Self-management is becoming more common in healthcare. Pioneering organizations like Buurtzorg have shown how empowering care teams can lead to better outcomes, higher job satisfaction, and more responsive patient care [1]. Across Europe, healthcare systems and organizations are experimenting with models that replace top-down control with team autonomy.
This blog shares findings from one such case: “Paths to Community in Elderly Work” project, a Finnish initiative (co-funded by the European Social Fund) that supported long-term elderly and home care teams in transitioning toward self-management. The goal was to help care professionals work more collaboratively, make faster decisions, and improve quality without adding chaos or confusion.
In this article, we bring together two perspectives:
- What management research tells us about how self-managing teams can succeed
- What we can learn from the project as teams put these ideas into practice
From theory to fieldwork, this article explores what it takes to make self-management in healthcare work, highlighting the central role of feedback in enabling team autonomy.
🔍 Also read: What Makes Self-Managed Teams Unique and How Do You Give Constructive Feedback to Your Peers in a Self-Managing Organization?
What Management Research Teaches Us About Self-Management
Over the past two decades, research has increasingly found evidence that self-managing teams can lead to better performance, higher engagement, and greater adaptability, but success depends on having the right conditions in place [2, 3]. First, self-management doesn’t mean working without structure. Even in decentralized teams, roles and responsibilities must be clear. Teams that lack visible coordination mechanisms risk overlapping tasks and inefficiency [4].
Second, a strong shared purpose is important. When there’s no one giving direct orders, the team must align around a common goal [5], like patient-centered care and the approach to achieve the purpose. Research shows this purpose must be consistently reinforced, not just defined once [6, 7].
Third, coordination happens through rhythm and transparency. Practices like daily check-ins, digital dashboards, and weekly planning help teams stay aligned without managerial oversight [8]. These routines not only structure work they also support collaboration and trust [9].
Finally, psychological safety and trust are foundational. Team members need to feel safe speaking up, giving feedback, or flagging concerns especially in high-pressure environments like healthcare [10, 11].
💬 Curious how this can be achieved Check out 7 Proven Techniques for Empowering Your Employees
Field Insights: Feedback as the Foundation of Self-Management
The most prevalent finding from the project was that self-management only thrives when feedback is part of everyday work. Across multiple care teams transitioning to self-managing teams, coaches and mentors consistently observed the same pattern: where feedback was strong, self-management worked. Where it was absent or underdeveloped, teams struggled to take ownership, solve problems together, or maintain alignment.
These insights come directly from the field. The coaches supporting the transition worked hands-on with elderly care teams through workshops, mentoring, and co-development activities. Their reflections point to three key enablers of self-management each rooted in how feedback is used, shared, and made safe.
- Communication as culture
- Feedback as coordination
- Emotional safety, honesty, and openness
At the same time, the coaching teams also saw what happened when these enablers were missing, when communication broke down, feedback was avoided, or trust was lacking. The themes reflect both what worked and what didn’t. All the quotes and input comes from project members and coaches, Satu Pirskanen, Jaana Piippo, Aija Hietanen, Heli Kekäläinen, Merja Partanen, Maiju Korhonen, Perttu Salovaara, Kati Toikka, and Tytti Mönkkönen, who guided the implementation of self-management during the project.
Communication as Culture
One of the most powerful lessons from the field was that feedback lives in daily activity. As one coach put it, “Feedback culture lives in small moments”. A thank-you note, a check-in, or a brief onboarding conversation can signal that someone is seen and heard. In self-managing teams, everyone is responsible for shaping and maintaining this daily rhythm.
"Even a short conversation or feedback survey at the start signals that the employee’s feelings are valued and heard."
Practical tools used by coaches included:
- Peer onboarding and shared welcoming rituals
- Quick feedback surveys during the first days
- Promoting the use of verbal micro-feedback like ‘thank you’ or ‘this works well’
However, the absence of proactive communication often meant missed opportunities for connection and support. When daily interactions relied on assumptions, important feedback simply didn’t happen.
"Feedback may go unspoken if interaction is based on assumptions."
Interested in how communicating feedback can become easier? Take a look!
Feedback as Coordination
In self-managing teams, where there is no manager coordinating daily tasks, peer-feedback becomes a key mechanism for coordination and quality control. Coaches observed that teams who embraced collective reflection and regular feedback rounds were better able to adjust to changes, identify care gaps, and stay aligned on their shared purpose.
"Not having someone to tell you what to do is tricky, but can be solved if the team sets direction together"
"Feedback is also a powerful tool for assessing performance and the quality-of-care work."
The main tools and formats included:
- Feedback rounds integrated into weekly or monthly team meetings focused on organizational and management activities
- Allow the system to self-correct
- Collecting and discussing client and team feedback
- Using design thinking tools such as mapping of customer journeys and empathy maps to visualize experiences and set goals
In contrast, some teams struggled to manage themselves. When feedback wasn’t part of the group process, problems accumulated, and clarity suffered.
"Feedback should be given by everyone in constructive ways, otherwise strange power imbalances emerge."
Emotional Safety, Honesty, and Openness
Perhaps the most challenging aspect of self-management is creating an environment where people feel safe, honest, and encouraged to speak up. Normally, a manager would be in charge of this, but without one everybody needs to take part in the responsibility. Coaches reported that small interventions, such as the “sticky note” feedback exercise, boosted morale and trust within teams.
"This exercise brought joy, a sense of belonging, and positivity to the work community."
"When the positive ‘vibe’ is present, it becomes easier to practice or bring up the topic of constructive feedback, and speak about deeper issues or challenges."
Key tools used to build safety and openness included:
- The ‘note exercise’: writing feedback to colleagues on sticky notes and reading them aloud
- Empathetic feedback models (e.g., What I observe / What I feel / What I need / What I suggest)
- Video-based training modules and live demos to show how to have difficult conversations
- Paired practice sessions to try out feedback in low-risk settings
(Check the project reflections on these activities)
Still, many employees found giving feedback challenging especially when it came to more critical conversations. Some struggled to express disagreement or concern without fear of causing conflict. Others lacked confidence in how to say what needed to be said. In some cases, negative feedback might even be a ‘necessary evil’
"Giving feedback requires a great deal of practice for it to become a regular and integrated part of everyday care work."
"It was challenging for participants to internalize and apply the feedback model."
The coaching team noted that people with roles between teams were often insecure too, which suggests the need for broader training and more consistent intra-team-level guidelines.
"Giving feedback is not necessarily easier for people who are not in the either. It should be emphasized in broader organizational training."
"Common team-level practices or guidelines are often missing considering that your work is not ‘just’ within your own team: how to give feedback, how to receive it, and what the shared expectations around feedback are important."
Best Practices to Support Self-Management Through Feedback in Healthcare (and Beyond)
The project shows that feedback isn’t just a nice-to-have, but it’s the foundation of self-management. Teams with autonomy, decision-making authority, decentralized communication and little to no managerial oversight: they need clear routines, trust, and shared tools for communication and learning.
Based on lessons from the field, here are three concise best practices directly recommended by the coaches:
- Co-create team-level feedback norms. At a team planning session, define shared principles for how feedback is given and received. Make agreements visible and revisit them regularly [12].
- Train everyone in feedback giving and seeking. Offer workshops to all staff (not just leaders or people with specific roles) using peer role-play, video analysis, and reflection [13]. This builds confidence and skill in initiating and receiving feedback, considering individual diversity. Think of non-violent communication.
- Use client feedback for shared learning. Regularly review patient or family-member feedback in team meetings to surface strengths, discuss improvements, and reinforce team alignment [14].
Final Thoughts
Self-management in healthcare and beyond offers great potential but only when supported by the right structures, mindsets, and tools. As the project shows, the path isn’t always smooth but it is possible. With the right balance of autonomy, rhythm, and trust anchored in strong feedback practices care teams can take ownership of their work and deliver better care as a result.
📌 Want to see how Talkspirit supports self-management? Reach outContact us or book a demo today
References
[1] Bernstein, E., Bunch, J., Canner, N., & Lee, M. (2016). Beyond the holacracy hype. Harvard Business Review, 94(7), 38–49.
[2] Bremer, C., Rylander Eklund, A., & Elmquist, M. (2025). Scaling or growing agile? Proposing a manifesto for agile organization development. Journal of Organization Design, 14(1), 23-34.
[3] Lee, M. Y. (2024). Enacting decentralized authority: The practices and limits of moving beyond hierarchy. Administrative Science Quarterly, 69(3), 791-833.
[4] Puranam, P., Alexy, O., & Reitzig, M. (2014). What’s “new” about new forms of organizing? Academy of Management Review, 39(2), 162–180.
[5] Martela, F., & Nandram, S. (2025). Buurtzorg: scaling up an organization with hundreds of self-managing teams but no middle managers. Journal of Organization Design, 1-11.
[6] Foss, N. J., Lyngsie, J., & Zahra, S. A. (2022). The many faces of autonomy. Academy of Management Journal, 65(3), 805–835.
[7] Reitzig, M. (2022). Get better at flatter: A guide to shaping and leading organizations with less hierarchy. Palgrave Macmillan.
[8] Lee, M. Y., & Edmondson, A. C. (2017). Self-managing organizations. Research in Organizational Behavior, 37, 35–58.
[9] Weirauch, L., Galliker, S., & Elfering, A. (2023). Holacracy, a modern form of organizational governance predictors for person-organization-fit and job satisfaction. Frontiers in psychology, 13, 1021545.
[10] Laloux, F. (2014). Reinventing organizations (Vol. 58). Brussels: Nelso
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