Applying systems thinking to commissioning: who will be the future system leaders?

I often wonder just who the leaders in the commissioning landscape will be moving forwards. Times are changing rapidly, organisational boundaries are blurring and merging and new integrated teams promise to be one of the enablers of different ways of working.

To survive in this new landscape will take a crucial shift in our awareness of the situations in which we operate and the ways in which we think. Fragmented, linear thinking is no longer appropriate for dealing with the wealth of complexity in today’s world. It is going to be ever more important to grow the state of mind from which one operates in order to survive. We should be mindful that what we are looking at is determined by how we are looking and a process of stepping outside of our normal ways of thinking may be required. (Jan de Vische, 2014)

Those of us who engage with systems thinking are very aware that, ‘A systems approach begins when first you see the world through the eyes of another.’ (Churchman, 1968) and some core concepts of systems thinking are ‘gaining a bigger picture (going up a level of abstraction) and appreciating other people’s perspectives.’ (Chapman, 2004) These are easy things to say, I guess, but much harder to put in practice if you are not used to it and yet I feel they will be important skills for the leaders of the new commissioning landscape as they lead within a wider system and not just the constraints of one organisation.

To see the wider system people must first move beyond the strongly bonded relationship they have with their current organisation, which will inevitably be hierarchical. Fritjof Capra in his book, The Systems View of Life, reminds us that people see their position in a hierarchy as part of their identity. Therefore, to me it is easy to imagine why people may not want to see other perspectives as they are happy to see the world as they currently do and feel happy with their current identity within the existent hierarchy.  Because of this, the demise of organisational boundaries and traditional hierarchies may generate some existential fears and I wonder to what degree this will hinder people’s ability to organically adapt to their new circumstances.

On a positive note though, it may act as a catalyst for new, emergent thinking. I wonder if those caught in this huge and prolonged change realise that there is a different kind of power they can harness instead of the traditional power gained through hierarchical positioning? It is the power to empower others. Capra tells us that the network is the ideal structure for exerting this kind of power, which, in my mind, fits perfectly with the newly emerging commissioning landscape. I feel that future system leaders will be those who can effectively facilitate the new connectedness, rather than resist it. They will be the ones who can develop rich connections, recognise new centres of power, grow alliances, partnerships and new relationships, learn their way forward with others and not be afraid of failure. They will be the ones who support new mechanisms of learning, grow shared values as oppose to being chained to one organisational culture and they will nurture a true sense of community.

The systems leaders will be those who can effectively work with the flux, rather than hide from it and they will be committed to the success of the whole, rather than one part of it. They will be able to focus on similarities rather than differences and will have a committed focus on deeper learning. Their tolerance for uncertainty will be enhanced, they will embrace new freedoms and they will accept the need for a longer-term focus.

I believe the new way forward has the potential to open up a plethora of freedoms and choices, which I believe will be hugely beneficial, because as von Foerster reminds us, ‘the more freedom one has, the more choices one has, and the better chance that people will take responsibility for their own actions. Freedom and responsibility go hand in hand.’ (Ison, 2010)

 

 

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Remembering Peter Block’s Community

On discussing the fragmented community and its transformation, Peter Block tells us, ‘the essential challenge is to transform the isolation and self-interest within our communities into connectedness and caring for the whole. The key is to identify how this transformation occurs. We begin by shifting our attention from the problems of community to the possibility of community.’ He also reminds us that the community should be a place where we are emotionally, spiritually and psychologically a member.

I don’t know about you, but I literally cannot function properly if I don’t feel connected in these ways. I’m not a ‘half in, half out’ type of person. I’m a 100% in person. I want a deep connection with my communities, I want to feel close to the people I deal with regularly, I want to experience the world as they do. I want to feel free to express myself whilst remaining psychologically safe. I want to be able to challenge thinking in a constructive way (both within my community and within myself) and I want to feel proud to be part of a larger whole.

I want to consider the wider purpose, give to that purpose unselfishly and focus on interdependence more than independence. I want to break down the doors of isolation and be seen not just as a stranger passing through, but as an active investor and creator of our collective space. I want to explore our community’s authenticity and identify where we can together trade problems for opportunities.

I want to build and share social capital. I want to use my skills to the full and share them with others. I want quality relationships, new conversations and to evolve in an organic way. Don’t ever think of forcing me in your direction without giving me choices or I will at best resist and at worst completely disengage.

I want to be able to act, not be done to. That is when I will choose to help build our collective desired future. If this takes different kinds of conversations, ones we have not had before, then that is the way I want to go. I don’t want the old and stale, I want the new and exciting. I want mutual assistance and trustworthiness and most of all I want to learn and feel alive.

I want to be around people who have the same values as me, who respect my principles and ethics and give me the freedom to be accountable. I want to be in contact with people who help develop my learning and I want the freedom to express how our future world might look. I want to be engaged in conversations constructively, not brushed off like an irritating insect and I want us to jointly explore our learning and developing possibilities.

As a systems thinker I want to understand and come to terms with the current story……..and then seek to build a new one. I want to do it in a way that allows us to create together. I don’t want to project the accountability for development and growth onto others.

In my communities, your identity is my identity. I want that identity to be mutually agreed, not enforced upon me or I cannot truly adopt it or be accountable for it. I want a sense of belonging, where all voices are heard, not just the chosen few. Only then can I truly focus on our collective gifts, rather than our deficiencies.

I want to be part of the vision, part of the plan and feel a deep sense of commitment through this engagement. You can’t build commitment without conversations though, so if you want my loyalty then you have to engage with me.

‘The way we change the room is by changing the conversation’ (Community, Peter Block)

 

Crossing the Bridge

I came across this blog recently and was very impressed by its content and the thinking that it sparked in me.

http://blogs.lse.ac.uk/impactofsocialsciences/2017/04/27/the-ngo-academia-interface-obstacles-to-collaboration-lessons-from-systems-thinking-and-suggested-ways-forward/

The text that initially caught my eye was this,

‘Most studies identify a need for “knowledge brokers” not only to bridge the gap between the realms of science and policy, but also to synthesise and transform evidence into an effective and usable form for policy and practice. An essential feature of knowledge brokers is that they understand the cultures of both worlds.’

I believe the skill of the ‘knowledge broker’ is absolutely key for systems thinkers working with and in organisations and trying to disseminate the practice. Some of those who have come through the Open University Systems Thinking in Practice courses have good skills in this area, I think. I believe that is why we sometimes have fewer issues with the ‘my method/ model is better than yours’ and the ‘no-one wants to know about systems thinking’ arguments than some. It may be because the course did something unique for us – it taught us not only the academic aspects of systems thinking but how to practically use it and how to develop ourselves at the same time. We have to develop our praxis in a way that embodies the understanding of the cultures of both the academic and practitioner worlds………or we wouldn’t be able to use systems thinking effectively.

Personally, I feel like I can work with organisations using systems thinking and engage in the academics because I can ‘cross the bridge’ from one side to another when I need to and I can guide others across the bridge (not all the time but certainly sometimes). It is the area on the ‘bridge’ where you learn how to make it work. I find it quite absurd to witness the two cultures (academic and practitioner) at loggerheads sometimes because without each other we are all nowhere. We need to cross that bridge and meet in the middle sometimes. It was never meant to be a drawbridge……I don’t think!

I spoke to an ex employer the other day. A Chief Executive who I have a lot of respect for. She said to me, ‘There are 2 groups of people – those who want to fight with each other about who is right academically and those who just want help to translate the academics into practical application. Until we can all learn to talk to one another in a helpful way then we are never going to move forward, even if we want to use the methods. If the academics come at us with their harsh academic arguments, we just can’t handle that because that’s not part of our world and if we can’t get across to them our challenges and how we need help, without being put off by their harsh arguments, then we are never going to be able to transform the good stuff into something useable.’ I wonder how clever we really are, then, if we don’t put some effort into developing that area in between……..the area on the bridge?

As a systems practitioner, my main progress has been in translating what I have learnt into practical application. That was part of the OU course – putting systems thinking into practice.  I don’t bark words such as ‘viable system model’ etc in people’s faces repeatedly, in organisations, wondering why they don’t listen. I demonstrate, I show where value is added, I enable appropriate outcomes….and then I tell people how to do it themselves. I believe in ‘show don’t tell’ as I think this helps people to visualise. If they can visualise the process you go through to translate the academics into practice they often find it easier to apply it themselves, but they need a demonstration first. We spend far too little time helping people visualise what the value could be for them and how they can go through a thinking process to apply the academics to their real-life situation. We just expect them to trust that ‘the academic knows best’ and use what they are told is the best method. The very nature of the way we expect people to take new thinking on board sometimes can foster the very rejection type of behaviour that we want to overcome.

Would we go into a car showroom and expect a sales person to stand and verbally describe a brilliant car to us and expect us to understand how fast it is or how smooth the ride is by telling us about suspension and engines, when these things are not our area of expertise and we have no understanding of engines or suspension?…..no. We would want to see the car, drive it, see how it feels when we drive over a bump in the road and what it does when we put our foot down on the accelerator. We might then want to know ‘What kind of engine allows that?’ but often only when we have experienced and been impressed by what it can do for us first. So, how do we give people a ‘practice run’ of viable system modelling? How do we allow them to ‘feel’ what it’s like to go through the process of developing a multiple cause diagram? We can’t do it just by telling them how it’s going to feel. We have to help them feel it for themselves.

I did some work for a Clinical Commissioning Group a few years ago to look at some health and care services with a view to developing a completely new model of care. I was absolutely sure that systems thinking, in particular viable system modelling, was the correct thing to use. I dropped the words ‘systems thinking’ into the project conversations right at the beginning of the process, only to be met with blank looks. This was highly expected, though. How could I expect anyone to understand the depth of the academic elements if they weren’t engrossed in that area of thinking themselves? My way forward was to undergo systemic inquiry type activities and show the process of thinking, rather than explain what it was. I used their language and over time I gently fed in more and more of the academic explanations and different language. I didn’t say, ‘and this is viable system modelling and you should use it more.’ I just showed them what I was looking at and what my observations said to me. I showed them how things fit together and what was causing staff to feel so desponded with their current situation. I got people on board by showing a depth of understanding about their current situation. I drew multiple cause diagrams with them and was amazed when they suddenly saw what they had previously been blind to, even though they had been encountering it on a daily basis.

It was only at the end, when I had helped people through the thinking process that they could visualise and understand the power of the process, the potential benefits, the added value and the outcomes from using such methods/ models and techniques. Some of the people on that project became real advocates of systems thinking after that. Now, how long do you think it would have taken me to convince them if I hadn’t used the ‘show don’t tell’ way?

Don’t get me wrong, I think we should fly the flag for systems thinking but there’s a way to do it…….not by having the harsh academic argument in the practical world but by crossing the bridge, getting to a place in the middle and then the flag will fly itself. But, we all have to be willing to compromise and come half way.

Remember…….if you don’t ever want to cross the bridge, how will you ever get to the other side?

 

A look back at my 10 year systems thinking journey

I’m reliably informed, by Google, that a lot can happen in ten years. Decades can see changes in norms and attitudes, see scientific, technical and medical advances and uncover new findings and theories in social sciences. We can completely change the shape of accessibility of information in ten years and I can learn how not to jam my hand between the bedroom door and the chest of drawers…..well, nearly. I still do that sometimes! And, in ten years I can go from my first introduction to systems thinking, in 2007 to a systems practitioner, still learning and always developing.

I was remembering my first major project this morning. It was looking at whether a Primary Care Trust was doing all it could to support appropriate prescribing for Type II diabetic patients back in 2007. It was via this project that I had my first real-life attempt at devising and using a hybrid methodology, incorporating aspects of Soft Systems Methodology, Hard Systems, Systems Dynamics and Viable Systems Modelling. Looking back at that piece of work, it struck me how I explicitly concentrated on the concept of autonomy. It felt natural to do so at the time and only now do I really understand its significance. I tried my hand at rich pictures, systems maps, utilising the CATWOE mnemonic, conceptual modelling, multiple cause diagramming and influence mapping. I made use of systems tools to open up perception, understand culture and to support complex decision making. I didn’t make a big deal of it at the time, but I was able to identify levels of recursion, systems and sub-systems in my situation of interest. I engaged a number of multi-agency stakeholders using systems thinking, identified how current policy had not been derived from appropriate information and I was able to identify how previous planning had been done. I started experimenting with the boundaries of acceptability of the language of systems thinking and began widening my views.

The personal learning was huge. I became very aware of the importance of self-knowledge – of unconscious prejudices, values and how I, personally, reacted to others.

I directly applied my systems thinking to projects within my workplace. I didn’t know it then but the way I worked, learned, developed and influenced others was going through a period of metamorphosis. It would never again look the same as it had before I came across systems thinking.

Outside of the workplace, in an academic capacity, I dipped my toe into the environmental decision making arena in relation to my systems thinking. Environmental issues are a fascinating area of interest for me and a piece of work on deforestation meant I had the diversity of learning I had craved for a long period of time. Why deforestation? I’m a passionate tree lover…..yes, really! Keep it to yourself though!

I also started to draw in techniques of innovation and user centred design to my systems practice, which I thoroughly enjoyed, and by 2009 I was able to see the complimentary elements of a number of types of thinking coming together in an extremely powerful way. My perspectives of everything in life were changing and I loved it.

At this point I believed that finding a supportive systems thinking community to network with might be to my advantage. I needed to talk about my work, share my experiences and hear the experiences of others. I did find such a community and engaged in as participative a way as I could. It was through this community that I was introduced to a different kind of systems thinking arena. An arena where systems thinking meant so many more things (some of which I would class as systems thinking and some I definitely would not). I talked a lot, learned a lot and felt happy with my choice. Based on my new conversations, I was able to formulate myself an updated development plan, incorporating aspirations to set up my own website, become self-employed and continue to share my thoughts and ideas with a wider audience.

I was now very firmly in the arena of systems thinking and at work I was routinely managing systemic change. I was loyally developing my praxis and began engaging with situations using systemic inquiry. I was able to frame situations differently, work with cultural and ethical sensitivity (or so I thought) and improve cross-organisational communication, based on what people required. I undertook projects on health inequalities in maternity care, how to help GP Consortia take over local health care commissioning and hospital discharge. I was routinely using Soft System Methodology, Systems Dynamics, Critical Systems Heuristics and Viable System Modelling

The environmental decision making popped up here and there, again, in my academic work also and at times I found it a welcome change. Particularly when I touched on the areas of marine environment and nuclear power, two things that interest me a lot.

I continued to develope my praxis, noticing what things made me engage with a situation and what would make me disengage, when I understood the relational dynamics and very importantly ‘what I was doing, when I was doing what I doing’ and how and when I needed to take a ‘design turn’ in my practice. You never really know how important a phrase like that is until you hit a situation that forces you to do it. I had such a situation in the NHS once. It was an insightful lesson which has served me well ever since. It was in my role as a Commissioning Manager when I wrote a proposal for a piece of work relating to the urgent care response to pandemic flu. It was systemic inquiry focussed and I though the recommendations about how we should approach things were sound but they were rejected by the Urgent Care Board! I was a little shocked as I knew the recommendations were appropriate but I instantly recognised, during the meeting where I was presenting my report, that the Board and I were speaking different languages. My style and wording relating to systemic inquiry meant nothing at all to people who were expecting to see a project/ programme management style with project/ programme management language. Hmmm……what to do? Two totally different languages in the same room and I had to sort it out! So, off I went to ‘take a design turn’ as Ray Ison from the Open University would say and rectify my mistake. I returned the next week with a completely different report, or so they thought! I presented my report and recommendations and it went down a treat. Apparently, my recommendations were, ‘much improved’ now I had done what the Board wanted. The reality was that I took the report away and changed the words systemic inquiry to project……………..and nothing else! It was a huge risk but I was confident that it was down to the inability of the Board to see what was in front of them because they were blinded by a couple of words they were not used to seeing, did not recognise and could not visualise in the context of the topic in hand and my initial inability to translate my language to one they could understand. It took me some time to stop giggling afterwards and it still brings me the odd moment of enlightened joy even today.

From that meeting, I went away to develop myself a learning contract, which prompted me to do some real exploration of my needs as a systems practitioner. It was then that I started to feel the weight and yet the strength in taking full responsibility for my experiential learning and orchestrating my own evolving praxis. My personal development plan at this point was rapidly changing. I undertook a continuing professional development module as part of my MSc and to my utter delight it made use of the viable system model. I have to say that using the VSM to model my development was one of the most powerful things I had ever done and I have repeated the exercise every year since. Don’t be fooled into thinking VSM is for organisational design only, it is far more versatile than that.

Then, before I knew it, I was back working on hospital discharges and this time I touched on social learning systems and communities of practice, the use of which I was critiquing as I went along. At the same time, I took a look at a systems thinking approach to urgent care redesign. Both big projects. Both extremely motivating and both were the sources of a rich learning experience.

Over the last ten years, I have continued to develop my practice by using systems thinking to improve urgent care escalation processes, input into emergency planning and pandemic flu planning, improve the quality of hospital discharge, form strategy, develop healthcare pathways, improve quality assurance, develop healthcare services, identify risk, flit between operational and strategic management, appropriately allocate healthcare funding, develop  new models of care and undertake a number of transformation and change projects. I’ve managed to get people on board with some of my techniques, develop and facilitate workshops and make large scale, multi-agency interventions. I’ve delivered many a training session on systems thinking, taught people the diagramming, the models, the methods and the concepts and I’ve supported and coached others to develop their own systems practice. I’ve used systems thinking in organisations, across organisations, as a consultant, as a trainer and on myself. I have to say, it’s been quite a journey! And, yes, I set up my website, got started as an independent consultant and continued to develop my networks. I refreshed my development plans to incorporate the cybernetics of self and how to develop mental toughness and I’m now on the next stage of my journey.

I’ve moved on from beginner over the last ten years. However, I will always remain a learner. Throughout it all there have been many ups and downs, many times of discomfort, many disagreements and things I will never resolve and also many times of delight, of insight, of pride in my fellow practitioners and excitement when someone new takes on board systems thinking for the first time. I often reflect on my past ten years and the advice I would give to myself at the start of the journey, if I could travel back in time. I will leave you with some of the things I would whisper into my own ears, if I knew then what I know now:

1.       When you are new and inexperienced in a discipline you will come across people who will not listen to you because you are new and inexperienced. You might think this will disappear over time. It won’t. You will hit this problem because you are young, because you are older, because you are male, because you are female, because you haven’t been an academic, because you are an academic, because you aren’t a practitioner, because you are a practitioner. It doesn’t go away. You will ALWAYS come across people who won’t listen to you or take you seriously. Don’t waste your time making excuses for what it is happening. Instead, use your energy to develop effective strategies for dealing with it. If you come across a situation where every strategy you can think of fails…….move on.

2.       As you move from brand new beginner, understand that you have moved on. You are not at the start line anymore. Continually refresh your development plans. Make sure they continue to challenge and develop you. If they don’t scare you a little, they are not ambitious enough.

3.       There will be times when working life goes wrong. When those you thought you worked well with disappoint you. There will be times when trust is broken and you feel disappointed. There will be times when you are disappointed at yourself. There will be times when you think everything is going wrong and your confidence leaves you. These times are temporary. If you hit times like these, remember why you are in this game. Always, ‘find your way back home’ https://www.ted.com/talks/elizabeth_gilbert_success_failure_and_the_drive_to_keep_creating