Interview by Anna Betz of Ian Sherriffs, manager of the Memory Service at Camden & Foundation Trust, in United Kingdom.
Creating more dynamic and interdependent structures to liberate creativity equals real healthcare
When interconnections in a system are not acknowledged, actively enabled, and supported, the whole system becomes rigid and stuck, and operates in silos. We need to listen to, recognize, value and utilize people’s different experiences and support them so that interconnections can deepen. This in turn allows us to perceive, better understand, and work with the interdependence of systems and their life-supporting processes.
The present system in the UK National Health Service is mechanistic and not dynamic enough to be able to utilize everyone’s experiences and skills. It doesn’t allow all those involved and affected to negotiate for a common purpose.
From this perspective, the NHS Trust feels like a false entity. It doesn’t feel as if it is for the people it is supposed to support. It has a face it wants to portray but doesn’t really engage the community. It doesn’t ask what the the community wants or what it could contribute to the community.
From its narrow perspective at the moment, the Trust and the whole of the NHS simply can’t see what the communities are. Being concerned about the face that would look good on a poster is not what healthcare should be about.
There is certainly potential for change, but this change needs to come from both the top and the bottom and meet in the middle.
The NHS Trust operates like a separate entity. Its interconnection with the community is not fluid; feedback loops don’t operate in a way that would allow more creativity. It could invite and facilitate the community, but it chooses to control and operate separately from it.
It could create spaces that are free of hierarchical structures, spaces for innovation, but this would require more forward thinking. This is a possibility with a lot of potential, but whether any London Trust would think forward in this way is questionable.
What holds the UK National Health Service Trusts back, in your experience?
Having to meet targets and being driven by data holds back progress. There are wonderful things going on in this Trust like the QI (Quality Improvement) projects but they are not shown well.
When you discover that the only way the Trust could send a senior member of staff to the celebration of the QI projects was by putting them on the board to judge people, that doesn’t show much real care.
If the Trust wants to value what is going on in QI projects it is not enough for a Trust representative to simply turn up because he/she has been advised to do so. The Trust could be more fluid than that and show more care towards young practitioners, treating them as whole people.
Leadership courses are not much better. You are shown what you should be like by watching presentations about theories and frameworks. This never brings about the change and transformation that is needed. Fighting against the rigidity of the system is both tiring and causes resistance to change. It wastes valuable energy and time.
A possibility would be for the leaders in an organization to give permission and hold space for transformation rather than wanting to control it. Maybe that change will be allowed now that it is becoming more urgent and unavoidable.
The age-old challenge of putting theory into practice exists in most leadership courses. Typically the fact that “the hard stuff is the soft stuff” gets ignored.
Bringing people into communities of practice (1) even if not generally known by that name, is an effective, efficient, and evidence-based method of addressing the challenge of putting theory into practice.
Members of CoPs are not accountable to those at the top but they need to be given permission to meet and a space where they can meet, explore, reflect, create, imagine and experiment around a shared domain– then take it back to their work/organization.
(1) https://co-creationnetwork.com/ sees Communities of Practice & Co-Creation Network as safe spaces for peer to peer learning, innovation and emergence of new practices.