Non-Hierarchy and the Work Itself

October 14, 2024

This piece first appeared as my column Business Different in the Santa Fe New Mexican‍ ‍as Life, death, and hierarchy on October 14, 2024.

At Biscochito, our non-hierarchical approach might seem wildly innovative, and I wouldn’t deny it over cocktails. But the truth is, we’re not alone in exploring flatter management structures.

Even big businesses are trying this — though often as a means to eliminate middle management roles and increase efficiency. For us, it’s about something far more profound: making the actual work of caregiving better.

This belief in our approach was put to the test last summer when we were asked to support someone who chose to end their life by voluntarily stopping eating and drinking, or VSED. This experience not only validated our methods but also deepened our understanding of what true support means in caregiving.

VSED is a legal end-of-life option where a mentally capable individual decides to refuse food and fluids to advance the time of their death. It’s different from medical aid in dying, which became legal in New Mexico in 2021 through the Elizabeth Whitefield End-of-Life Options Act. VSED requires significant caregiving and support, making it a complex and emotionally challenging process for all involved.

When approached with this request, we didn’t have specific experience with VSED, but we knew caregiving. After consulting with experts and advisors, we assembled a team of seven caregivers for 24/7 support, a therapist for ongoing counseling and two support staff to fill gaps. We structured caregiver shifts to overlap, ensuring continuity and easy communication.

At the outset, as the leader of Biscochito, I felt the weight of responsibility. Experts like doctors and death doulas also carried significant authority. But something remarkable happened when the actual work began: The center of gravity shifted entirely to the person we were supporting, held there by the caregivers and family surrounding them.

This shift exemplified the core of our non-hierarchical approach. Instead of managing from the top down, my role became one of support. I focused on ensuring our caregivers had the resources, emotional support and autonomy they needed to provide the best possible care. The therapist we engaged met regularly with caregivers, our client and their family throughout the process, creating a network of support that extended beyond just physical care.

I visited our client during their VSED journey, including on the day they died. What I encountered surprised me: Two caregivers were present instead of the scheduled one, both smiling and light. The client’s children, also present, shared this gentle joy. They invited me to sit with our client, who was transitioning to their death. Despite having sat with people in transition before, I’d never been welcomed with such warmth and brightness.

This atmosphere was a direct result of our support system, and our client’s remarkable spirit. By creating an environment where caregivers could flow in communication, compassion and connection, something emerged that was beautiful and profound. Interestingly, we used fewer support resources — and less money — than anticipated, and far less than if I had managed the situation traditionally.

The success of this approach lies in its focus on supporting rather than directing. By trusting our caregivers and providing them with the necessary resources and emotional support, we allowed them to fully engage with their work and respond to the needs of our client with autonomy and compassion.

This experience reinforced my belief in our non-hierarchical system. While I don’t know exactly how it will look when it’s fully developed, I know how it will feel. It will feel like that room — filled with gentle joy, deep respect for the individual’s choices and a network of support for caregivers and those they support.

As we continue to refine our approach at Biscochito, this experience serves as a guiding light. It shows us that by supporting caregivers and trusting in their abilities, we can provide care that truly honors the autonomy and dignity of those we serve, even in challenging circumstances.

In the end, our non-hierarchical approach isn’t just about organizational structure. It’s about creating a system that allows for the deepest expression of compassionate care. And that, I believe, is truly innovative.

What Stayed With Me

When I reread this now, I feel the familiar warmth of mild embarrassment — the kind we all feel about recent versions of ourselves who believed they had arrived somewhere definitive.

We weren’t non-hierarchical.

We were loosening the structure. We were redistributing attention. But the deeper shift — the one that feels obvious now — hadn’t fully taken root.

What strikes me most is how I wrote about the system.

I was still describing structure as the primary innovation. Now I see more clearly that the structure was never the point. The work was.

Caregiving, especially at the end of life, has its own center of gravity. It organizes people around it when they let it. In that room, during that vigil, it wasn’t my leadership or even our model that held things steady. It was the work itself — demanding presence, inviting softness, insisting on attention.

The caregivers were not executing a plan. They were stewards of that gravity. They were musicians inside something already moving. The structure only mattered insofar as it allowed the work to unfold without interference.

I had to let my own nervous system catch up to that understanding. It is easier than I imagined to describe a new structure. It is harder — and more humbling — to step back enough to see that the work knows more than you do.

What feels natural now within our core group isn’t a lack of hierarchy. It’s alignment. The work leads. We follow.

The ongoing effort is not to design something innovative. It is to keep building conditions where the work can be practiced in its fullest expression — beyond the core, across the whole organization.

I am sympathetic to the version of me who wrote this. She was pointing toward something real. She just hadn’t yet surrendered fully to the work itself.

Reflection

Sometimes what changes is not the structure, but your relationship to the work.

Have you ever experienced something similar?

You begin by trying to design it well.
Eventually you learn to listen to it.

The work has its own intelligence.
The question is whether we are willing to let it lead.

That has become clearer to me over time.