Do teams have true autonomy to organize their work themselves without excessive management control?

 

 

Business as Usual tries to exercise central control over employees

Co-Med - Netherlands

Co-Med operated with a highly centralized model for managing general practitioner practices. Planning, operational decisions, and performance targets were largely set by the central organization rather than by the medical professionals working on the ground.

This structure limited professional autonomy for healthcare workers, as key decisions about patient flow, scheduling, and business operations were externally directed. In healthcare settings, this can create tension between operational efficiency targets and clinical judgment.

The model also came under scrutiny in reporting by the Financiele Dagblad and other sources, including allegations of healthcare fraud such as billing for extended or additional consultations that were not actually delivered. These issues highlight the risks of excessive central control in complex care environments where local judgment and autonomy is critical.

 

Future Entrepreneurs trust their teams and build their autonomy

Buurtzorg - Netherlands

Buurtzorg is built around small, self-managing teams of district nurses who operate without traditional managerial layers. Each team is responsible for organizing its own work, including planning, scheduling, and patient care delivery.

This structure gives healthcare professionals direct control over how care is delivered, allowing decisions to be made close to the patient rather than through centralized management systems. The model assumes that frontline professionals are best positioned to organize their work effectively.

With thousands of teams operating across the Netherlands, Buurtzorg demonstrates how autonomy can scale without introducing hierarchical control layers. Coordination is supported through light systems and peer learning rather than top-down management.

 

FaSinPat (formerly Zanon) - Argentina 

When Argentina went through its economic crisis in 2001, the owners of the Zanon ceramics factory shut its doors and walked away, leaving 250 workers unpaid and unemployed. Rather than accept that, the workers walked back in. They restarted the machines themselves, renamed the plant FaSinPat (Fábrica Sin Patrones, "Factory Without Bosses") and have now run it that way for more than two decades.

What FaSinPat did isn't a one-off anecdote: it reflects a pattern documented across Argentina's broader wave of worker-recovered companies. A peer-reviewed study published in the academic journal Sociology (Ozarow & Croucher, 2014), based on a survey of 85 recovered companies and in-depth worker interviews, found that 70% of these enterprises run on "horizontal" structures: managerial tasks are either divided equally among all workers, or rotated so each person takes on a broader coordinating role for a limited period, then hands it back. 88% hold regular worker assemblies as their actual decision-making body — not a symbolic consultation layer, but where votes are cast and binding calls get made. Only a small minority (8%) fall back on a fixed administrative council that concentrates power the way conventional management would. The same research found that self-management tends to run deepest in workplaces where the recovery involved a hard-fought struggle to reclaim the factory in the first place — the shared experience of that fight is part of what makes the resulting democracy stick.

For FaSinPat specifically, that self-management extended outward as much as inward: the cooperative hired workers from the local unemployed movement, donated ceramic tiles to community centres and hospitals, and built a health clinic in a poor neighbourhood nearby The same community later showed up by the thousands to physically block police eviction attempts.

FaSinPat has grown into Latin America's largest ceramics manufacturer under worker control, and in 2009 the provincial government legally expropriated the factory, formally transferring ownership to the cooperative that had already been running it for years.

 

What can you do

If you want to organize your teams like a Future Entrepreneur, here are some practical tips:

• Push decision-making to the edge of the organization
  Let teams closest to the work decide how tasks are organized instead of centralizing planning and execution.
• Replace control systems with clear principles
  Define clear goals and boundaries, then trust teams to choose how to achieve outcomes within those constraints.
• Design for accountability without micromanagement
  Use transparent results, peer feedback, and shared metrics instead of managerial approval loops.