Strategic banana skins


“The urge that was common to them all was a need to improve on the thin texture of life as they saw it; by ordering themes and events into an artistically pleasing whole, they hoped to give to existence a pattern, a richness and a value that in actuality it lacked”   Sebastian Faulks

 This is surely the essence of strategic thinking, redesign and restructuring, (re-engineering is a nice term also). Most of us are drawn to create order out of chaos, some being better than others at doing so. There are so many traps along the way, let’s choose one and see where it takes us….Reductionist thinking often adds value by communicating the nub of things in a simple and accessible way, but when does it sidestep complexity and miss the point? Does it then become a danger because it is more likely to influence the uninitiated who have no seasoned grasp of reality to use as a reference point?

To be able to distil complexity, filter the noise and provide a focal point conceptual frameworks are powerful things, particularly if it comes with a compelling narrative. On the other hand I have twice recently been in the audience to witness our NHS launch tender processes to commission what they used to do themselves. At both diagrammatic models were presented that were utterly undecipherable and added almost nothing in the way of value. Except of course to highlight the fact that even on paper the disparate services could not be explained away. Stop there; if one cannot take out a pencil and draw a coherent representation in theory, then how do we think it will be experienced by those that use the services and by the staff expected to populate the various circles, arrows and triangles?

We can relax a little because nobody is going to be influenced by an ‘artists’ impression that is undecipherable, this will not be driving change. But what happens when an artist comes to town that can paint? This of course can be more influential and will likely bring about more change, especially if we are standing on a burning platform brought about by the last artist’s bright idea “Today’s problems being the result of yesterdays solutions”, how good will the painting look when the canvas has been stretched over what has gone before?

Surely the advance acid test is asking people who deliver and receive services what they think. Not only will those who have to do the change be able to offer advice because “only the wearer knows where the shoe pinches” (three quotes for the price of one, I am spoiling you now) but frankly if they don’t like it then it ain’t gonna happen in a recognisable form.

So when we expand this to a more macro level, say the NHS in its entirety, the challenge expands to intimidating, and let’s be honest, impossible proportions. Why then do we make it harder for ourselves by subjecting this complexity to continual fundamental change, one layer on top of another? We end up of course with the complex organism now becoming a moving target – impossible squared!

On a more positive note where I have seen reductionist thinking (of a type) used powerfully is when we focus on the user experience. I first came across this some years ago in specialist education where the different professional groups were enabled to talk to each other via the sharing of a common language; the student experience.

The NHS Leadership Academy have truly embraced this approach. On my first day on the Nye Bevan programme we started by listening to the patient experience, the good, the bad and the ugly, this acted both as a powerful reminder of how important it is to try and get stuff right and how unifying a common language can be in allowing clinicians, commissioners and policy writers et al to communicate. A glimmer of hope then to inoculate our heads from being filled with the logic of despair.


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