at all (which ratchets up the tension). They appease, make excuses and generally cover-up.

The major BAMS move however is toward dependence. Dependence occurs when the tension in the group becomes so uncomfortable that the group deposits the discomfort on a designated leader. This dependence begins a subtle seduction on the leader of the team. At Buurtzorg, without a designated manager, this may be a moving target, but a leader will emerge. Or the team will self-select a leader. This is a slippery slope as an archetypal response in the dependence cycle. BAMS is collusive and most managers, given the opportunity (for new-found power) afforded by the group, can hardly resist.

Unfortunately, BAMS (non-work) never solves the problem, and neither will this dependent relationship. The ONLY solution is when the leader (manager, coach) puts the issue quite squarely back on the team, in the midst of discomfort. Without a doubt, when the leader-manager-coach puts the issue back on the table, the team will panic.

“The reason for this meeting today is to discuss Fred’s underperformance in relationship to the performance standards set by the team. The decision we make today is whether Fred continues as a member of the team or if Fred’s membership on the team should be terminated.”

The leader’s role is very simple – outlast the panic. Any issue that affects the team, the effectiveness of the team, must be dealt with by the team. Staying in “work” mode can only happen as a conscious decision to do so. That is the role of the leader. This has little to do with power, more to do with “work.”

At Buurtzorg, teams that recognize they are in BAMS can reach out for a coach. The structure at Buurtzorg defines this relationship with strict parameters to prevent group dependence. Laloux describes, “If teams get stuck, they can ask for external facilitation at any time, either from a regional coach or from the pool of facilitators of the institute.” Again, I think we found the manager.

In Requisite Organization, Elliott Jaques would describe this identical scenario, AND have a designated role of MANAGER. The manager would be in touch with the team sufficiently to recognize the team going into BAMS, to put real issues squarely on the table for the team to grapple with. High performing teams are those that are comfortable with discomfort and run toward (not away from) tough problems. The function of the manager is to keep the team in “work” mode.

It might be construed that Teal and Requisite Organization are identical, except for their terminology. I think not. The distinction is stark, has to do with hierarchy, which should be worthy of discussion in my next post.