Applying systems thinking to commissioning: remember Barry Oshry!

If you aren’t using the wisdom of Barry Oshry in your commissioning practices, I’m not going to say you should be, but I am going to say you could be.

For those who can’t remember, or who haven’t come across, the basic pattern that Barry tells us develops with great regularity in the widest of organisations and institutions, it looks something like this:

‘There are conditions we all face in whatever organisational position we occupy. Sometimes we are a Top, having overall responsibility for some piece of action; in other interactions we are a Bottom, on the receiving end of initiatives over which we have no control. In other interactions we are Middle, caught between conflicting demands and priorities. In other interactions we are Customers, looking to some other person or group for a product or service we need. So, even in the most complex, multi-level, multifunctional organisations, we are all constantly moving in and out of Top/ Middle/ Bottom/ Customer conditions.’

‘Tops are burdened by what fells like unmanageable complexity; Bottoms are oppressed by what they see as distant and uncaring Tops; Middles are torn and confused between the conflicting demands and priorities coming at them from Tops and Bottoms; Customers feel done-to by non-responsive delivery systems.

Top ‘teams’ are caught up in destructive turf warfare; Middle peers are alienated from one another, noncooperative and competitive; Bottom group members are trapped in stifling pressures to conform.

Tops are fighting fires when they should be shaping the system’s future; Middles are isolated from one another when they should be working together to co-ordinate system processes; Bottoms’ negative feelings towards Tops and Middles distracts them from putting their creative energies into the delivery of products and services; Customers’ disgruntlement with the system keeps them from being active partners in helping the systems produce the products and services they need.

Throughout the system there is personal stress, relationship breakdowns and severe limitations in the system’s capacity to do what it intends to do.’

(Barry Oshry, Seeing Systems 2007)

Sound familiar? Is should do if you are in the changing environment of public services. I’ve seen this, to some extent, in nearly every area I’ve worked. The thing that makes me feel most pain is when it is being explained in terms of the character, motivation and abilities of individuals, just as Barry describes in his book, ‘Seeing Systems’. What follows is the inevitable moving round or dismissing of staff or alienating them to a point where they leave voluntarily. Alongside this comes reorganising and restructuring and then…………..it all happens again! As Barry tells us, that is because the problem is not the staff, nor is it specific to a particular organisation, it is systemic. He terms the inability to see that it is systemic as ‘system blindness.’ I fear we are all blind at least some of the time.

I’ve seen this particularly in times of great change. Let’s face it, that’s most of the time! As a systems practitioner, I tend to identify it when I am also identifying the pathological archetypes of the viable system model, which tends to widen my vision, helps me to ‘zoom out’ from the situation and look at things from a systemic viewpoint, rather than a personal one. For example, if I see failing change programmes where some parts of the organisation do not know why then need to change or who they need to work with, a lack of cohesion and stretched operations, resulting in questions to management around responsibility, staff unable to co-ordinate efforts and rifts throughout a number of levels in the organisation then I can potentially see the ‘identity crisis’ archetype. With this archetype, there may be some strategic issues or organisational design flaws that require attention. However, once it has happened, attention needs to turn to ensuring that people know what is intended, implementing effective co-ordination mechanisms and supporting staff to solve their own problems. Additionally, the potential management turf war, that is causing the mixed messages, also requires resolution. So, I can see the ‘identity crisis’ and I can also see the pattern of the ‘Tops’ being crushed by unmanageable complexity, the Middles becoming more isolated from one another in the confusion and the Bottoms feeling oppressed and disengaging in response to that.

When the Bottoms start to have negative feelings towards the Middles and Tops and when the Middle peers start to compete, I’ve also seen the ‘baronies’ archetype emerge, albeit not very strongly, but I believe it was there. I have seen a group break off and gain independence. They have remained in their own silo and stopped seeing the worth they can get from being part of the wider ‘whole’. I’ve seen competitiveness prevail and learning shielded from other teams. Fortunately, the group were persuaded to recognise the synergies of working as a whole and were able to re-integrate back into the wider system. I was able to recognise what was happening by applying systems thinking to the situation, which made things feel a lot less disturbing. I felt that I could understand it and then use that understanding to carefully start edging things back in the right direction.

Admittedly, it is difficult to actually see the system, if you are embedded in it. Believe you and me, systems practitioners engage in the patterns above all too often, even though they are aware of them and work to recognise them on virtually a daily basis, sometimes. But, you can try to ‘zoom out’ and see the wider system and the systemic nature of the situation you are in. Systems thinking is a model of thinking that can support you in doing that.

To leave you with another quote from Barry Oshry, ‘We humans are systems creatures. Our consciousness – how we experience ourselves, others, our systems, and other systems – is shaped by the structure and processes of the systems we are in.’ (Barry Oshry, Seeing Systems. 2007)

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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.’

Applying systems thinking to commissioning: what can the viable system model bring to the party?


I first met the viable system model (VSM) in 2008, when I embarked upon my systems thinking journey with the Open University. Admittedly, it wasn’t an easy introduction. There it was, in the corner of my change management party, staring at me like a monster never to be approached. But, me being me, I couldn’t resist poking it with a stick a little bit, just to see how it would react.

I guess it confused me, at first, because I was never quite sure if it was about ‘an organisation’ or ‘organisation.’ This was mainly because the text I was learning from used both phrases/ words so very closely together that I sometimes mixed the two up. I wasn’t the only one either, a number of other colleagues made the same mistake too. It wasn’t long though before I realised it was about organisation (be that ‘an organisation’ or any other kind of system) and then we soon learnt to get along.

Managing complexity and being adaptive is key in the public services in which I have worked and therefore the VSM has been an ideal model to apply because the five systems that exist in the VSM have that purpose in mind. Maintaining a system in a state of homeostatic equilibrium is no easy task but the VSM encourages and supports the learning, adaptation and evolution required to do just that.

When I look at public services I look to see what makes them breathe, what makes their heart beat, what conditions have to exist to enable them to live, what makes them die? I look at how they interact with their environment and within elements of themselves. I look at what interdependencies exist, or don’t exist but should or could. I look to see what the drivers of both internal and external complexity are and are they being absorbed/ matched/ batted away or simply ignored? I look for the energy levels in my system – are people and processes energised, frantic? Are they stressed, fearful or in despair? Or are they asleep, calm, laid back with not a care in the world? I don’t just consider, ‘What is this thing?’ I consider, ‘What does it do?’ These are all clues you see, and when you can spot them and apply them to the VSM you get to know exactly where things are going right or wrong.

The VSM’s party trick, well one of them anyway, is to encourage you to identify if there are any variety imbalances driving disorder in your system and if there are, from where do they originate? Is it the workload between the environment and the operational units of your system that is causing a problem? Is there disorder between the operational units themselves? Could it be that there is an imbalance between the autonomy required to innovate and the cohesion required to maintain your identity? Is the rate of change causing a problem; is there an imbalance between changing at a pace to match the environmental variety and yet maintaining the current status quo?

Looking for requisite variety in all of these areas of potential critical variety imbalance has been a very powerful approach for me in my work. I am able to recognise the resource conflicts and the turf wars between clinical teams, indicative of issues in co-ordination mechanisms (knows as system 2 of the VSM). I am able to identify if there is a common sense of purpose, what the structural couplings are and what kind of identity this creates. I know what pathologies to look out for, for it is the pathologies that indicate that my system is sick.

We can only manage organisation if we know how it works. The VSM helps us to understand how it works. It guides us to consider what value our system provides to its environment and the things it does to keep itself in existence. It helps us to decide if primary activities are split by: task, customers, geography or time. It guides us in explicitly identifying mechanisms that enable primary activities to run smoothly. It gives us a platform from which to examine resource bargains and identify control dilemmas. It allows us to understand the type and nature of monitoring loops that are effective and those that break the bond of trust. It encourages us to link performance measurement in a meaningful way. It encourages us to gather intelligence from outside of the system and guides us in making better decisions.

I have used it, in combination with other systems thinking methods and concepts, to identify and reduce quality incidents in health services, to redesign pathways, to identify where and why services have been underperforming and help them improve,  to evaluate strategy and to form strategy, to decide whether to re-commission or decommission and to build new services from scratch.

So, after a tentative introduction to each other, the VSM and I get along just fine nowadays. In fact, I believe it is one of the single most powerful models I have ever used to help me understand a situation, diagnose weakness in a situation or design something from scratch. It gives me the skills to make better choices. It helps me understand why a situation is like it is, taking away any preconceived ideas and prejudices. It makes me feel at ease working with large, messy social situations and supports me in identifying problems and opportunities. VSM is no longer standing in the corner of my party…..it’s dancing, right in the middle of the floor!

 “… vision without systems thinking ends up painting lovely pictures of the future with no deep understanding of the forces that must be mastered to move from here to there.” Peter M Senge, The Fifth Discipline.

Applying systems thinking to commissioning


I’ve been applying systems thinking to my commissioning practice since about 2008 now, from when I first started on the systems thinking in practice undergraduate courses with the Open University.

Commissioning to me, back then, seemed a logical approach to achieving the health outcomes aspired to by the NHS and yet the turbulent journey through multi disciplines and across organisational relationships rarely made it an easy job. So, I welcomed with open arms the Systems Dynamics which allowed me to unpick the complex areas of hospital discharge and urgent care. It supported me in examining the potential consequences of different configurations of the wider system and thus vastly informed my commissioning decisions. I can tell you this, no matter how bad the problem seemed at first glance it rarely needed a huge commissioning exercise to make improvements. It just required a different perspective and an understanding of how things work as a whole system. I welcomed learning about Donella Meadows places to intervene in a system to increase effectiveness. I especially welcomed the Viable Systems Modelling, which I use virtually every day in my practice and in my personal life now. It taught me how to explore organisational arrangements and governance and how to spot variety imbalances that were preventing systems from operating to their maximum effect. More often than not, a number of strategic tweaks, informed by rigorous examination of the system before hand was all it took to make a difference. By difference, I mean maintaining delayed discharge figures at below national and regional average for over three years, gaining sign up from three major regional hospitals to a Transfer of Care Protocol, reducing high prescribing costs in over 50% of GP practices in the area, understanding and preventing the reasons for high care home admissions to hospitals, building effective and efficient escalation systems that people actually respond to, reducing frequent callers to the ambulance service, to name but a few things.

The key thing that my systems thinking taught me in the early days was that examining the thinking behind some of the faulty decision making in my complex world was essential to making a difference. To allow me to enable the multi-organisational relationships I firstly needed to understand the prevalent patterns of thinking in each stakeholder group so that I could facilitate a joint understanding. Critical Systems Heuristics helped me here, as well as Soft Systems Methodology. Again, welcoming them in with open arms I was able to encourage meaningful conversations and understand the different reference systems at play. Sources of motivation became visible, as did value systems and sources of legitimacy in appreciating the consequences of any changes.

Unbeknown to me at the time, the methods, concepts, tools and techniques that I was learning back then were forming a solid bedrock that I would use time and time again to examine and deal with complex, dynamic and diverse problematic situations. Common sense approaches sometimes just aren’t good enough for improving situations and creating better outcomes. But, a more highly sophisticated commissioning approach, incorporating systems thinking, has proven to me time and time again to be powerful, effective and believe it or not….quick!

After all, Mary Catherine Bateson once reminded us that systems approaches continue to serve as a continually creative endeavour, ‘It’s confusing, but we have a right to be confused. Perhaps even a need. The trick is to enjoy it: to savour complexity and resist the east answers; to let diversity flower into creativity.’ (M.C. Bateson, 2004)

The Power of Peer Support in Developing and Devolving Systems Practice


It is easy to confine systems thinking to the comfort of the academic forum where exciting concepts tantalise the mind and modelling constructs the solid foundations for thought. But, failing to link this to how people actually think, behave and work in the real world can be a recipe for disaster for systems practitioners. Separating academic concepts and models from behavioural insights, psychology, social neuroscience, but to name a few areas, can be a recipe for at best a failed attempt at applying systems thinking to your situation and at worst, a disaster in the form of a failed piece of work and alienating the very people you are trying to get on board.

So, what do we do if, and when, the transition from academic insight to real world application becomes overwhelming? Who do we turn to and from where do we get our support?

Well, my suggestion would be peer support. It isn’t the one and only thing we can do to get support as systems practitioners but it is immensely valuable. I, for one, certainly wouldn’t want to be a practitioner going it alone without the input from my valued friends and colleagues. Using, sharing and disseminating our practice in the real world in addition to understanding the concepts and modelling techniques in the academic world is vital, not only to our personal success but for the success and development of the discipline.

Our choices for peer support are wide and varied, from using an unstructured medium, such as social media, through to engaging in formal mentoring schemes. There is something out there for each and every one of us.

Personally, I find social media a solid platform from which to give and receive peer support. It minimises feelings of isolation, supports constructive challenge, enables us to share models, concepts and ideas and thus creates inclusion and mutual advancement. Strong relationships can emerge, increasing capacity for personal, relational and community change and growth. It goes one step further than argumentatively challenging the views of those we don’t agree with. It allows us to share our experiences and knowledge and provides mutually beneficial motivation when energy levels are low or challenges seem overwhelming. It is ongoing, accessible, and flexible. There’s no pressure – you can come and go as you please – and engaging across geographical, social and cultural boundaries becomes effortless.

There are many other ways to engage in peer support, of course, so if one way doesn’t suit you, don’t give up but try something else instead. Peer support helps us learn and grow. It helps us support one another and disseminate our thinking to others. It supports us in being successful, which, in turn, helps a whole host of other people also.  

Let’s help one another in the practical world. Let’s get systems thinking out there. The only way we can do this is to help and support one another. Don’t keep your practical success under wraps. Get it out there and share how you did it. Encourage newcomers, constructively challenge the experienced and most of all….enjoy it! Systems thinking and practice really doesn’t have to be dry and dull. It can be as exciting, creative and innovative as you want it to be. Share yours widely and most of all…..be proud of it!

 

 

Why I’m focussing on the writings of an ex FBI agent to develop my systems practice

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Everyone in the systems thinking arena must have heard it, “no-one wants to know!” “no-one’s interested in systems thinking” “I just can’t get my organisation on board!” Don’t you get tired of hearing it? I do. I do because in my experience, and from my observations, it isn’t the system thinking that people/ organisations don’t like – it’s the practitioner’s way of using it and their associated behaviours that they object to.

Do we routinely consider that in organisations where systems thinking might be beneficial, a number of people are in high stress situations – frightened of losing their jobs, their only source of income, the security for their families etc. Huge change programmes are upon us and I for one (amongst many, many others) have been going through them for most of my career. They are not ‘one offs’ any more, they are just how it is. But with those changes often comes restructuring of staff. Those who stand out, are often forced out. I’ve seen it happen time and time again.

So, why do we think that encouraging people in those organisations to be mavericks is a good idea? ‘Mavericks?’ I hear you say, ‘who said anything about mavericks?’ Well, covertly, we – the systems practitioners – did. We expect people to take on ‘different thinking’ to encourage an alternative perspective….and to be enthusiastic about it. Whilst different thinking and new perspectives are great (in my opinion) they make you stand out…..at a time when you might need that like a hole in the head! You challenge your boss, you are likely to be the next head on the chopping block. I hear many organisations cry out for different/ new thinking, but only if that different/ new thinking is totally in line with what they think.

There is something about being one of the crowd – safety in numbers – that often makes people want to keep their heads down in such situations. Do we need to focus on social inclusion, rather than encouraging different thinking that can potentially lead to social rejection, causing people the pain that comes with that which can often lead to them rejecting system thinking because it feels ‘too difficult’? Do practitioners need a different set of skills that allow them to help maintain people’s socially inclusive status whilst at the same time encouraging them to move toward systems thinking in a way that isn’t so powerfully maverick like?

Aren’t we neurologically wired to “fit in”? I think so. So, to ask people to stand apart from the crowd may be asking just a little bit too much. But, all is not lost – as long as we understand the situation we are in well enough.  If we don’t, we must be prepared to learn, with an open mind.

So, how have I started to think differently about systems practice to overcome the above and succeed as a practitioner? Well, it all started one lazy Sunday afternoon when I read a book called, ‘Mental toughness for women leaders’ by LaRae Quy, former FBI undercover and counterintelligence agent. I have to say that  this isn’t the kind of title I would usually pick up and read. I have no idea why I was drawn to it, but I’m very glad I was. Above all else it gave me a different perspective.

I learnt to consider the politics and protocols of a situation – what are the rules of the game? I learnt to consider situations I might come up against that might make me defensive (like an initial reaction to a VSM being that it is ‘far too complicated for us to use’) and I learnt to tailor my reactions accordingly – work out how I might react in advance and combat the defensive stance I might have previously taken. I learnt how to work to increase my requisite response to other people’s values and emotions (something I was shocked to find I was extremely poor at doing previously). I learnt to recognise where people might have a high level of emotional investment and take care in this area. I learnt to consider the reason for the emotional investment and contemplate whether or not it was valid. I learnt that I needed to understand what my own go to reflexes are in relation to negative reactions about systems thinking and that I needed to learn a new set of reflexes to deploy in the event of those negative reactions. Passion often means people care – what I really needed to do was get to the root of what they care about and try and maintain that throughout the change. I learnt how showing emotional empathy was important to gaining buy in and I learnt that people need some degree of emotional stability to make learning more effective. Was I really trying to build this kind of environment as I was going along before now?

What I learnt was how to take a genuine interest in people – starting with myself. ‘But we already do all that!’ I hear you cry……..really, do you? Is that why I very rarely see it happening in practice?

 

Simplify, support, share and sustain!

SmallLogoSystems thinking can be bewildering to someone who has not been steeped in its concepts and methods. It is very easy to forget what it was like when you first came across the concepts and they scared the living daylights out of you. It’s helpful to remember this when you are exposing new people to systems thinking. Use easy to understand examples, which clearly demonstrate what you are saying. Explain the words you are using to support people in developing an understanding. Then, follow that up with a real live example that they can relate to. e.g. show how you have used a method or concept in the workplace and what the outcome of using it was. Show how you might have thought about that situation without the method/ concept and then with the method/ concept; show the difference…..then do it again!