My experience of appreciating the NHS and public health reforms

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(Activity 3.12)

As Blackmore (2010, 20) explains in an editor’s note, Vickers did not represent his idea of an appreciative system in a diagram or model.  However, Checkland and Caser did produce a model based on their understandings of Vickers work in 1986.  This is reproduced in Blackmore (2010) on page 21.

I struggled with this diagram at first – mainly because of its title “Diagram of Vickers’ appreciative systems model”.  After posting about this to the course forum, I was helped by one of the tutors (Jitse) who said that it may be better to think of the diagram as a “conceptual representation of the process of appreciation”.  I found this much more helpful as a trigger to understanding my own experience.  I am still not sure about the diagram itself but I can now use it as a springboard for reflecting on a recent experience  of appreciation.

In my area of practice, the most significant events in recent months has been the reforms proposed to the NHS by the new coalition government.

The flux of key events and ideas included: publication of the original Equity and Excellence white papers; coverage in the national press and also professional press; publication of accompanying more detailed consultations, such as on Outcomes frameworks, Information and so on; publication of Healthy Lives, Healthy People (the public health white paper); publication of the response to the consultation; publication of the draft Health and Social Care Bill.

As this has gone on I have been engaged in appreciating these changes.  I have experienced this as process of questioning.  What do the documents say? What new or different issues arise in each of the sequentially published documents? What are the perspectives of others? What are the strengths of the proposals? What opportunities do they bring for what we would like in this city? What are the weaknesses of the proposals? What potential problems may they give us in implementation?

The ‘standards’ I have used in this process have been a comparison with what I know of contemporary public health theory (such as that used by World Health Organisation on the social determinants of health).  I have also looked for consistency with my values and ideals – such as notions of ‘responsible autonomy’, fairness and equity.

As a result of appreciation and comparison with standards I have taken action.  For example I have talked to others – both to inform them of my interpretations but also to learn from theirs.  I have been involved in responding to the consultations.  I have also been taking steps to prepare us for local implementation.

My personal appreciative system (“state of affairs in my head”) has changed during this process.  There were some documents that I was really dis-interested in at first  but later realised their relevance (readiness to see? readiness to value?).  In the early stages, it was so overwhelming and confusing that I had very little ‘readiness to respond’ – other than through knowing I had to engage in the processes of sense-making and appreciation.  Now I have a much better sense of practical actions we need to take locally.


Various abstracts from the writings of Geoffrey Vickers reprinted as Chapter 2 in Blackmore, C. (Ed) (2010) Social learning systems and communities of practice, The Open University/Springer, Milton Keynes/London

2 thoughts on “My experience of appreciating the NHS and public health reforms

  1. Hi Helen,

    this is a helpful verbal acccount of a personal appreciative system in addition to the one in the study guide. I think there is a timely sequence of standards and appreciation (re-informing each other in an iterative way) and resulting in action which then feeds back into the timeline of ‘flux of events and ideas. My question is whether the appreciative system then starts again. I have posted a diagram of my own appreciative system onto the TU812 forum website
    Best, Anne

    • Hi Anne
      I am beginning to think of appreciation as an ongoing iterative process. In this example the whole process kick-started with the original publication of Equity and Excellence and has continued since then in one long-stream – of sense-making, appreciation and then new documents, commentary or local conversations that trigger that again sometimes many times a day. In describing (whether in words or through the annotated diagram) we seem to be taking a ‘cut’ at a point in time or summarising all the iteration over a period of time. I’ll have a look at yours now.
      All the best

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