Placed based work will actually serve people’s needs more completely and more cheaply.

The consciousness of place is not hierarchical or expert. It relies on the intrinsic value of each member of the place. Any flattening is frightening to the expert, and those who certify and train them. This is a big political challenge most of all – Reyn Archer

The responses to my last post on why decentralised pilots fail have been insightful.

In the excellent comment thread, Paul Jansen offered a provocation that framed this follow up post:

“There is little alternative to place based, whole system thinking in order to get health and care to move in the right direction.

The challenge is therefore how to get an immunosuppressant to work on the current system, in order to get new DNA to take hold.”

Paul is right. We cannot just hope for cultural change. We need to administer systemic immunosuppressants.

Firstly, though lets look at how the organisational immune system (OIS) actually works.

The OIS resists decentralised governance and innovation efforts not through a single decisive action, but through a complex, synchronised network of defence mechanisms all designed to maintain stability and homeostasis. Just as a biological immune system identifies and neutralises foreign agents to protect the body, the OIS identifies radical changes—such as self-managing teams or place-based decision-making—as threats to the organisation’s identity, consistency, and control structures.

This resistance manifests through specific antibodies embedded deep within the organisation’s architecture:

One Size Fit All: Why Organisations Prefer Standardisation

Large organisations rely on standardisation to minimise variance and maximise control. The immune system defends this logic by rejecting the local variation required for decentralised working.

• The “Fairness” Trap: Human Resources departments often block local autonomy by citing fairness or equality. For example, if a decentralised team attempts to set its own working hours or recruitment criteria, HR may block this on the grounds that “if we do it for them, we’ll have to do it for everyone”.
• Rigid Job Classification: In the NHS Buurtzorg experiments, the immune stystem resisted the generalist nature of self-managing nurses. The pay framework required rigid hierarchical banding making it administratively impossible to classify a flat structure where responsibilities rotate. This forced the reintroduction of ‘team leaders’ effectively killing the self-management model.
• The IT Straitjacket: Enterprise IT systems are frequently designed for low trust (security and control) rather than the high trust required for autonomy. Centralised systems often restrict access rights preventing team members from performing necessary cross-functional tasks, while legacy systems remain siloed, preventing the interoperability needed for holistic, place-based decision-making.

Control The Resources, Control The System

The flow of resources is the lifeblood of any initiative; so the organisational immune system restricts this flow to maintain central control.

• Procurement Barriers: Centralised procurement rules, designed for economies of scale, often forbid small, discretionary spending by local teams.
• Unfunded Mandates: A common resistance tactic is the devolution of responsibility without the devolution of financial power—often termed an ‘unfunded mandate’. Local teams may be given the duty to solve complex problems but lack the financial authority to redesign services or allocate resources differently, trapping them in a cycle of failure.
• Siloed Budgeting: Traditional cost-centre silos prevent holistic solutions. If a preventative measure saves money for one team but costs money from another’s budget, the immune system typically blocks the expenditure, prioritising departmental budget compliance over system-wide efficiency.

The Shadow Hierarchy and Middle Management Resistance

When formal hierarchies are flattened to create decentralised teams, the immune system often reconstructs them informally to preserve the status quo.

• Shadow Management: Middle managers are often the demographic most threatened by decentralisation, as their traditional value proposition (directing resources, monitoring and approval) is eliminated. Without retraining or new incentives, they often engage in ‘shadow management’—attending meetings they shouldn’t, demanding detailed reports, and subtly directing the team’s decisions.
• The Boss Shadow Effect: Even when titles are removed, the ghosts of old power structures remain. Employees conditioned by hierarchy may struggle to take initiative, waiting for permission from former leaders. If the organisation does not explicitly dismantle old approval mechanisms the shadow hierarchy reasserts control at the first sign of stress.

Bureaucratic Inertia and Risk Aversion

Finally, the organisational immune system uses the sheer power of inertia to wait out change initiatives.

• Risk Intolerance: Public sector organisations often equate risk with doing something outside the norm. This leads to an overemphasis on evaluation to mitigate all potential risks before a project can begin, effectively paralysing innovation efforts in a limbo of analysis.
• Preference for the Status Quo: There is a deep-seated institutional preference for predictable, familiar processes over innovative ones, even if the current processes are inefficient. This manifests as ‘passive inaction’ where projects stall and deadlines are missed not due to active sabotage, but due to a lack of momentum and resource hoarding.

To fully protect new and emerging ways of working we must diagnose these specific antibodies that will attack local autonomy. Only then can we administer the correct immunosuppressant to prevent the host system from neutralising the new DNA.

As Reyn Archer said – the consciousness of place is not hierarchical or expert. And any flattening of the organisation or system in order to give power to individuals is frightening. Indeed, it is antithetical to the very of idea of top down leadership that is propagated by the likes of LinkedIn.

A necessary rule of place-based or decentralised approaches lies in recognising that, left unchecked, the system will seek to overpower any efforts to change or disrupt the natural order.

The power is in the targeting and strength of those immunosuppressants.

This post is the second in a series of three looking at decentralised and place based approaches. You can read the first one here.

Image by Gedesby1989 from Pixabay