Thread by @BenAllenGP

One reason our NHS is failing?

We try to manage complex problems as if they are simple (top down targets & outcomes)
🌟We need approaches that enable our systems to actually produce results🌟

A 🧵of the solutions in this SUPERB talk @tobyjlowe ⬇️ 1/11

We are complex
Our problems are complex
The organisations impacting on our problems are complex

🌟PRETENDING it's simple so it feels easier to manage DOESN'T work🌟

Outcomes are a result of MANY factors. So if we commission/strategise to produce outcomes, we achieve gaming 2/11

Instead of purchasing services that produce outcomes, we must nurture the systems from which outcomes emerge.

'Outcomes are not delivered by organisations.
Outcomes are emergent properties of complex systems.'

Scrap process specs, output & outcome targets. And do what? ⬇️
3/11

1) We can't predict the impact of our long term strategies/ actions within complex systems.

Therefore we need to:
Act & observe the effect
Rapid feedback loops
Be open to failure as a positive aspect of learning.
4/11

2) We need to allow our colleagues on the front line to have the trust to make decisions about HOW need is met. 5/11

3) Because outcomes are produced by systems, we need to nurture the health of our systems:
Build relationships & connections between partners
Enable leadership at all levels
Have shared goals & purpose to rally around (data used to observe reality, not targets to manipulate) 6/11

How would we expect to happen in a system that serves people with complex needs well?
What does a healthy system look like? 7/11⬇️

Findings from 'Whole new world' report
How do we commission/ plan in light of complexity?
We need to think differently about 3 things.
1) Motivation is intrinsic (people want to make a difference) not extrinsic (someone else's targets demotivates)
philanthropy-impact.org/expert-opinion…
8/11

2) Great outcomes happen when colleagues are enabled to improve their work through learning.
Positive error culture
Peer based reflection
Measurement (to LEARN & IMPROVE not accountability) 9/11

Instead of purchasing services that produce outcomes
We nurture the systems from which good outcomes emerge
-Invest in networks, enabling collaboration
-Nurturing the trust that enables people to be honest about what is really happening 10/11

For NHS management give up the (illusion of) control, we need to fund organisations that we trust (or be one that can be trusted!) to do the right thing.
⬇️ 11/11

This thread may on complexity may resonate with you? ⬆️ @MinalBakhai @annanursesheff @AimeeRobson4 @ArtfulDoctor @Dr_Ayan @DrSteveTaylor @DrSelvarajah @eleanor_rutter @HelenBevan @fhussain73 @NikkiKF @joannabircherQI @BenXGowland @sheinazs @JennieJoyce6 @mattcope16 @polak_jasper