Integrated Care Systems: Finding inspiration in unexpected places.

Hello Systems Thinkers,

This post recounts an email discussion a few of us had about an article Chris Ham of the the Kings Fund published last month on the subject of “Integrated Care Systems”, an NHS evolution of the concept of “Accountable Care Organisations”.  I shared an anonymised version of the email string with a friend in the systems/complexity community, who has an interest in the topic and he suggested I post it as a blog, so here it is.

The article in question can be found here:

It’s a good article and our critique was not of the article or the author, but rather on the approach it describes and lessons we might learn from elsewhere.  As ever, the views expressed here are personal and not necessarily those of our employers, or any other organisations we’re involved with.

A conversation began

We were first made aware of the article when a group member shared it and said:

It’s getting hard to keep up with all the changes!”

Another group member quickly replied saying:

“It’s interesting that success in this setup, in the absence of aligned formal accountability, rests on organisations’ abilities to maintain a partnership approach. The level of maturity in the relationships between acute, community, commissioning, local authority etc will impact massively on Integrated Care System development.”

I agreed and jumped in with a reflection and comparison of a past experience working on the development of an altogether different type of mega-project:

Infections team spirit

“I completely agree.  I’m reminded of my experience on the Heathrow Terminal 5 (T5) construction project.  BAA moved heaven and earth to create an environment and contractual arrangements where trust between parties could flourish and as a result barriers to delivering evaporated.  I happened to meet a chap who is now senior position on the Hinckley C project a couple of months ago, who had also worked on T5. He described the T5 project has having a unique “infectious team spirit”.  And he was right. It was quite special and I still feel inspired by what was achieved by the project team; which included may different organisations

That didn’t come about by accident though.  There was enormous effort made to develop the supply chain to a place where that could occur, and then very specific and revolutionary approaches to contracting and pooling risk used.  A decade before construction even began, they realised they would need to take a new approach and set about creating an environment on other projects to start nurturing the new culture and approach and to develop the supply chain to a place where it could deliver T5.  Prior to that, there was no way the UK construction industry would have been able to deliver T5 on time and to budget.

A serious and deliberate approach

They really focussed on building the team.  It was all very deliberate.  I think a similarly deliberate and long term approach to developing the technical capability, environment and culture will also be needed to support the creation of sustainable “Integrated Care Systems”.  

The T5 approach wasn’t an Integrated Care System, but it was absolutely an Integrated project delivery system.  I think there are a lot of parallels.

Have a read of these articles.  They set out what an incredibly challenging project it was and the approaches to contracting BAA pioneered in order to deliver it.:

Back to Integrated Care Systems

Back to the article about Integrated Care Systems.  This paragraph stands out for me:

“Mutual accountability hinges on the existence of a high degree of trust and respect between organisations and their leaders. It also requires the establishment of governance arrangements that support collaboration while respecting the statutory responsibilities of these organisations. Integrated care systems have no basis in law and they depend on the willingness of the organisations involved to think and act as part of a wider system even when it may not be in their interests to do so.“

It describes perfectly what was achieved on T5.  Apart from the final sentence:

and they depend on the willingness of the organisations involved to think and act as part of a wider system even when it may not be in their interests to do so.“

I’m not sure how likely it is managers and organisations will act against their interests and without addressing this, they might struggle in the long term.  The reasons it might not be in an organisation’s interests to act as part of a wider enterprise are systemic.  Like they did on T5, the job at hand is to identify those systemic drivers of behaviour and address them. 

Chris Ham does identify this as a potential difficulty in the article where he says:

“……..workarounds are inherently unstable, even in the most favourable circumstances, and can only be sustained for so long.  Informal mechanisms such as memoranda of understanding and partnership boards to underpin decisions about the use of NHS resources have a part to play but may break down when difficult decisions arise. ” 

It’s not easy in public services

The point about the T5 project is that they deliberately created an environment, structure and contracts that meant all organisations were incentivised to pull together and do whatever it took to deliver the project.  That is why it worked. There was no fairy dust involved. 

It’s probably harder to do this in public services than it is in the private sector, where there is less political interference allowing for a longer term approach and accountability is more easily traced.  Accountability for the delivery of T5 lay firmly with the management of BAA and the company’s shareholders would hold them to account. 

But T5 is still a source of inspiration

Even so, we shouldn’t underestimate just how impressive an achievement it was for BAA to deliberately invest in and build up the capability of the UK construction industry to be able deliver a project as large and complex as T5.  It’s a great place to look for inspiration.”

Happy 10th Birthday!

And by happy coincidence, this month is actually the 10th anniversary of the opening of T5.

I will raise a glass to the project this weekend.  Join me.

Systems Thinkers Anonymous

Complexity Map 2018

Hello Systems Thinkers,

I picked up a tweet from Brian Castellani (@complexcase) this week.  He has issued an all new and updated map of the complexity and systems sciences. It’s very cool.  I linked to an earlier version of it in  a post a year or so ago, but it’s well worth another look.  Here it is:

complexity map castellani map of complexity science

No Description



Reworking the SSM Root Definition & Final Conceptual Models

Hello Systems Thinkers,

This is a fairly short post, just to wrap up on the SSM work.  We finished with it quite a while back and have been busy exploring a variety of systems ideas and concepts, and in particular, have been dipping our toe into cybernetics and the Viable System Model. It’s good stuff.

For the moment though, I just wanted to write a note to complete the work on our SSM models.  If you recall, the last post I wrote on SSM was a summary of the conceptual model building we’d been doing.  Here’s the post:

Building the models was very much a learning process.  We learned about building models, but also about the thing we were studying and thinking about, the canteen.  The process helped us to  reframe our thinking and understanding and we gained a number of insights into functions that would be required to run the canteen along the way.  This was helped, by us showing the work we had done to the canteen management team, who pointed out areas where our thinking was incomplete.  They also found the experience helpful and highlighted several areas to them they had not considered.

All new and improved Root Definition

Because our understanding of the situation changed, we decided to revisit our original Root Definition to see if was still appropriate.  It wasn’t , and so we modified it to reflect our new understanding.

First of all though, here is our previous Root Definition:

A facility and service owned and operated by the Local Authority through their employees, to provide an environment that supports relaxation and social interaction and provides nutritional food at lunchtimes that satisfies the need for affordable hot and cold food and drinks and facilities to heat and eat home prepared food, which recognises appropriate legal requirements within the existing canteen space within the building, in the belief that doing so will have a positive effect on wellbeing and motivation of the workers in the building and also enhance revenues coming to the Local Authority by making a profit from selling food and drink and also by making the building a more attractive place for prospective rent paying tenants to locate their operations.”

And here is our updated version:

“A facility and service owned and operated by the Local Authority through their employees, to provide an environment that supports relaxation and social interaction and provides nutritional food that satisfies the need for affordable hot and cold food and drinks during regular office hours and facilities to heat and eat home prepared food available 24/7, as well as providing opportunities for local charities to supply and showcase produce and providing training opportunities for people with learning difficulties which recognises appropriate legal requirements within the existing canteen space within the building, in the belief that doing so will have a positive effect on wellbeing and motivation of the workers in the building and also enhance revenues by making the building a more attractive place for prospective rent paying tenants to locate their operations, whilst the canteen facility’s direct revenue impact must be cost neutral.”

You can see we’ve added elements about the community focus of the canteen, using local charities as suppliers, and offering training and employment opportunities to people with learning difficulties, as well as defining the financial performance expectation it operates in.

Again, what stood out about SSM process is how iterative it is.  We came back to iterate the Root Definition, and in doing that, realised our Conceptual Models were not complete.  We hadn’t considered the need for the canteen to market its offering.  It was helpful that this process of iteration and development drew this out.

Our new and final models

So, we returned to our top level Conceptual Model and incorporated a “marketing” node.  Here is the revised top level model:

Revised top level Conceptual Model

You can see the new marketing node, number 6, in the middle of the model.  And here is the Conceptual Model for the marketing function:

Conceptual Model of Node 6 – Marketing


The end of the SSM road……..for now.

This brings our SSM story to a close for now. The next steps in the process would have been to compare the models to the reality to identify  gaps in the organisation and things that could be changed or improved. We did have some conversations with the canteen management about this and discussed areas for improvement with them, but given this was a case study and not a piece of work they commissioned from us, we were only able to go so far.

You can’t beat an occasional CATWOE

We certainly learned a lot on this journey and will be using SSM again.  Indeed, I have been using it frequently in my own work.  In particular, I find the CATWOE mnemonic very helpful when starting on a new project and trying to state what the purpose is.  That’s part of the beauty of SSM I think.  It is a 7 step process, but you can actually take most of those steps on their own and use them independently and get helpful results.  It’s like a bag of several tools you can pick and choose from, rather than a single approach. Although, of course, you can run all of the way through the process if the situation allows, and warrants it.

Team of Teams

Hello Systems Thinkers,

General Stan McChrystal – Team of Teams

A short post this time.  I just wanted to share a wonderful podcast we listed to as homework a few weeks ago, and then discussed.  It’s an interview with General Stan McChrystal, an American General who was in charge of their special forces.

The organisational and cultural transformation he undertook is amazing. It’s clear he is a natural systems thinker and is an inspiration to us all.

All of us in the group were seriously impressed by what General McCrystal did and the insights he provided us with.  Loads to try to learn and apply.

It’s all about awareness of context

The focus he put on helping everyone at all levels in the organisation understand the context they operate in was seriously impressive. The priority and investment he put into enabling everyone to understand the context, what’s going on and to connect with others who had something useful to share is a standout point.  Totally doing away with silos and treating knowledge as power that individuals keep hold of tightly for themselves.

I also love the way he gave autonomy to teams, but also made sure they were accountable.  There was nowhere to hide.  He went to great lengths to make sure people understood that so long as what they want/need to do to get the mission done is legal and ethical (i.e. they need to take responsibility) then they can do whatever they want, and should not give a bureaucratic process as an excuse for not taking action.  I loved that.

Sharing responsibility is to pass the buck

The subject, reminded me of an old John Kay article I’d read not long before on the subject of accountability. I shared it with the group.  Do have a read.  It’s not long:

Sharing responsibility is to pass the buck

I’m a big fan of John Kay’s writing, and for me, and in relation to my experience of the public sector, he is on the money.  Here is key paragraph:

“Appropriate accountability is not “why did you do that?”, still less “you should have told me before you did that”. And it is certainly not “it would be helpful if you did this instead of that”, the classic means of imposing a course of action without taking responsibility for it. Constructive accountability gives people freedom to make decisions but holds them fully responsible for the consequences. A traditional public sector ethos does just the opposite.”

I want to give thanks and credit to Mike Haber, who first pointed this podcast out to me.  Do check out his excellent systems thinking blog, here:

Enjoy the long weekend.


SSM Conceptual Modelling

SSM Conceptual Models

Dearest Systems Thinkers,

I can only apologise for the blog becoming quiet.  There have been a combination of reasons.  We’ve all become much busier at work these past months while our organisations go through a “turnaround” process, and our attendance at sessions has been a bit more sporadic.  I’ve personally become even busier out of work too and have become involved in a few more projects that have diverted me.  We’ve stuck with it though and have been plugging away at Soft Systems Methodology (SSM) and other things, but at a slower pace.

Return to the Root Definition

If you recall, the last time I posted on  SSM, we had defined our Root Definition and extracted the key “Transformations” from it, with the intention of then building our top level conceptual model from them.  I had some doubts about whether this was going to produce a coherent model.  I was right.  

A way to coherence

When we came to build a conceptual model with these Transformations, it didn’t fit together.  There were not obvious links or relationships between each of the bubbles/transformations.  It wasn’t coherent.  This was a powerful insight, as it made us realise SSM and conceptual modelling in particular provides a way to check our thinking is coherent. We decided to dive straight in a build a model without referring to the Root Definition.  Here, after a number of iterations is what we came up with.

Canteen top level conceptual model
Harder than expected

We found this pretty difficult to do.  Because this type of modelling and thinking about things was new to us, because it’s quite difficult, and we also found that our 1 hour lunchtime sessions weren’t really long enough for us to get our teeth into it and build momentum. It always take us a little while to warm up and it seemed that as soon as we managed to begin to make progress, it was time to pack up and end the session.

Take your time

We eventually overcame this by deciding to get together for an extended session of 4 hours one Saturday morning. It was great. The extra time enabled us to really get into model building, develop our own technique and make proper progress.  We got stuck into the work  and redrafted and agreed our top level model, and then also completed 2 sub-level models.  So, if you are doing this yourself then I’d recommend you set aside plenty of time and space for it.  Here is a picture of some of us at work.

Saturday morning eager beavers
Keep it flexible

I mentioned we developed our own technique for doing this.  That probably makes it sound grander than it is.  We found that as we built models, we changed our minds about what the nodes should be included, how they should be titled and how they related (connected) to one another.  That meant trying to do this with pen and paper as we tried at first ended up producing a mess of crossed out and redrawn stuff.

The method we found worked well, was to start out by brainstorming the nodes we thought might be appropriate by using a post-it note for each one and writing it’s name on it.  A not dissimilar process to the first step in the creation of an Affinity Diagram approach we tried out previously.   The target is to have between 5 and 9 (7 +/- 2) nodes per model, but we would create as many as we could and then start to try to put them together the model and discard those that didn’t belong and reword any that needed it in order to fit coherently. We would connect them with arrow shaped post-it notes and reorganise until we were happy with what we had.  At that point, we would commit pen to paper and set out the model. Here’s a picture of us doing this.

This is how we do it
Building momentum

During that Saturday morning session we completed the top level model and then 2 sub-level models.  We found that after that, we were able to build 1 sub-level model in a 1 hour lunchtime session.  Once we had figured out what we were doing, it was a lot of fun building these models.  There was always a lot of debate as we went and we gained a deeper and broader understanding of the “problem space” we were looking at.

The Models

So, here are our models. I’ve drawn them up in Insight Maker and shown each individually.  It would be nice to be able to embed each of the sub-level models into it’s owner node in the top level model and then have it display when you click on that top level node.  Does anyone know a free piece of software that will do that?

1. Find out what people want
2. Prepare items for sale
3. Provide Canteen Space
4. Food and drink purchased
5. Monitor sales and stock
Peeling the layers of an onion

We decided the next steps would be to then pick a few nodes in the sub-level models and create underlying models for them.  You can keep on going down layers and getting into finer and finer levels of detail.  The question is how far is it helpful to go, and that is a judgement call.

Returning to the Root (again)

We also want go back to the top level model and compare it to our root definition and see if the worked together and whether we needed to modify the root definition now we had learned more about the problem space the top level “system”.  And then of course complete the remaining SSM steps, which include comparing our idealised conceptual models against the reality of the canteen set-up and identified where changes might be made.

How to handle management???

Another thing we weren’t quite sure how to handle is the general management and then monitoring functions.  The various tasks and people involved in the canteen will need to be managed. It wasn’t clear to us how to integrate that task/function into a conceptual model.  It needs to sit in all of them at all levels one way or another, but that would also seem wrong.  We figured that perhaps the management and also the monitoring of performance is somehow an external function that wraps around the whole thing.  We’re not confident that is right though and this will need more research.

We’ll be back!

We’ve put that on hold for the moment though and have been following a few other paths.  I’ll try to write up more about that, when I can.  There have been some interesting developments with the canteen though and our work is not done there.  I promise to write more.

Enjoy your weekend!



InDevelopment – INCOSE UK Bristol Local Group Systems Thinking Problem Solving Group Learning Event

Review of the InDevelopment Event on 30th Jan 2017

On January 30th 2017, the International Council on Systems Engineering (INCOSE) Bristol Local Group (BLG) staged a new type of working group event called InDevelopment. It was originated and organised by me, and BLG regular Richard Bray, an independent Requirements Engineer.  This blog follows the journey from concept through to putting the event on, and discusses what worked well and what we will change for future events.

I wrote a shorter piece for the INCOSE e-Preview magazine, so if you have been directed here from there, welcome.  I will use much of that piece, but wanted to expand on it with more information about the evolution and concept of the workshop.  I’ve also included all of the materials we used, which you can download at various points within this post.  Anyone interested in staging a similar kind of event, as other INCOSE Local Groups might, can essentially use this as an instruction manual.

Multiple inspirations

InDevelopment came about through the combination  of two distinct ideas Richard and I had for new BLG events.  I had been inspired by attending Systems and Cybernetics in Organisations (SCiO) Development Days. The format is simple, it runs from 10:00 till 16:00 on a Sunday.  Typically, between 6 and 12 people turn up, each bringing a problem they’re working on and want input with, or a general topic of interest they want to use Systems Thinking to unpick.  At the start of the day, each person tells the others what their problem/topic is, and a schedule for when each will be discussed is drawn up.  Then one by one, the topics are discussed, and everyone uses Systems Thinking approaches, and in particular, the Viable System Model (VSM) and General Systems Theory to gain insights and to help to expand the understanding of the problem/situation.

I have found these Development Days to be brilliant.  Both for expanding my own knowledge and understanding of Systems Thinking, and also for developing connections and community.  I’ve learned so much, whether we’re working on a problem I#ve proposed, or on someone else’s.  The bringing together of the various perspectives and experiences of those present is quite powerful.  I wanted to try this out in an INCOSE environment.

Richard, had been inspired by two  recent BLG talks. The first, by Gary Smith of Airbus, on the subject of using the Systems Tree model he developed with Brigitte Daniel-Allegro, to better understand and approach the deadly medical condition, Sepsis. The other, by Kevan Boll of Atkins, on the work of Daniel Kahneman and in particular the idea of Thinking  Fast and Slow.  This involves two distinct and competing thought systems that come into play in decision making, he calls System 1 and System 2. Richard had gone away and read Kahneman’s work and wanted to see if we could put together a kind of Learning Group for interested INCOSE people that would meet regularly to learn and gain insights in application.

The development of InDevelopment

Paul Handisides, the BLG Chairman, saw an opportunity to combine these two different formats and brought Richard and I together.  After some discussion, and consultation with local members, it was agreed we would be best sticking with our regular weekday evening timing for events, rather than a weekend daytime.  It was also felt better to predetermine and, prepare the problems/topics to be worked on rather than having people turning up with them on the day.

In merging and accommodating our two ideas for an event, Richard and I identified four core outcomes we both wanted to achieve.  They were:

  • Collaborative problem-solving: Collectively investigate a potential framework for learning from experience using anonymous examples based on real-life challenges.
  • Shared learning: Create a learning experience for all present, not just those whose topics are being worked on.
  • Decision support: Increase awareness of how people make decisions and consider the related benefits of systems thinking.
  • Community Building:  To allow local group members to get to know one another better through a format that provides for more interaction than the normal presentation format.
    Adapted for our audience

We decided we would run the event over the course of 3 hours on a Monday evening.  We would loosely structure the format on the “World Cafe” method, and tackle 3 separate topics/problems in small groups and then include a wider feedback session at the end. Here are some notes Richard prepared in advance to help in briefing the committee and also the event facilitators.  I think I’ll just mention at this point how much I enjoyed working with Richard on this.  It was great to work with someone who independently shared a similar vision, but who was also highly thorough in his approach to the planning and staging of the event.

Download (PDF, 223KB)

Download (PDF, 231KB)

Looking for problems

In early December, we emailed a request to the local membership for three topics to be used at the event.  Submissions were reviewed, and three chosen and then further prepared to maintain commercial discretion.  Each offered a different type of organisational problem, and they were generic enough for most people to be able to relate to.  You can download the short briefing descriptions of each of the topics/problems below.

  • Integrating MBSE into a mature organisation – process vs pragmatism

Download (PDF, 282KB)

  • Removing bottlenecks in ‘brownfield’ infrastructure

Download (PDF, 343KB)

  • Transforming mission-critical health services

Download (PDF, 366KB)

Setting the scene

On the evening, we began with Richard giving a short presentation, setting out the systems methods we were employing, the “problems” we would be working on, and the format of the discussion groups.

Here is a copy of the slides:

Download (PDF, 1.95MB)

Everyone was also given a selection of handouts relating the the systems approaches we were referring to.  You can view and download them at the bottom of this post.

The fun begins

The 15 of us participating then drew 3 pieces of  numbered paper from a bag to determine which of the 3 groups we would be in for each of the 3 rounds.  The group members were switched around between each round depending on the number they’d drawn, in order to keep everyone on their toes and the energy levels high.  A trio of flipcharts were placed in the centre of the room with their backs to each other, then each of the groups stood with their nominated chart and began exploring the problem.  Keeping everyone on their feet and keeping each of the 3 topics tightly time bounded resulted in a real sense of energy in the groups.  A facilitator in each group wrote ideas up on their board as they emerged.

After 25 minutes of work, the groups reformed into their new configuration to work on the next “problem” and then after another 25 minutes the groups changed again, and the final problem was tackled.  Momentum was maintained through all of the discussions and the facilitators didn’t need to encourage people to come up with ideas, insights and perspectives.  We’ve typed up the notes and you can download view and download them at the end of this post.

Once the 3 cycles of problem exploration/solving had taken place, the flipcharts were put aside and the 3 groups recombined and a feedback discussion took place.  Each of the 3 topics were discussed and specific learning points and insights put forward. This was a rich discussion and each of the people who had proposed a “problem” were impressed with the insights gathered and that they were able to take away.

Reflecting together

As well as discussing the specific problems, we reflected on how our own thought processes had been working during the sessions.  We realised that deciding (too) quickly pushed us into what Kahneman calls System 1 thinking.  A more emotionally driven, less rational and considered thought process.  It was fascinating to reflect and see this had been at play. Most of our thinking though had been in the more rational System 2 mode and this enabled us to generate lots of useful insights.

Having said that, one interesting insight that was mirrored across the groups, was that when we discussed the NHS “problem” (Topic C), we seemed to have a job shifting out of the “faster” thinking “System 1”.  We thought this might be because of our familiarity with the health service and that we all bring our own emotional experiences in relation to it into the discussion. Here is where I as a facilitator might have stepped back and asked better questions to guide the thinking and conversation.  I think the “problem” itself was also more complex and and less well bounded and needed more detail to be filled in, and this probably meant the time frame was a little tight to really get into doing System 2 thinking and gaining the types of insights we had on Topics A & B.

Possible changes to the format

Indeed, one of the comments that came out of our subsequent committee meetings was that we might be better off focussing our time on just 1 rather than 3 topics, and giving more space for it. This would certainly give greater opportunity for gaining deeper insight.  The flip side though, is some of the energy of the evening and the approach might be lost.  We’ll debate this and think about it before staging the next InDevelopment.

Some notes I took during the final group feedback session are at the end of this post.

Positive feedback (I didn’t get any negative)

The feedback from those who attended was very positive.  Here are are some comments:

“It was tremendously worthwhile.  I instantly gained powerful insights into ‘systems thinking in action’ across a diverse set of practitioners as the workshop played out and returned to the office the next day with useful material for the whole team!”   

“Really interesting to experience how other people think whilst trying to do it yourself.”

“Exploring Systems Thinking in practice at InDevelopment’s INCOSE BLG session encouraged me to think about the NHS in a different way.  The analysis of MBSE was interesting – to unpick the obvious expertise of the participants from the facilitated discussion about how to apply the techniques” 

The BLG committee have taken on board the feedback, along with their own views and the intention is to make a few adjustments to the format and then make InDevelopment a regular, recurring fixture of the BLG calendar.

My own reflections

My own reflection, is that as a group facilitator, it would have worked better if I’d had a firmer grip on the the various models and approaches we were referencing.  I’d have been able to ask better questions, tried to make sure we stayed in “System 2” thinking, and drawn in more from the models we were referring to.

I think for future events we might need to either reduce the number of approaches, perhaps focussing on a single one (the Systems Tree for example) at an event, and then using a different each time we run it.  Another way to improve this, might be to pull together a small sub-group to form a Learning Group to get to grips with the material, and then this group forms the core facilitators for InDevelopment events. There was an appetite to do this, but there’s just not been the time to make it happen this past couple of months.  Then again, I think this wasn’t a big issue, and I’m sure we facilitators will naturally improve as we run these events again.

Any other Local Groups interested in staging this kind of event should get in touch with the Bristol Local Group, or directly with me here, and we will be happy to assist and guide.  An advantage of InDevelopment is it can be run solely by local Local Group members and doesn’t require a specific speaker, thereby increasing the number of events a group is able to run over the course of a year.

So, if you’d like to know more about the event, and/or would like to have a go at running one yourself, do just get in touch.


Supporting handouts:

Download (PDF, 189KB)

Download (PDF, 456KB)

Download (PDF, 1.34MB)

Download (PDF, 340KB)

Topic A – Integrating MBSE into a mature organisation – process vs pragmatism flipchart transcriptions:

Download (PDF, 222KB)

Download (PDF, 45KB)

Download (PDF, 223KB)

Topic B – Removing bottlenecks in ‘brownfield’ infrastructure flipchart transcriptions:

Download (PDF, 38KB)

Download (PDF, 221KB)

Download (PDF, 194KB)

Transforming mission-critical health services flipchart transcriptions:

Download (PDF, 33KB)

Download (PDF, 210KB)

Download (PDF, 194KB)

Final Group Session Notes:

Download (PDF, 49KB)


Embracing Complexity: Jean Boulton INCOSE Talk on 24th April 2017

A quick post to let you know about an upcoming talk being put on by the Bristol branch of INCOSE on Monday the 24th April.

The speaker, Jean Boulton, is a good friend of Systems Thinkers Anonymous and kindly came to speak to us last summer.  Here’s a reminder of the session:

I think Jean is great.  She will be talking about her her book, “Embracing Complexity” and experiences as a manager, consultant and academic in relation to Complexity Theory and what it means for managing organisations.

This is one I don’t think you should miss.

The evening will start at 18:30 for a 19:00 start.

Presentation Details:

Meeting Title:     Embracing Complexity: Adaptive management in a volatile and complex world

Presenter Names:    Jean Boulton

Date:            24 April 2017

Time:           18:30 for a 19:00 start – 21:00

Venue:            Atkins, 500 Park Avenue, Aztec West, Bristol, BS32 4RZ

Cost:            Free – Non-members welcome

You can book here:


Beginning to move from SSM Root Definitions, to Transformations, to Conceptual Models

Hello Systems Thinkers,

Today we are talking about Transformations and Teddy Bears.  Honestly, it’s not as camp as it sounds.

Teddy Bears

Last week we had a slightly eclectic session.  We spent some time beginning to think about the further Transformations we could identify that would be required to deliver on our Root Definition, but if I’m honest, we didn’t spend a lot of time doing that.  I had just finished reading an excellent book about ambiguity and wicked problems and how to manage them, so told the group a bit about it, and some of the things I’d found most interesting in it and and we discussed how they might be applied in our environment.  The guys who wrote the book use the concept of Teddy Bears and how we all metaphorically have them in the management methods we’re attached to.  They bring us comfort when we are faced with ambiguity.  They’re not always that helpful though, and so we need to learn how to let them go and embrace and even use ambiguity to our advantage. Here’s the book:

I hope to write more about it, as it’s an excellent book and has a lot to offer us.

Then we took our Root Definition….

In the meantime though, I had better recount what we got up to in yesterday’s session.  We managed to stay focussed on task and started to decompose our Root Definition into the Transformations we felt we’d need to make happen to fulfil it.  We did that quite simply by reading thougth and then pulling out phrases that sounded like they could be Transformations.  To remind you, here’s the Root Definition:

A facility and service owned and operated by the Local Authority through their employees, to provide an environment that supports relaxation and social interaction and provides nutritional food at lunchtimes that satisfies the need for affordable hot and cold food and drinks and facilities to heat and eat home prepared food, which recognises appropriate legal requirements within the existing canteen space within the building, in the belief that doing so will have a positive effect on wellbeing and motivation of the workers in the building and also enhance revenues coming to the Local Authority by making a profit from selling food and drink and also by making the building a more attractive place for prospective rent paying tenants to locate their operations.

….and derived key Transformations

We extracted the following as things we thought might be required Transformations:

  • provide an environment
    • supports relaxation
    • social interaction
  • provides hot and cold food & drinks
  • provides facilities to heat and eat home prepared food
  • recognises appropriate legal requirements
  • Increase revenues
  • Increase appeal of offices

After a bit of thought and discussion, we whittled this down to the following four Transformations:

Input Transformation Output
No food and drink for sale Make food and drink available for sale Food and drink for is sale
Uninviting space Create and maintain appealing space for dining, socialising and relaxing Inviting canteen space
Cold home prepared meals Heating facility for home prepared meals Hot home prepared meals
Canteen not operational Management function Canteen operational
No profit being generated from space Running a profitable canteen service Profit being generated from canteen space
Who needs to know grammar?  Systems Thinkers do!

We decided these may need some more work and revising, but that they were good enough to get us onto the next stage; that being creating conceptual models.  We checked back with the SSM process and decided to pick one of
Transformations and identify between 5 and 9 (7 plus or minus 2) activities we’d need to undertake to deliver the Transformation.  The SSM guidance we were referring to, reminded us that we should use “imperative verbs” when describing these activities.  This caused us to have to look up exactly what an imperative verb is.  Here’s a link:

It’s basically a type of command.  Words like, Give, Clean, Do, Take.  This reminds me of when we learned about “Functional Requirements” when we studied the Holistic Requirements Model.  Functional Requirements need to be “Verb Nouns”.  So I think this is an area of commonality between the two approaches.  They are focussed on system function.  

This sparked some conversation and reflection of the usefulness of thinking in terms of functions in enabling innovation to take place.  By focussing on the underlying required function, you enable yourself to consider a whole array of different ways of delivering it.

Activities for our Conceptual Model

So, back to our task.  We chose to start with the “Make food and drink available for sale” Transformation.  We felt the following activities we’re essential to make it happen:

  • Obtain Food and Drink (might be ingredients, or it might be ready prepared meals.  We’re staying solution agnostic at this point)
  • Store food and drink
  • Prepare food and drink for sale and consumption
  • Display food and drink for sale
  • Take payment
  • Provide eating equipment (aka cutlery and crockery)
  • Clean stuff up

We ran out of time at this point, but agreed we’d try to turn these activities into a bubble and connector type conceptual model at the next session.

Second thoughts

Since then, I’ve been reflecting a little and wonder if we should have actually done this with our top level Root Definition. I mean, we probably should have built a conceptual model with the Transformations we identified there first, to make sure the sit together coherently and we’ve not missed anything. I think it would have been sensible to d that before jumping down into a sub-system and trying to define that.  We’ll jump back up a level next time and run through those steps.  This certainly is an iterative process.

OK, until next time, have a great weekend and take care,


Tightening up our SSM Root Definition

Hello Systems Thinkers,

Before jumping into SSM Root Definitions and what we’ve been doing with ours in the group this past two weeks I thought I say something about our new friends, the Seven Samurai.

The Seven Samurai ride into action…..

After our fantastic session with Warren Quinn, we’ve been putting what he told us into action.  Outside of the group, a few of us have been using the Seven Samurai model he introduced us to in projects we’re working on.  It’s really helpful.  A great way to put some perspective and structure into our thinking about a problem situation and distinguishing between the problem, its context, the intervention and the systems required to deliver the intervention and then sustain it. And then, any unintended problems the solution might create.  It’s great.  Very simple, yet very powerful.  To jog your memory, as well as the diagram at the top of teh page, here are the slides i found online.  It’s well worth browsing through them.


Since the write up of Warren’s session we’ve had two STA regular sessions. Both continuing with work on the canteen Root Definition.  By some twist of fate, only half the group could make it last week, and then only half this week.  The funny thing being that completely different people made it each week, so we had fun this week picking up and carrying on with what the others had done the previous week.

Back to our Root Definition

To remind you, here is the Root Definition (RD) we came up with previously:

“A system owned by the Local Authority and operated by their employees, to provide an environment that supports relaxation and social interaction and provides nutritional food at lunchtimes that satisfies the need for affordable hot and cold food and drinks and facilities to heat and eat home prepared food, which recognises appropriate legal requirements within the existing canteen space within the building.”

At this point, I ought to highlight that we are doing this without consulting the Local Authority, so the views are purely our own.  If we were consultants doing this for real, it would be absolutely essential to spend a good deal of time getting to the bottom of the Worldviews of the stakeholders, but the reality in this situation is it’s not practical and so we are making it up.  So, our assertions, are simply that, our best guesses.

What happened last week?

Here are some notes Lee kindly made after the session last week (I wasn’t there):

Re. the root definition, we discussed reflecting the Local Authority worldview – coming from the angle that we’re placing ourselves in their shoes as the owner of the building.  

“With a view to…”

  • Maintain a productive workforce
  • Tick a required box as an building operator to offer this type of service, but do it at minimum cost
  • Working within a set budget and ideally generating additional income for the Council
  • Maintain Castlewood offices as an attractive office space for leasing tenants.

We talked about needing to ideally identify the most important one of those, and we felt that “Maintain Castlewood offices as an attractive office space for leasing tenants” is ultimately the main driver behind the local Authority’s decision to use that space as a canteen (obviously ignoring the meals on wheels).”

They continued on to begin to discuss the key Transformations required to fulfill the purpose, but for now, let’s stick with the RD.

Warren’s tip – “ the belief that…”

One really nice tip Warren gave us when he came is to us the expression “….in the belief that” before stating the worldview in the Root Definition (RD).  If you look back at theoriginal RD you’ll see we didn’t really explicitly state the W from which it’s proposed.  Warren’s tip is a good one and we found it helpful.

Thinking about Worldviews

This week looked at the potential Ws the group proposed last week.  Here they are, along with our thoughts:

  • Maintain a productive workforce

We agreed this may well be a strong motivating factor behind the Local Authority, the building owner, landlord and principal employer of staff in the building providing the staff canteen.  We didn’t feel there was much more we could add.

  • Tick a required box as an building operator to offer this type of service, but do it at minimum cost

We were less sure about this one.  As far as we know, there is no legal obligation to provide a canteen, and given the other motivations above and below, we didn’t think this one had much leverage.

  • Working within a set budget and ideally generating additional income for the LocaL Authority

We liked this.  It’s certainly imaginable the landlord see the canteen as a way f bringing in additional income.  I suspect the reality of the situation is it doesn’t make them a lot of money, but we don’t know and it’s not unreasonable to think it turns a profit..

  • Maintain Castlewood offices as an attractive office space for leasing tenants.

This is an interesting one.  Again, it’s actually the same motivation as above, one focussed on bringing in revenue.  However, it’s approach is to do so obliquely.  I like it, and again, you can imagine that the landlord maintain the canteen as they think it will be attractive to the public sector organisations they seek as tenants

Time to combine……

So, how do we incorporate this into our RD.  How about adding this statement at the end:

.”… the belief that providing the facility will have a positive effect on wellbeing and motivation of the workers in the building and also enhance revenues coming to the Local Authority by making a profit from selling food and drink and also by making the building a more attractive place for prospective rent paying tenants to locate their operations.”

Well, that’s a bit of a mouthful, but I think it’s helpful.  When we come to start building our RDs for the “subsystems”, and then our conceptual models, this will lead us to need to include functions relating to things like monitoring of competition, pricing mechanisms, etc.  We might have implicitly assumed we had to do these things, and in a simple everyday example like a canteen it’s not a problem, but when we get into more complex services, where there is greater ambiguity of the purpose, being comprehensive and explicit in this way can only help.

…and then integrate

And now to integrate that into the RD, which I’ve also tweaked a little.  Now hold your breath, here we go:

A facility and service owned and operated by the Local Authority through their employees, to provide an environment that supports relaxation and social interaction and provides nutritional food at lunchtimes that satisfies the need for affordable hot and cold food and drinks and facilities to heat and eat home prepared food, which recognises appropriate legal requirements within the existing canteen space within the building, in the belief that doing so will have a positive effect on wellbeing and motivation of the workers in the building and also enhance revenues coming to the Local Authority by making a profit from selling food and drink and also by making the building a more attractive place for prospective rent paying tenants to locate their operations.

Yes, I think that’s enough for now.  I’m sure you need to recover too, after reading that.

Any views???

I’d be very interested to hear from any seasoned SSM practitioners out there what they think of this.  Have we got it about right?  Could we have improved it in any way? Have we missed something?

In the remainder of the session we carried on with defining some Transformations.  We’ve more to do on that though, and I’m tired, so I think I’ll leave writing that up until we’ve done more work on it next week.

Enjoy your weekend,


Warren Quinn and the Seven Samurai

Hello Systems Thinkers,

Just a very quick note today. We had a brilliant session yesterday.  Warren Quinn, a Systems Engineer who has deep experience in the structuring of complex sociotechnical problems using Systems Thinking approaches.

Warren is a great guy.  You won’t meet someone with a bigger passion for systems approaches and a better ability to explain how to get the best out of them.  I loved listening to him taking us through a project where he used several techniques to make improvements to a real life situation using SSM and other approaches.  

Everyone enjoyed it and Warren was given a warm round of applause when he finished.  There was a real energy in the room.  I appreciated Warren showing the group that SSM is a powerful approach for real life problems and works to great effect outside of the classroom environment.  Everyone came away keen to get on with honing and using their knowledge.

You can’t “solve” a Wicked Problem

For now, I just want to pick out two points that really stood out from the session for me.  The first is Warren’s assertion that it’s not really possible to “solve” the the messy, wicked type problems we’re dealing with. Rather, we should think more in terms of trying to improve the situation.  This isn’t really new to us, as one of the criteria for classify a problem as being wicked is that “potential solutions are not right or wrong, but in fact just better or worse, and that depending on who you are and your relationship to the situation”.

It was really helpful to have Warren point that out though. We often lapse into talking about “solutions”, but it’s important to remember we can’t really solve these problems.  For example, Simon Stevens’ Five Year Forward View and the Sustainability and Transformation Plans the NHS is working on aren’t going to “solve” the the situation/problem perse. They will hopefully improve the situation though.  Indeed, we hope they will improve the situation a lot.  But that will depend on who you are and your perspective or relationship to the situation.  Indeed, it’s likely the interventions and changes made will lead to unforeseen consequences of some sort and new problems.  We will constantly be working to improve the situation.  The challenge is to focus of systemic, rather than reactive and reductive interventions.

But the Seven Samurai can be helpful

This brings us to the second thing I want mention.  The “Seven Samurai of Systems Engineering”.  It’s model Warren introduced us to that he uses at the beginning of his exploration of a situation.  It’s a way of beginning to structure a problem.  I think it’s absolutely brilliant and have already had a go at using it in my own work.  Here is the model:

The Seven Samurai of Systems Engineering

And here’s the set of slides I’ve taken that image from.  I just found them online, but think they’re very good.


I like that in one 7 part model, they have managed to encapsulate a way of structuring the principal things you need to think of when considering an intervention, including problems resulting from the intervention.  In that sense, it’s an iterative, or even recursive model.  I’ve a feeling we’ll be using it a lot!

Next week we’ll get back to SSM and developing our Root Definitions.  Warren gave us a nice piece of advice for how to integrate the Worldview into a Root Definition, so we’ll give that a go.

Until then, have a great weekend and week.