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The aim of this project is to identify 'redesign principles' to accelerate the implementation of new care models in the UK and across the globe. Hmmm implementation of new care models - like Vanguards? There's something quite interesting happening over there, which is the use of logic modelling, what the third sector have started to call 'theories of change' and it's very exciting. Vanguards' logic models should be out in February next year, in the meantime the NIHR have a commissioned...

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A tiny but hugely important bullet point I would add is to hold one person clearly accountable for an outcome and as such make them completely responsible for the system which achieves the outcome. Then, because what could constrain or limit the outcome would be another constraint in a different system, make someone else responsible for identifying those conflicts and resolving them, to challenge the assumptions underpinning the constraints which would encourage innovation. Evaporating...

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I hear many stories, most with some kind of safe guarding theme, directly from the person experiencing a situation . And I speak to many health and care professionals who feel unable to change the system, and who feel unbearable pressure to protect themselves and be able to demonstrate compliance with rules in case their practice is audited.  Herein lies the dilemma - As a system professional I must do what needs to be done for the person in my care which means using my professional...

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Driving out waste, eliminating duplication, unnecessary variation and complexity - it all sounds a bit Lean to me and Lean didn't achieve the kind of system improvement heralds sang about. Why? because while Lean is a systems methodology it like to operate in hard systems not soft people-based systems. How something should work and was designed to work, and how it works officially on paper is one thing, how it's actually working, and the inherent human systems dynamics operating on the...

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In principle I agree with this as a statement but I do think its all bound up in some of the other design principles, particularly the network one but several really. If we took a constraint-based approach to the examples we would ask "what is stopping this being true right now?" And I suspect we would find people (at a population level) don't really want to be accountable for their health and well-being, and of those that do, that really do, some don't know how and some are not able....

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As a design principle this is an imperative so fundamental it should be a necessary condition of all the other design principles rather than stand alone.  Where are now is patients (or service users or carers) telling their story multiple times often on the same day or in the same hour. The danger is they (we) add things and subtract things, we change our story as it becomes rehearsed, it no longer was what we first said. It is different. The same goes for the listener if we rely on them...

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The way this is worded is all about the system and could end up in first order change not second order. To help with second order it might help to conceptually consider network more generally, and help us locate patients, public, service users,carers, the police, school's, Brownie's even, in the network. Health, and indeed ill-health flows, it's progressive. Similarly care flows across and between nodes and is progressive - or not! The central problem I think is that some people are...

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Focusing on flow changes people's whole perspectives and in my experience is a great way of aligning disparate groups across functions and silos, getting them to focus on the same thing, and an really accessible entry point to genuine whole systems thinking. People didn't know what integrated care meant - horizontally? Vertically? geographically? organisationally? who knew? But flow enables focus. Flow begs the question - what's flowing? And why? And from there means there must be a purpose...

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Two points here: 1. Managing and leading for complexity and 2. Checking we are taking action against the actual problem and not an effect of the problem Clogged A&E, waits for GP appointments and elective waiting lists all receive media attention and management attention. Yet we know they are effects not causes. If we were genuinely taking a whole systems approach we would see that demand failure is everywhere. Services built but people don't use them or don't get referred to them...

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Mobilising community assets sounds a great idea in principle and I'm involved in lots of conversations in Birmingham's health and care systems on this very topic. However many assets are dynamic and don't stay mapped, which means the approach to mapping them must be continuous and dynamic. And that's tricky because how do you continuously map a dynamic system? The assumption here is that 'someone' must, which implies command and control again - we (the system) map it so that we can design...

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Candy Perry
 

Candy Perry

United Kingdom

Joined this community on Nov 15, 2015

Bio Candy Perry is an independent management consultant specialising in whole systems improvement through soft systems change, and is currently Consulting CEO to Healthwatch Birmingham advising the Board and leading the staff team through a process of transformational change. Candy has held a number of senior leadership positions including Executive Director of National Childbirth Trust where she designed and lead transformational change programmes for the charity’s trading company and separately its commissioned services operation; and Director of Communications and Business Development for Education for Health where she conceived, developed and led the charity’s business to business operation. More recently Candy set up Concinnity Consultancy and Research Ltd to provide consultancy, coaching and training in whole systems change and performance improvement in complex service operations, working primarily with third and public sector clients. She has an MSc in Whole Systems Improvement in Health and Social Care with Distinction from Nottingham Business School’s Centre for Lean Improvement and recently completed accredited Focus Group Training with the Market Research Society. Candy is a Non-Executive Director of the Institution of Occupational Safety and Health (IOSH) where she is also Chair of the Risk Management and Audit Committee; a Lay Members of the National Institute for Health Research (NIHR) Health Services and Delivery Research Board; a lay reviewer for the BMJ; and for Healthwatch Birmingham is a member of NHS England’s Working Group for Patient and Public Participation in Primary Care.

Your role / job title
CEO

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Healthwatch Birmingham

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@candyfleurperry

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