New ways of organisingHealthcare

Creating a new structure in a bottom-up manner

From steady start to fast track

A large national volunteer organization in the care sector wanted to transform itself from 12 separate regional organizations into one national organization with provincial departments. The organization offers a wide range of activities for the chronically ill and their caregivers. In the regions, this multitude led to a fragmentation of manpower. Each professional combined many different roles and areas of interest. As a result, they were overwhelmed by work, were often unable to provide the volunteers with sufficient support, and operational issues required so much attention that innovation was lacking.


The director wanted to set up a more efficient provincial structure and at the same time maintain the strong sense of ownership and responsibility with staff and volunteers at the regional level. That is why he envisioned a participatory process through which the organization could evolve towards one structure without teams feeling that they were being taken over or absorbed by each other.



A project group with directors, heads of department and voluntary chairmen from all provinces set a framework. Subsequently, an intake with each regional team took place. Using Appreciative Inquiry interviews, we brought the individuality of each team into focus and the team members were able to make clear what was important to them in terms of moving towards cooperation with other teams from the same province. The common thread was 'looking for synergy'.


We then organized a provincial team event in which, again through a process of Appreciative Inquiry, professionals from the different regions clarified with each other what synergy could mean for their work and the support of volunteers, patients and care-givers. Groups of employees set to work on concrete initiatives in their own sphere of influence with which they could create '1+1=3'. For example: dividing and streamlining work, learning from each other, applying complementarity, adopting best practices... The formal structure was also addressed: people redistributed work and designed new working processes.


In two- or three-monthly return meetings, people exchanged information about the steps they had taken, the results they had achieved and the lessons that could be learned from working together.


We started in one province, but soon found ourselves working all over the country. From that moment on, we also invited managers to join each other in peer-to-peer meetings to learn from each other and identify themes on which they, in turn, could create synergy through alignment and collaboration.



Paradoxically, by opting for a gradual approach and starting from what the teams themselves thought was important and meaningful, the process was accelerated. Employees requested to redistribute roles more quickly. Volunteers asked if they could also work together in a provincial structure, much faster than planned. Building the bridge together as we walked over it, freed up creative energy, strengthened mutual trust and led to concrete results: a streamlined organization that people themselves feel to be the owners of.