How the system design drives our outlook, work, and behaviour

An Integrated Health and Social Care systemic design complex prototype

Deming’s famous quote “A bad system will beat a good person every time.”

We know that change in complex services, really does not work when we use the traditional change methods that are more suited to transactional services.
This is a short direct and personal account of a front line persons realisation and shift in mindset, that can occur when looking at her service and role from a systemic perspective. We were using a systemic design methodology to undersand and redesign Health and Social Care.
This shift is a key to designing citizen centred services, and enabling staff to focus on value, rather than activity.

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My regular job is as an Occupational Psychologist, leading a team of OT’s. However, for 12 months I was seconded onto a new prototype team, working with John Mortimer, using a new way of looking at doing my job.

This is what I was experienced when I was working as part of the community health prototype team. We had been working for some weeks, taking citizens who were asking for some kind of support, and we responded by first Understanding their whole situation, and then working with them as to what their problems are, and then helping with solutions:

‘At the start of engaging with a resident, we make assessments. First, someone else makes an assessment on the phone. Then weeks later, by the time I get the referral, I need to make another assessment. Typically thereare 89 pages of forms and assessments to complete.’

I worked with this team to help them carry out an exercise to map out the end-to- end flow of work that it took to deal with a particular person who needed some help. It was a really, really long flow, with 95 steps. And out of that long flow, only five steps were actually ones that provided the value to the citizen!

Then we decided to put those assessments aside, and create their own approach to working with people who had asked for help. And that was the difficult bit — we had to go back to basics and start by focusing on the real needs of the person. Yes, a bit like an assessment, but this time we decided to do something different, we listened. We asked them about whether they had relatives, what made them happy, what mattered to them, and so on.

After some weeks, and when we had done this new way of working to about 15 people. As a team together we then spent some time gathering evidence of what we had done and the impact it had. We asked ourselves the question;

what are the main causes of the issues that citizens face, that cause the problems that we help them with?

In answering this, and going to the deeper causes, despite all the differnt medical and other problems they had, there was one particular theme that kept coming out; and that was that so many people we visited just had no ambition, no interests, no reason for looking forward in their life. All they saw was that their health was getting worse. When we engaged with them, our new way of working was to help them reconnect with a sense of purpose in their lives, and reconnect them with those things that made then get up in the morning. Once we did this, the more obvious medical and life issues that they had come to us about, began to find easier ways to be resolved in ways that were often new to us.

Then one day:

‘I had just finished writing up the difference that we made to Len, one of the people that we had helped. The core role that I played in this was simply to help Len to get over the death of his wife, look forward to things he likes to do, and take charge of his life.

‘As I wrote that up on the board, John asked where in the health system can people go to get this help? Perhaps it does not exist? I suddenly realised that I knew how to do this; I was trained to do this when I was studying to become an Occupational Therapist. I stopped, and thought, after I joined the health service, I never did that anymore. I had forgotten about that … What had become of the hopes I had to make a difference?

I was lost in thought, and it dawned on me how the system that I work in has truly affcted and changed me…

‘While it was still fresh in my mind, I wrote this down:

Now that I have seen this, my working life is never going to be the same again…

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John Mortimer runs a workshop to help understand this type of change and design work

https://www.improconsult.co.uk/service-design-workshop-systemic.html