Every conversation about flattening an organization eventually hits the same wall: fine for a startup, but it will never survive real scale. It is a fair worry. Coordination gets harder as headcount grows, and the usual answer to that problem is to add layers of management. So the interesting question is not whether small teams can run themselves. It is whether a large organization can run on self-managing teams without rebuilding the hierarchy it removed. At least one has.
The arithmetic that should not work
The Dutch home-care organization Buurtzorg operates more than nine hundred self-managing teams, each capped at around twelve nurses, with roughly 14,700 employees as of January 2021 (Martela and Nandram, 2025). Above them sits almost nothing. Two directors, about fifty back-office staff, and no middle managers or supervisors at all. The coordination that a conventional firm would push through a chain of command is handled instead by the teams themselves, supported by a thin layer of internal coaches. And thin is the word. Around twenty-one coaches support roughly nine hundred and fifty teams, on the order of one coach for every forty-five teams or more, and crucially those coaches hold no formal authority and carry no responsibility for the teams' productivity (Martela and Nandram, 2025). They advise. They do not command.
This is what Lee and Edmondson mean by decentralizing authority radically, formally, and systematically across an organization, rather than delegating a bit more within an intact hierarchy (Lee and Edmondson, 2017). The manager-to-subordinate relationship is not loosened. It is absent by design. What replaces it at Buurtzorg is a structure of nested self-governing teams plus a support role that is deliberately stripped of positional power, so that authority stays with the people doing the work.
Why it holds together
The reason this scales is not magic and not culture alone. It is the nature of the work. Home care decomposes cleanly into small teams serving their own patients, which means interdependence between teams is low. That is the first and most important of the boundary conditions the researchers identify, alongside a highly motivated and competent frontline and services that a compact team can deliver largely on its own (Martela and Nandram, 2025). Low interdependence is what lets you add teams almost indefinitely without the coordination burden exploding, because each new team mostly minds its own work rather than negotiating constantly with the others.
That is the quiet lesson hiding inside the headline. Self-management scales in proportion to how little the units need each other. The systematic review of self-managing teams makes the same point from the organizational side: outcomes depend on getting the right input factors at the individual, team, and organizational levels, and the gains are not automatic (Magpili and Pazos, 2018). Scale does not remove that dependency. It multiplies it. Nine hundred teams that each need heavy cross-team coordination would not be a flat organization, they would be a coordination crisis.
The asterisk worth stating
Admiring the model without its caveats would be dishonest. Buurtzorg's low administrative overhead, put at around eight percent against a sector average near twenty-five percent in a 2015 assessment, is often quoted as proof that abolishing managers simply saves money (Martela and Nandram, 2025). But the same case notes that its cost per hour of care was actually higher than a comparison figure, not lower. Cheaper overhead did not translate into a cheaper service on every measure. And the whole structure leans on a frontline of nurses who are trained professionals with strong intrinsic motivation, exactly the boundary condition the authors flag. Transplant the design into work where the front line is less autonomous or the tasks are more entangled, and the arithmetic changes.
There is also the matter of what the coaches are not. Because they hold no authority over productivity, they cannot rescue a team that is failing by simply taking over. The model's resilience depends on teams that can genuinely govern themselves, which loops back to the input factors and competencies the research keeps insisting on (Magpili and Pazos, 2018). Scale without managers is not scale without conditions.
What to take from it
The practical implication is precise. If you want self-management to survive growth, do not start by removing managers. Start by decomposing the work so that teams depend on each other as little as possible, then invest in a frontline capable of running its own affairs, and only then thin the layer above them. Add a small cadre of coaches with influence but no command, and keep them scarce enough that teams do not mistake them for bosses. Buurtzorg did not scale by having faith that flat structures work. It scaled by matching a flat structure to work that happened to suit one, and by being clear-eyed about where that match would break.
Sources
- Martela and Nandram (2025). Buurtzorg: scaling up an organization with hundreds of self-managing teams but no middle managers. Supplies the scale figures (900+ teams, ~14,700 staff, 2 directors, 21 coaches) and the boundary conditions that make them possible. https://link.springer.com/article/10.1007/s41469-024-00184-y
- Lee and Edmondson (2017). Self-managing organizations: Exploring the limits of less-hierarchical organizing. Defines radical, formal, systematic decentralization and the elimination of the manager-subordinate relationship. https://www.sciencedirect.com/science/article/abs/pii/S0191308517300059
- Magpili and Pazos (2018). Self-Managing Team Performance: A Systematic Review of Multilevel Input Factors. Establishes that team outcomes depend on multilevel input factors and are not automatic, the dependency that scale multiplies. https://doi.org/10.1177/1046496417710500