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This two-part study aims to contribute to the body of knowledge on team development by examining the development of self-managing teams (SMTs) in healthcare. Based on an exploration of the team development literature, a perspective on SMT development was created, which suggested that SMTs develop along a non-sequential pattern of three processes–team management, task management and boundary management and improvement–that is largely the result of individual, team, organizational and environmental-level factors.

The perspective on SMT development was assessed in a Dutch mental healthcare organization by conducting 13 observations of primary mental healthcare SMTs as well as 14 retrospective interviews with the self-management process facilitator and advisors of all 100 primary mental healthcare SMTs.

Empirical results supported the perspective on SMT development. SMTs were found to develop along each of the three defined processes in a variety or possible patterns or simultaneously over time, depending on many of the identified factors and three others. These factors included individual human capital, team member attitudes and perceived workload at the individual level, psychological safety, team turnover, team size, nature of the task and bureaucratic history at the team level, and management style and material and social support at the organizational level.

This study provides a non-sequential model of SMT development in healthcare, which healthcare providers could use to understand and foster SMTs development. To foster SMT development, it is suggested that cultural change need to be secured alongside with structural change.

Even though various team development models have been described in the literature, this study is the first to indicate how SMTs in the healthcare context develop toward effective functioning.

Flexibility is essential for healthcare organizations to anticipate the increasing internal and external dynamics. Mental healthcare organizations in the Netherlands face major policy reforms made by the government, increasing involvement from municipalities and gradual replacement of clinical care with outpatient care. Top management plays an important strategic role in creating this flexibility because they make important choices, give direction and structure the organization. To create flexibility, managers have to deal with complexity and paradoxes. In this study, the authors aim to contribute to the knowledge on how healthcare managers can create flexibility in their organizations.

This is a qualitative empirical field study. In total, 21 managers of mental healthcare organizations participated in open in-depth interviews. The authors explored flexibility on three perspectives: organizational direction, structure and operations. The COVID-19 pandemic has provided an opportunity to explore flexibility. The authors asked participants to reflect on their organization's response to the pandemic.

Most mental healthcare organizations create flexibility in an implicit way. Flexibility and resilience are closely linked mechanisms. Flexibility ensures a quick response while resilience provides the counterforce and rebound needed to adapt. Adaption ensures that healthcare professionals learn from their experiences and do not return completely to the way things were done before. The primary urge to survive ensured rapid and adequate responses to the COVID-19 pandemic. Whether this is a manifestation of flexibility remains difficult to conclude.

The complexity theory offers some guidance in creating a flexible organization without losing consistency. Flexibility and resilience are closely linked mechanisms that antagonize and protect each other. With this insight, managers in mental healthcare can utilize the qualities and balance them without falling into the various pitfalls.

In this research, the authors are concerned with flexibility as a proactive attitude and capacity of organizations. By looking at the response of organizations to the COVID-19 crisis, the authors find out that responding to a disaster out of survival instinct is something else than flexibility. There is an interesting relationship between flexibility, resilience and adaptability, and they can balance each other.

Flexibility is necessary in a dynamic healthcare environment. However, balancing flexibility and consistency is difficult for healthcare teams, especially when working in threatening conditions. Methods are needed to help teams create, monitor and maintain flexibility.

This study evaluates a practice-based program –– the Flexmonitor – which aims to help teams develop and maintain flexibility. Here, realistic evaluation was used to refine the program and define building blocks for future programs.

The Flexmonitor can be used to monitor implicit criteria and differences in interpretation and beliefs among team members to promote flexibility. It also monitors team behavior and the effects of this behavior on self-defined indicators. Using the Flexmonitor, team members can discuss their beliefs and the definitions and criteria of flexibility. Strikingly, teams were not able to effectively self-manage their flexibility using the Flexmonitor.

This article contributes to our knowledge of self-managing teams, particularly the question of whether team members can take responsibility for team flexibility.

Stakeholder management is not yet incorporated into the standard practice of most healthcare providers. The purpose of this paper is to assess the applicability of a comprehensive model for stakeholder management in mental healthcare organization for more evidence-based (stakeholder) management.

The assessment was performed in two research parts: the steps described in the model were executed in a single case study at a mental healthcare organization in the Netherlands; and a process and effect evaluation was done to find the supporting and impeding factors with regard to the applicability of the model. Interviews were held with managers and directors to evaluate the effectiveness of the model with a view to stakeholder management.

The stakeholder analysis resulted in the identification of eight stakeholder groups. Different expectations were identified for each of these groups. The analysis on performance gaps revealed that stakeholders generally find the collaboration with a mental healthcare provider “sufficient.” Finally a prioritization showed that five stakeholder groups were seen as “definite” stakeholders by the organization.

The assessment of the model showed that it generated useful knowledge for more evidence-based (stakeholder) management. Adaptation of the model is needed to increase its feasibility in practice.

Provided that the model is properly adapted for the specific field, the analysis can provide more knowledge on stakeholders and can help integrate stakeholder management as a comprehensive process in policy planning.