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

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

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.

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.