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:
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.
We’ve charged head first into learning various tools and methods, but haven’t had much discussion about what Systems Thinking is and where the approaches we’re learning sit within the wider discipline. We’re now on the verge of heading into learning about Soft Systems Methodology (SSM) and I thought it worth us taking an opportunity to catch our breath and talk about Systems Thinking more generally.
You’d think it’s all about System Dynamics
When you google “Systems Thinking”, the overwhelming majority of the top listings relate to the approach of System Dynamics and its proponents such as Peter Senge, Donella Meadows, the Waters Foundation and others. System Dynamics is a valuable approach and is especially good for understanding relationships, causal effects and feedback loops between system elements.
Another approach sitting high on the google rankings is John Seddon’s “Vanguard Systems Thinking”. This is a kind of overhauled version of “Lean” specifically for service provision and has gained a lot of traction in the Public Sector here in the UK. There is debate about whether it is genuinely a form of Systems Thinking or not. Personally, I don’t intend to add to that debate, so will leave it there. It is a good and useful approach in the right context, and the core concept of “failure demand” is particularly insightful. Why not look it up. Whether they are genuinely Systems Thinking approaches or not, these approaches have valuable uses and much can be gained from employing them.
But there’s a problem.
Whilst they may dominate, these approaches only account for a very small part of what’s on offer in the world of Systems Thinking. The problem comes when you tell people you’re into Systems Thinking, as they tend to think this is what you mean. Well, it’s largely not what we mean. Not to say there’s anything deficient about these approaches, it’s just that given our particular context, I don’t think they are the most useful for us right now.
I hope we are going to be relatively agnostic in our approach and embrace the diversity of what is out there and become “mixed methods” practitioners. There’s such a wealth of amazing stuff out there, with each approach having its strengths and weaknesses for any given context. Here is an amazing map showing some of the incredible diversity and range of theories and approaches available to us:
System Dynamics, is from the “hard” school of approaches and is the dominant approach on the other side of the Atlantic. Here in the UK, we use “hard” approaches extensively, where they are the more appropriate, but there has also been significant development in “soft” approaches. The term “soft system” is one coined by Peter Checkland when he created Soft Systems Methodology (SSM), but it has been extended to encompass the range of approaches created to help understand and intervene in complex situations involving humans, or “Human Activity Systems”, where “purposeful Activity” is being undertaken.
Are systems real?
One way “soft” approaches differ from their “hard” relatives is they don’t view systems as things that have their own objective existence. In this view, systems are not real things. The operative word in Soft Systems Thinking is “thinking”. It’s about using the various conceptual qualities of systems, such as boundary, purpose, structure and interrelationships to better understand messy real life situations. There is a difference between thinking about systems and thinking in terms of systems. Here is a quote from the Systems Engineering Book of Knowledge (SEBoK) describing this:
“The identification of a system and its boundary is ultimately the choice of the observer. This may be through observation and classification of sets of elements as systems, through an abstract conceptualisation of one or more possible boundaries and relationships in a given situation, or a mixture of both concrete and conceptual thinking. This underlines the fact that any particular identification of a system is a human construct used to help make better sense of a set of things and to share that understanding with others if needed.” http://sebokwiki.org/wiki/What_is_a_System%3F
The System of Systems Methodologies
I am proposing we learn about SSM next. I think it an appropriate method to support us in commissioning health services. To give some perspective of where it sits in relation to other approaches, here is a very nice table called the System of Systems Methodologies (SoSM) created by Robert L. Flood and Michael C. Jackson. It’s described and explored in their excellent book, Creative Problem Solving: Total Systems Intervention (I just checked and there are some second hand versions of this available for just £0.01 plus postage. Why not treat yourself). It also gives a good description of what Systems Thinking is and is not, as well as describing a variety of approaches and in what contexts it is most appropriate to use each. I must admit I’ve copied this version of the table (to save me re-drafting it) from this rather good blog post about Critical Systems Thinking, another approach: http://wulrich.com/bimonthly_november2012.html
For now, we’re in the Pluralist/Complex Zone
As commissioners, when we come to design new services, or intervene in existing ones, I think we’re very much in the pluralist/complex zone. Pluralist, because not all parties involved are directly under our control and will have different views, interests and motivations. It is likely those interests are compatible though and an accommodation can be found, so ours in not a “coercive” environment. It’s “Complex”, because as we’ve discussed previously, the problems we face in commissioning and intervening in services are “Wicked” in nature.
Having said that, if we find ourselves redesigning parts of our own or other organisations, we will likely shift to the left, a “Unitary” environment. In that case, we would find a Cybernetic approach like the Viable Systems Model useful. And if we find ourselves doing Lean, or Quality Improvement work within a single organisation we would drop into a less complex, simple/unitary environment and find an approach like System Dynamics useful.
The value is in matching approaches to contexts, not in the approaches themselves
To finish, I just want to make it clear that this System of Systems Methodologies is in no way a hierarchy. I’ve observed some practitioners who tend to specialise in one approach, come to view their favoured approach as the “right” or “best” way to do Systems Thinking. I’ve also observed a kind of perception that there is more kudos and prestige in being involved in problems and approaches that are sited in the “Complex” domain. I suppose it’s not helped by terminology such as “Simple”. Perhaps we imagine that the less capable people deal with the “simple” problems, whilst we more impressive folk deal with the “complex” problems. I think this is an unhelpful and wrong view. As the SoSM shows, it’s about horses for courses, and selecting the most appropriate method for the problem you’re facing. In our working lives, we’re likely to face organisational problems in all six of the zones. Let’s just hope there aren’t too many in the Complex/Coercive space.
I’ve said we’re going to look at SSM next. It seems to be the most appropriate approach for us, given our context, but I don’t want us to become attached to it, or personally identify ourselves with it. I want us to be open to all approaches and to even get to the point where we are able to mix them. We have to start somewhere though, and the best place for us to do that, seems to me to be with SSM. Let’s see where it takes us.
A couple of weeks ago, we were very fortunate to have Jean Boulton come to talk to us at Systems Thinkers Anonymous. These are some rather belated reflections on what was an excellent session. It was a real thrill and a pleasure to have Jean come. A real coup. For anyone who doesn’t know who Jean is, have a look at this previous post. In person, she is as charming as she is formidably bright and enthusiastic about her subject. Happily for us, that subject is directly relevant to our work.
I’d read Jean’s book “Embracing Complexity” earlier in the year and had heard her talk at the SCiO Winter Open Meeting, so was reasonably familiar with her approach and views on how complexity theory can help us better manage our organisations. It’s a different kind of approach to the prevailing school of thought in management and for me, it feels very right.
An alternative to Reductionism and Determinism
We had about an hour and a half with Jean in total. She began by giving us a 15 minute whirlwind tour of complexity theory and the differing view it takes from linear scientific approaches, such as those influenced by Newtonian Science, before having an informal discussion. Not that Jean says there’s anything wrong with linear approaches, there’s a time and a place for everything. Holding that linear cause and effect view of all actions having equal and opposite reactions can lead us into trouble when we face complex problems in open systems though, and those are the types of problems we’re faced with in organisations everyday. In complex environments, what emerges when you take action is unpredictable and nonlinear. This is the world of Volatility, Uncertainty, Complexity and Ambiguity (VUCA). Our world.
To set the scene, I’ll recount the essential points of Complexity Theory as an alternative to the prevailing reductionist and deterministic approaches, before then giving my own reflections on what I’ve personally taken from it. Jean began by differentiating between two differing scientific viewpoints that have converged to dominate the management of our organisations, markets and societies. Those being the Newtonian, mechanical view where everything moves in a predictable, deterministic fashion, and Equilibrium Thermodynamics which see most situations as near equilibrium. This is extended to the belief that when things are close to equilibrium we can predict what will happen next as things tend to move back to equilibrium.
Jean argues that the mechanical worldview, a deterministic and reductionist one, has led to too high an importance being placed on design, control, prediction and measurement. It has come to dominate the idea of what is professional. Historically, in the West, we have been conditioned to believe that predictability and therefore control, measurement and structure are ‘scientific’ and hence professional ways of working. Management and professionalism have come to be about being “scientific”, where scientific means being singularly reductionist to the exclusion of also being systemic in enquiry.
A reductionist view believes that to solve a “big” problem we should divide it into smaller problems that can be solved. The solution to the bigger problem is therefore the sum of the solutions of the smaller problems. This is logical and seductive in its simplicity, but is actually simplistic, as it does not address the interactions between the problems. System Thinking still tends to involve dividing big problems up, but pays close attention to the relationships between the smaller components.
Reductionist and deterministic views of organisations assert that;
They behave like machines and are predictable.
The things that are important can be measured
Departments can be dealt with independently.
Change can happen top down
One method or “best practice” can work everywhere
The future is predictable and follows from the past
People behave rationally and like parts of a machine
Measurement leads to control and clarifies what to do next
Projects, functions, groups can largely be treated independently of each other (and indeed this is the best option) and can be made to follow a controllable process
This is the world of Budgets, Project Management Offices, and Strategic Visions of the future. In “machine thinking”, there is also an implicit assumption that organisations cannot learn, adapt, that nothing new can emerge and that the future is just a continuation of the present.
So what is Complexity Science?
To quote Jean:
“Complexity science is the study of the evolution of systems which are open to their environment. It explores how the reflexive interdependence of constituent elements leads to self-organisation and emergence of new characteristics in a way that is shaped by, but not determined by history.”
Jean explained to us that Complexity Science has stepped beyond Newtonian and Equilibrium Thermodynamics views of science and offers an alternative. It is grounded in Evolutionary Theory and yet emphasises that “survival of the fittest” is more like “survival of those most able to prosper in a given context”. It emphasises that what emerges is very much context/environment dependant. That which is a strength in one context, may well be a weakness in another, and the nature of contexts and environments are often beyond our control. They change in ways that are not random but not predictable either.
Complexity Theory says that the world and human systems and economies and organisations are types of ‘complex systems’, and that they behave more like living organisms than like machines. In a world that is increasingly fast-changing, things often do not go to plan, people and situations are individualistic, many things impact on each other, change can happen radically and rapidly. Thinking you can control things when you cannot can create more harm than good and lead to unintended consequences.
What does this mean for management?
Jean said that in her experience, public services are too often managed towards “economies of scale” and efficiencies are sought through hierarchical standardisation, and top down, “Command and Control”. She expressed her belief that we over measure organisations in the belief that it’s the right, professional thing to do, but the learning from these measures does not necessarily lead to better outcomes. She referred to the example of the British education system, which has been increasingly managed like a “machine”, with everything possible being measured, yet literacy and numeracy rates among British children have been decreasing and are right at the bottom of the pile compared to other developed countries. Something important is being missed.
Jean feels we need to work to understand what really matters to our customers, patients, service users, stakeholders, society, rather than simply measure what can be measured. She believes much more emphasis needs to be placed on “bottom up”, localised organisation rather than top-down machine like focus on “economies of scale” – albeit situated within clear principles and intentions, with strong review, learning and sharing processes.
So, what do I make of all this?
By and large, this all rings very true for me. I don’t think it’s a black and white case that we should forget about scientific reductionist and deterministic approaches to management and be purely systemic, as we’d end up in quite a pickle. And indeed, as Jean would point out, complexity thinking is a middle ground between thinking we can predict and control everything and thinking we know nothing. Complexity thinking is not advocating a laissez-faire approach – rather it is bringing our attention to the fact that many things are interconnected whether we like it or not – and to ignore that can bring failure.
After all, we have an enormous amount to thank scientific reductionist approaches for. I think the point though is we shouldn’t be blinded by their brilliance and in honour of their successes ignore their deficiencies and apply them inappropriately. There is a time and a place for all methods, including measurement. We just need to be careful and considered in our approach and try and ensure that the approach to measurement is fit for purpose.
As when anyone tries to argue against a status quo, in our discussion Jean took a fairly hard stance against the reductionist and deterministic approach and I know a couple of group members found this a difficult view to agree with. I think that was probably a symptom of us not having much time with Jean, as having read her book and having heard her talk more extensively, I know she values these approaches. She is after all a physicist by training. It’s just a question of finding the right balance and using the most appropriate approach for the situation and context we find ourselves in. I think it can also be quite shocking to hear someone say something negative about a “scientific” approach to management (or at least to question which ‘scientific approach suits the complex social world). I think the point though, is that there is nothing scientific about using a “scientific” approach inappropriately. And of course, complexity theory itself is a science!
Often, the things that really matter can’t be easily measured quantitatively
Something that stood out for me from Jean Boulton’s talk was that sometimes, the things that really matter just aren’t measurable. Or at least, are very difficult to define, monitor and measure. I think that’s probably the case with patient outcomes and it’s something to think about. There was a feeling among some in the group that Jean’s approach is one that dismisses measurement altogether. I’m don’t think that’s correct. I believe that for her it’s more about stepping back from measuring absolutely everything we possibly can (and then doing nothing useful with the data, apart from beating people with it) and instead really understanding what’s important and it may or may not be possible to measure that. That’s my interpretation, and also my belief. We need balanced approaches that rely as much on qualitative feedback as quantitative measurement. We need ways to spot and then monitor emerging trends and deal with multi-causal inputs and interconnected outcomes. Sounds difficult, but to me, it seems that to aim for anything less would be to let ourselves and those we serve down.
The question that “the things that really matter are not always easily measurable” is one that seems less relevant in business. That is to say, it is still true, but I wonder if it matters as much. In business, you gauge whether customer outcomes are being fulfilled by their willingness to pay you for your goods and services. It’s just so much harder in public services, where that customer supplier relationship and the direct payment for services doesn’t exist. Please don’t read that as a suggestion we privatise and introduce direct charging in healthcare services, it absolutely isn’t, it’s just a recognition of how difficult our job is in identifying and then knowing if we’re fulfilling the right outcomes for patients. Feedback may be more important than direct measurement, and the best feedback comes from open, honest and direct conversation. We need to be sure we are we having those conversations. Even then, cause and effect are often hard, if not impossible to attribute in our complex multi-causal world. Being too simplistic about what is measured and what is assumed to cause what, can not only waste money, but result in a dysfunctional “system” and unintended consequences.
We need to pay attention to context and complexity
Another point I took away from Jean’s talk was that the approach you use, hard or soft, tight or loose, reductionist or systemic depends on the stability of the environment and the degree of control you have. We need to ask ourselves where we sit on those continua. How Volatile, Uncertain, Complex and Ambiguous is our commissioning world? The approach, tools and methods we pick for doing commissioning will be influenced by the answers to those questions.
I think the answer to this will be constantly changing. I mean, even in my commissioning role and in the context of our organisations, some things are relatively clear, constant, simple and predictable, while others and most certainly not. Even then, these can quickly and easily flip and change to being more or less stable states. We need to be open to the possibility of change in our environment and honest about our ability to predict and control it.
Not only provoked, but also inspired
So taken were some of us with what Jean had to say, that we’ve been inspired to set up a small sub-group to work on a project together. We were particularly taken with the idea that “sometimes, the things that really matter can’t be measured”. This made us wonder what it means for us as commissioners and in particular, what it means for the Commissioning for Outcomes agenda.
We have resolved to write a paper titled something like, “Commissioning for Outcomes – Using systems thinking to think about how to do it.”
Ultimately, I think Systems Thinking, as a complementary approach to Complex Systems Thinking is well placed to meaningfully support commissioning for outcomes. After all, the task at hand is to design and configure a system that has the capability to deliver the defined outcomes. Initially though, we just want to think about what it means and how to do it, and good quality literature and evidence on the subject appears to be rather thin on the ground. Questions we’ll be looking at include:
What does Commissioning for Outcomes mean?
How do we go about deciding what outcomes are important?
And if they can’t be easily measured quantitatively, how do we know whether they’re being achieved?
Even if we can measure outcomes and know they’re being achieved, can we attribute that success to any particular interventions? How do we approach the difficulty of proving cause and effect in this non-linear complex world?
We plan to use the Systems Thinking tools and approaches we’ve been learning about to look at these questions. Thank you to Jean, and watch this space!
Sorry I wasn’t there yesterday lunchtime, but I’ve heard from a few of you who were, that it was a good session and you got on with looking at understanding the “purpose” of a GP practice.
If no one objects, I think we should probably continue with that next week.
To compliment the reading and thinking you’ve already done on “purpose”, I’ve linked another Stuart Burge download. This one is called “18 Word Statements” and helps us to refine our thinking around the purpose of a system.
Another excellent session today. There were 11 of us in the room and a good selection of organisations represented. We discussed the “wicked problems” paper and our own experiences of this type of problem in our work. Conversation regularly returned to subject of “inappropriate” and “unnecessary” A&E attendances and admissions.
For those of you who couldn’t make it to the meeting, and weren’t able to pick up the print outs for this week’s reading, I’ve attached the papers for you. There is a zip file containing a selection of short papers/notes on different aspect of properties of systems. In particular, I’d like us to focus on thinking about system “purpose” in advance of our next meeting. Here are some links:
The paper on “purpose” uses a pen as an example. I’d like it If we could think of the example of a GP practice (it’s probably the part of the NHS everyone is most familiar with) and try to define its purpose. Please have a think about that before we meet again. It’s actually a pretty tricky example for us to begin with, but let’s challenge ourselves and go for it. It will at least surface some interesting issues I think. So, what is the “purpose” of a GP practice???????
When we discussed wicked problems and the cycle of over “studying” problems and “paralysis through analysis” we covered the option of modelling and simulation of potential solutions as being a productive approach. I thought I’d send out this short video clip. It’s a basic simulation put together by a fellow systems thinker called Simon Dodds. It’s only 5 or so minutes long, so do have a look.
Simon is someone to keep an eye on. He’s very heavily into using systems appraoches for quality improvement including system dynamics approaches and writes a very good weekly blog, which is well worth following:
Today’s inaugural session went very well I thought. I thoroughly enjoyed the discussion and can see we’re going to be able to help one another with our “wicked Problems”.
We’ve Got Wicked Problems
Before I recap on what we did and agreed today, for those who couldn’t make it, I want to point out what the homework is for next week’s session. We’ve agreed we’re going to read the linked paper on “wicked problems”. It’s excellent and will help us gain an idea of what these complex problems are, that they’re the types of problems we’re faced with as commissioners, and why standard linear problem solving techniques aren’t enough on their own.
We’ve decided we’re going to meet on a weekly basis and try to keep the sessions to just 1 hour. It’s appreciated not everyone is going to be able to make it every week, but we thought it worth trying to build some momentum and cover some ground. It will be good to get through a reasonable amount of theory quite quickly so we can get on with working on real example projects together and even helping one another with real commissioning issues.
Stuart Burge, a fellow INCOSE member and founding partner of the Burge Hughes Walsh Partnership has made available loads of resources detailing how to then do the various aspects of systems thinking through his website. Have a look here:
Our thinking is that we’ll pick a different download from the list each week, and read it before we meet and then discuss how to apply it in the group and work on examples together. It might be that we need to take several weeks for some of the bigger concepts/tools, but that’s fine.
Before we dive into that though, we’ve agreed to spend next week’s meeting discussing “wicked problems”. They’re basically the starting point and the reason we need to employ systemic approaches. As mentioned above, we’ve some homework to do, so please do read the attached paper.
OK, I look forward to seeing you next week. In the meantime, please do feel to ask me any questions.