Emile.nu: students facilitate home care services in self-directing teams

2014 Emile, founded in 2005, is an organization in the home care services sector. It offers a combination of domestic help, personal care and support. Currently, it offers services in Amsterdam and Groningen. More than 200 district nursing assistants are employed, all of them students. Working with students is what makes Emile unique in the home care services sector. One of the advantages of working with nursing assistants is that they have a cheaper hourly rate than nurses. As a result, more time is available for caretaking in comparison with traditional home care services. 

Workplace Innovation

Emile works with self-directing teams who manage everything that is necessary to function properly as a team and as an organization. To facilitate this, every employee needs to obtain a diploma (intermediate vocational education) at Emile’s own academy. Emile is an organization with little overhead and it fully functions through digital working. Emile’s coordination runs largely through Yammer (a social media tool specifically designed for organizations , which combines aspects of Facebook and Twitter). Furthermore, Emilie’s staff makes use of online scheduling and administrative systems and Wiki’s (online pages with guidelines on how to perform services). 

Method

Emile’s employees provide domestic help, personal care and guidance. The provided assistance can vary from cleaning windows and emptying a catheter bag, to setting up a weekly schedule for clients to structure their daily activities. In principle, employees provide all home care services, except for those that require a nursing license, such as injecting medication and taking care of wounds. Every client has a client elderly. This is an employee who is responsible for reaching the goals set out in the care taking plan and for making sure that the roster for the client is in order. This way, each client has an employee that has overall responsibility, even when he/she comes into contact with multiple employees working for him/her. Depending on the demand for care, a client is taken care of by a team of 1 to a maximum of 5 employees. In order to build a bond between the client and the team, a client’s team is always constituted by the same members. Each employee visits clients individually.Yet, because the employees work in the same team, it becomes possible to exchange experiences and provide tips to each other concerning the client. In this way, team members support each other and are able to share insights and knowledge.

Each client-specific team is part of a bigger team of 10 to 20 employees, which provides care for a constant group of clients.The team itself organizes all tasks necessary to function properly. Every team has a ‘teamer’ (team leader) to support the team. Employees carry out this task along with their normal activities, and the role of ‘teamer’ rotates within the team. The teamer is responsible for several tasks: keeping up with the administration (checking reports and timesheets), updating the monthly schedule, organizing the monthly team meeting, responding to new applications from clients (there is an online application pool for new clients), and deciding if the team is able to adopt a new client. A teamer has one hour per week to fulfill these tasks.

The remaining tasks within the team, familiarizing with new clients, and the recruitment of new employees is regulated between team members. Anyone within the team could take up these tasks, if he/she has the necessary competences.

The mutual coordination mainly takes place digitally. The team’s schedule is mutually taken care of through an online system. Clients have a say in planning the visits in consultation with employees. To facilitate this coordination with clients’ needs, clients have access to the online scheduling system as well. Communication within and between teams mainly takes place via Yammer. Reports from client visits, describing successes and problems, are uploaded on Yammer. In this way, employees can share knowledge and experiences with each other. If they want, clients can also have access to Yammer. Some even receive guidance and advices through Yammer, by informing employees about how they feel and what activities they will undertake. The guidance refers to a plan with daily activities set up with the client. This way, employees do not need to visit clients every day, but they do offer support and structure by keeping an eye on the daily activities that they undertake. Personal information about clients is documented in online electronic client files, which only the client’s specific team can access. Additionally, there are guidelines concerning standard procedures, such as how to do an interview. These are described in Wiki’s (online pages) and could also be in the form of a short movie.

To make sure team members also meet in person, a team meeting takes place once a month. The teamer formulates the agenda for this meeting. Furthermore, every team has a mentor, which is one of the team members. The mentor is responsible for supporting the employees, and this role does not rotate. The mentor guides employees in their personal development, supports new teamers and supports new team members in their educational process at the acedemy. Furthermore, the mentor functions as a coach for individual employees and has four hours every week to fulfill these tasks. 

Developmental process

In 2005, Emile de Roy van Zuydewijn founded the organization Emile based on the idea that home care services could be better. Working as an intern in a large home care services organization, he noted that providing personal and small-scale care was difficult. Due to fixed protocols, high workloads, and an elevated number of clients (sometimes 15-20 clients per day), there was little time to build a relationship with the client. He thought that care taking should be more personal and small-scale, and decided to start his own business. Soon, demands increased and he had to hire employees to meet the demand. Because Emile was a student himself, he knew a lot of other students and decided to hire  them. Students like flexibility, and that is what Emile offers.

Emile’s employees always visit clients minimally one hour and not just 20 minutes, which sometimes is the case in regular home care services organizations. This leads to more personal care, which is made possible by the employees’ broad education (they offer domestic care, personal care and guidance). Thus , the same person can perform multiple tasks in one shift, differently from other home care organization which make use of different people to do all these different tasks.

According to the founder of Emile, one advantage of working with students is that they more easily form a relationship of trust with the client, being more likely open-minded and unprejudiced. This is important because they enter the homes of many people with different lifestyles, who cannot be judged for this. Students need to want to work at Emile for at least one year.

At one point in time, the organization was so successful that the founder of Emile lost track of his clients and employees. In 2007, he, therefore, decided to shape the organization based on the cell splitting formula from Eckart Wintzen, which allows to retain a small-scale and personal approach in a larger organization. This implies that every team splits once the team has become too large. Furthermore, there are virtually no staffing functions. In this way, Emile retains its flat organizational structure and more money is available for home care services. By splitting the teams, a new function had to be created: the teamer (manager). At first, the role of the teamer was fixed, but it was later decided to let it rotate within the team, giving all team members more responsibility. The founder of Emile and the fixed teamers trusted that the teams could manage themselves in accordance, and that this shared responsibility would bring more involvement. For example, an employee could conduct an intake with a client and also work with that same client. This change meant that team meetings had to be held more regularly and more professionally. Currently, teams have monthly meetings. Previously, meetings were held once every three months, and they took the form of an informal drink without agenda. Also, it was decided that there should be a client elderly, so that one carries final responsibility for a client. Together with this change, the academy was founded. Everyone that works for Emile must obtain a degree as a nursing assistant, to increase the professional working level of the teams. This degree provides employees with a broad education, so that they are able to take on different tasks. 

Results

Despite a steady increase in staff, Emile continues to provide personal and small-scale care to its clients. The introduction of self-directing teams, the cell splitting formula , appointing client elderly’s, working with students and the flat organizational structure (little overhead) all contributed to this.

The current evaluation of the delivered care happens internally. At the time of writing, Emile is developing a measurement instrument for measuring the quality of the delivered care. They believe the standard measurement methods do not adequately adhere to self-directing teams.

Emile’s concept of self-directing teams consisting of students works: they are a financially healthy organization, which has been steadily growing since its creation. Besides Amsterdam, they are currently located also in Groningen, and they are orienting on starting in Delft.

The teams work in a self-directing way, mainly digital, and do their own administration which leads to virtually no overhead. This is evident from the fact that, according to the founder, there is only one administrator employed for 30 hours per week for over 200 employees. Through the cell-like structure, Emile stays a flat organization with short communication lines. Furthermore, thanks to its own academy, but also thanks to the experience gained within the organization, Emile has become more professional.

Emile is a popular employer amongst students, and there is a long waiting list for students who want to work for Emile. Employees are satisfied: in a recent employee engagement index (from 2013), Emile got a score of 7,9 out of 10. The transition to teams with a rotating teamer has led to more understanding in the teams and to better cooperation. In an interview, an employee expressed appreciation for the monthly team meetings, as one can focus more deeply on areas of concern by meeting face-to-face rather than via Yammer. Previously, the work was more individualistic. Now employees support each other, by sharing more knowledge and advices. The possibility for planning in ones own worktime, is appreciated as well. For example, employees can indicate that during exams they are not able to work or want to work fewer hours. The team members manage who takes over these shifts among each other, thus helping each other out. 

Lessons Learned

A first lesson is that giving confidence and responsibility in the form of setting up the role of client elderly and rotating teamers, has led to a higher quality of the provided care. Client elderly’s feel more involved because they are responsible for their clients. They cannot pass the responsibility on to someone else. A potential downside to this is that it asks for more time from the employees. At first, employees found this frustrating, but  they are now used to it and satisfied about the fact that it leads to better care.

A second lesson is that, because there is room for implementing ideas and experimenting, the organization continues to learn and employees dare to show initiatives. The short communication lines facilitate this process. For example, a dyslectic social worker indicated that she would like to see a movie at a Wiki, because for her, watching a movie is more convenient and clarifies things better. The founder himself took on such a demand. 

Theme: self organisation, flexible organisation, teamworking

Sector: Welfare

Source: cases