Applying systems thinking to commissioning: knowing what makes a system ‘sick’ can help you minimise the instances of ‘sickness’ in the future

In commissioning, it isn’t all about looking backwards, diagnosing weakness in services and trying to ‘put things right’. It’s quite the opposite. The focus is on creating whatever is required to give the right outcomes going forward. The focus, nowadays, is very much on things like integrating a number of suppliers into the whole system, taking an asset based approach and using levers to stimulate and shape the environment.  New kinds of systems are being created, with different boundaries and an extended repertoire of partners. This doesn’t come without its problems, of course, and a number of people, who are taking a commissioning approach in a new world of integrated public services, are often learning as they go along. That’s not a bad thing either. It’s great that people are learning their way forward together. It fosters a sense of community and encourages deeper thinking and enhanced learning as people deal with greater complexity together.

The tool for handling complexity is organisation. But our belief about what organisation is and how it might work may still belong to a world which is perceived as far less complex. Today, we operate in a much more complex world that we would sometimes like to admit. It challenges us, it makes us uncomfortable, it makes us think differently, it questions our current perspectives. But, if we are really lucky, it stimulates us, excites us and encourages us to strive forward.

It does help, though, if, during times of change, we have some idea of what makes systems (be that an organisation, a service, a group of services or anything that works together as a whole) ‘sick’ so that we can either seek to reduce the level of ‘sickness’ in the first place or be aware of early signs of ‘sickness’ so that we can administer the right medicine to avoid it getting worse.

As different types of organisations become integrated we may well start to see signs of an entangled character as different cultures, which once had to adhere to different criteria, merge together and try to find common ground. There may be some challenges establishing common governance mechanisms/ procedures during this time. We might notice that clear boundaries of responsibility have not yet been established, or appropriate quality indicators and monitoring are not yet in place or that contingencies to reduce risk have not been fully considered. If we understand that this could happen as we are creating something new, then we increase the opportunities to put things in place to prevent any adverse effects. We may need to clarify mission and purpose and who it is we aim to serve and be consciously aware that a new identity could take a little while to establish itself.

It is easy for people to become confused during these times of change. Having moved through a period of potential denial that the change needs to happen they can easily enter a stage of indecision and hesitation as ambiguity prevails, before the bigger picture becomes clear. It is easy, during these times, to default to old job roles and habits, assumptions and expectations. I have seen many instances where operational elements of a previous job role have remained the default focus of people who have moved into different and more strategic roles. Strategic planning was not given the attention it required and instead of embracing the meta-perspective needed, the focus was on micro-managing operations. This caused the organisational focus to be internalised. As a result, changes generally took longer to embed and the risk of the organisation being unable to respond to its environment was significantly increased. Being aware that this might happen and realising the risk that it brings can help us to mitigate against that risk, thus minimising the ‘sickness’ and ensuring that both an internal and external focus are maintained as we move along our journey.

One of the most disruptive ‘sicknesses’ I have encountered during times of change has been in relation to what we call ‘co-ordination mechanisms’ – the things that are in place to prevent operations of the system from causing chaos for one another. For example, a timetable in a school. On the surface, it may be almost invisible. But, without it, the school would be in chaos. It is omission of these near invisible co-ordination mechanisms that can cause our systems to be terribly ‘sick’. It can cause oscillations in performance, turf wars, staff feeling like they are bobbing around in a small boat, all alone, in the middle of a crashing ocean, inter-team disputes and recurring problems and yet the scheduling, the co-ordination, the policies, the planning, the information systems etc. which are vital for maintaining stability are often overlooked, deemed unimportant, invisible, and are often the very last things to get any attention.

These short snapshots of a very few kinds of ‘sickness’ are not exclusive to any one group of people or any one organisation or group of organisations. They happen repeatedly in a number of situations. They can arise when elements of the system, which are required for viability, are not well implemented or are dysfunctional. The system may not be in a state of homeostatic equilibrium and as a result the ‘sickness’ emerges. Left unchecked this will, as best, hinder success and at worst, cause the system to die.

I believe that commissioners who understand organisation and can apply models of organisation, like the viable systems model, to their work have an increased chance of successfully transitioning into a new integrated environment. They gain an understanding of complexity and how it can be matched. They understand and recognise ‘sickness’ and attribute it to systemic failings, rather than blaming individuals – their character, motivation and abilities. They are able to see past the system blindness to which we so often succumb. To quote Barry Oshry,

‘With system sight we can become captains of our own ships as we understand the nature of the waters in which we sail.’

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