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The UK government outlined their ambitions relating to the domain of wellbeing and health, in a range of publications including:

At the time of writing the related Health and Social Care Bill 2010-2011 is currently before parliament.

Stakeholders in the city where I work have responded to these changes as an opportunity for a step-change in the way in which we organise ourselves to work together to improve wellbeing and health and reduce inequalities in health. Senior leaders of the main statutory partner organisations have agreed to what is locally referred to as “a whole system approach” to the implementation of these changes.

This situation is important to me because I am one of a small team of people who is designing and facilitating the processes through which we will deliver these changes. I experience the situation as one characterised by interdependencies, complexity, uncertainty, multiple perspectives and controversy. It therefore seems appropriate to approach this work systemically.

Although local stakeholders are not specifically using the terms “learning” or “social learning”, there is a general consensus that ‘more of the same won’t do’ and that we need to do things in new ways. According to Schon (1973, 6), “a social system learns whenever it acquires new capacity for behaviour”. This is not just about individual cognitive learning, it includes changes to the meanings, norms and institutions that shape behaviour in groups, organisations and society as a whole. To be able to do things differently, we need to learn and, in my view, part of the work we do in implementing our upcoming changes needs to focus on creating the conditions for that learning to take place.

I am really interested in hearing what readers think of this situation and the need for social learning – please leave a comment using the ‘leave a comment’ facility.  Please note comments will not appear straight away because they come to me first for moderation (to protect against spammers).  Thank you.

References

Department of Health (2010a) Equity and excellence: liberating the NHS, HM Government, London.  Source http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353 [accessed 13 March 2011]

Department of Health (2010b) Healthy Lives, Healthy People White Paper: our strategy for public health in England, HM government, London.  Source http://www.dh.gov.uk/en/Publichealth/Healthyliveshealthypeople/index.htm [accessed 13 March 2011]

Department of Health (2010c) A vision for adult social care: capable communities and active citizens, HM government, London.  Source http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_121508 [accessed 13 March 2011]

Schön, D.A. (1973) Beyond the stable state pp.30, 116 – 179. The Norton Library, W.W. Norton and Company INC, New York reprinted as Chapter 1 in Blackmore, C. (Ed) (2010) Social learning systems and communities of practice, The Open University/Springer, Milton Keynes/London  pp. 5 – 16


8 Responses

  1. #1
    Rob Gillies 

    Hi Helen – there is some relevance for me here as my situation of concern is my perception of the current (English) Waste Policy Review being run by Defra as being an opportunity for social learning.

    My issue with Defra’s approach is that there is nothing new – using your Schon reference I am struggling to see how their traditional approach to policy development will lead to any capacity for new behaviour in how we deal with the issue of waste management in England.

    I’m intrigued therefore with your suggestion that local stakeholders in the health sector have taken it upon themselves to use the new bill as an ooprtunity to re-organise. Is there a direct relationship with the new bill and this new approach – in other words was the bill a catalyst?

    I am wondering whether I have missed a trick here in seeing the Waste Review, not as a missed opportunity for the Government to lead social / public learning, but the fact of the Review taking place acting as a catalyst for new behaviour.

  2. #2
    Helen 

    Hi Rob

    Thanks for your thoughts and interest.

    The answer is a bit of both. The Health and Social Care Bill is creating some significant changes to the NHS. Most significantly:

    – health care commissioning responsibilities will be transfered from existing primary care trusts to Consortia of GPs
    – health improvement leadership, which is a key part of the public health agenda, is coming from the NHS to Local authorities
    – we have to set up new statutory Health and Wellbeing Boards.

    In essence this means new partners on the scene and old partners with new responsibilities. It has to be said it would be possible to make these changes with a ‘tick box’ mentality and very little visible change. However, in this area I think people are working to a motto of “if do what we always did we will get what we always got” so the nationally required changes are offering us the opportunity to take a whole new attitude and approach to our work- a kind of new beginning.

    I had not really appreciated the significance of this attitude until I read your post – yes the national changes were a catalyst but I guess we may not have taken this approach if we had a different local set-up.

    I am not familiar with the Waste review and whether it offers you a similiar opportunity – I hope it does…

    regards

    Helen

  3. #3
    Colin Williams 

    Hi Helen. This is very much an off the cuff response.
    I’ve recently been part of the senior leadership development programme run by Ashridge College for the Council. Through that I was introduced to the work of Stacey (can’t recall specific references, but could find if you’re interested). Essentially Stacey proposes that effective leaders should actively resist the pulls towards either order/stasis or chaos, and should position themselves permanently in the complexity zone. That resonated really strongly with me and it immediately came to the fore when I read your blog. On one level, I agree with your proposition that a key part of our role is to create the right conditions for learning, but on another level I think that the ‘complexity zone’ in itself creates those conditions. Our task may therefore be to draw attention to that fact! Cheers – Colin

  4. #4
    Helen 

    Hi Colin

    Thanks for your post. I have heard of the Stacey matrix – interesting that you covered it in the leadership programme.

    I agree that the ‘complexity zone’ creates the need for us to learn – but I think so many of our usual practices don’t necessarily enable stakeholders to do so together.

    If we take a ‘meeting’ for example – having an agenda; having members that feel they are ‘representing’ their organisation; having papers that people agree to – is a great way of doing things to get decisions made when we assume that the world is ordered, certain and uncontested.

    But maybe not so good when we need people to explore complexity, understand others’ perspectives, be a lot more curious and open minded, and create concerted action. Perhaps we need other ways of setting the tone of ‘meetings’ so that the ‘learning’ mindset is brought to the fore, rather than the decision-making/representing my organisational interests one?

    what do you think?

    Helen

  5. #5
    Barbara Douglas 

    Helen

    I completely agree with your latest comment re

    But maybe not so good when we need people to explore complexity, understand others’ perspectives, be a lot more curious and open minded, and create concerted action. Perhaps we need other ways of setting the tone of ‘meetings’ so that the ‘learning’ mindset is brought to the fore, rather than the decision-making/representing my organisational interests one?

    I was involved in a couple of meetings today (both with academics) which were examples where if we could get together with a view to open minded and exploratory discussion, I feel sure we would find common ground and be able to move quite quickly to concerted action in a way which we would never achieve through our more traditional meetings.

    It’s a frustration I often feel in some of the partnership meetings we organise, where we put vast amounts of time and effort into preparing for the meetings, but the reality is that the more interesting and productive discussions are actually going on elsewhere! It’s a challenge to make sure we are working in a way which is accountable and carrying out the formal work we need to do, but at the same time making space to capitalise on the resources and creativity in our system.

    If we could find a way of doing our main business in a way which enabled this more creative learning and sharing, what a wonderful world it would be!!
    Barbara

  6. #6
    Helen 

    Hi Barbara

    Thanks for you comment – though I must admit I was thinking in part of our conversations when I wrote that!

    This OU module I am studying has introduced me to systemic inquiry – you can read a little about it in this post http://helen.wilding.name/2010/11/28/systemic-inquiry/

    So I think that there are some ‘methods’ there for more creative learning and sharing, it is mainly working out a way of starting to use them – and being prepared to put ourselves and others out of our comfort zones for a while.

    see you soon

    Helen

  7. #7
    Gillian Davison 

    Hi Helen,

    this is interesting! A few questins spring to mind when framing this discussion – What kind of changes do you think are required? Who has decided that things have to change? (Who are the influncers of policy?) What problems do the ‘new ways of working’ want to address? What was wrong with the ‘old’ ways of working/ Why do we need to do things differently? I read an interesting article yesterday, you may have allready come across it – “Systematic Action Research” – A Strategy for Whole Systems Change, Bristol, Policy Press It looks at what we mean by ‘social learning’ and challenges our views about conceptions of learning, arguing that we often neglect to ask the people who allready ‘know’ (have allready learnt and have the answers)- the participants, communities and service users who use public services. It looks at the complexities of assessing ‘impact’ and what we mean by impact, Thought provoking!

    Gill

  8. #8
    Helen 

    Hi Gill

    yes – all questions I am pondering today as I try to pull together the assignment! And it is sunny and my allotment is calling – a hard day to engage.

    I have heard of Systemic (rather than systematic) action research – is it the book by Danny Burns (2007) you are referring to? There is also a chapter on it in one of my course texts but I have not read it yet – so much to go into.

    see you later!

    Helen

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