The bitter public battle now being fought over the future of the NHS looks set to continue. Its future shape uncertain, and the mounting resistance that is so visceral is based upon fear, uncertainty and crucially a genuine lack of trust in those that claim to be guiding us to the best possible future the NHS.

The Lancet in January 2011 agreed that the current system stifles innovation and that although vast sums have been invested in the NHS we have not seen the benefit delivered as valuable frontline services. So we need transformation.

But the question is how do we get to that best possible future? How do we create a more sustainable NHS? Here are a couple of thoughts.

Participatory healthcare for chronic disease

Patients Know Best is a platform, that enables patients and clinicians to engage in individual and collective diagnostic practice, that allows for patient sovereignty and patient empowerment (where patient data sits at the very epicenter) and for clinicians to provide more accurate and dynamic healthcare assessment and advice. Patients can interact in full confidence with the clinical team online, uploading information about their medical history, patients can also read and interact with other clinical information inputs. This means patients are empowered, they are engaged in the process. Appointments can be made online within 24 hours – everyone has full access to all relevant data, which has proven significant benefits for everyone involved. Clinicians now have the right information with the right time to consult, reflect and properly advise. They can discuss with their patients and decide together next best steps.

In this process everyone learns with deep knowledge translating into meaningful action. The insight is that patients know a great deal, they are curators of their personal histories, and all to a lesser or greater degree possess uncommon combinations of common conditions in unique personal circumstances. Clinicians can them combine that unique knowledge with their own knowledge blending together unique and relevant programmes for chronic disease care.

Founder of Patients Know Best Mohammad Al-Ubaydli says it is not only significantly cheaper but a greater degree of comprehensive accuracy is achieved in one to two orders of magnitude.

Participatory leadership in healthcare

Nova Scotia was facing significant challenges in how it was going to evolve its healthcare system. In 2006 the Government asked Nova Scotia’s public health practitioners, to ‘articulate and be guided by a collective vision for the public health system.’ This is a complex challenge, and how does one go about articulating a collective vision?

Large-scale organisational change of the healthcare system that is happening in Nova Scotia, is being enabled through a process described as ‘Participatory Leadership’, whereby it is the participation of the people that are the true actors (nurses, clinicians, patients, etc.) within that healthcare system that are being hosted (guided) into co-designing, and co-creating how they are going to find the answers to their difficult and challenging issues.

In December 2008, a group of practitioners and partners in public health from across the province took on this challenge. They initiated a search to find a process that would bring people together to seek new solutions for the common good. They also knew the process would have to take into account the complexity of public health. And they also felt that any attempt to address the current challenges of public health demands the collective intelligence of all stakeholders. They sought a process that would launch Nova Scotia into a new beginning, an approach that would foster leadership and innovation.

The real insight was that the answer to such a complex problem lay in the minds of the many, that the way forward was held collectively in all the stakeholders that worked in the current system – not in the PowerPoint charts of highly paid specialist management consultants.

The benefits of participatory learning and leadership in healthcare

Patients Know Best and Nova Scotia are stories that are real world – they are serious and they represent two simple ways in which a best possible future for our healthcare service could be delivered, that can cost effectively meet the needs of many millions of people.

They are cost effective because ‘we’, become part of the process, we have co-created it. We begin to build a shared narrative around the people’s NHS. This is entirely different to the ideology and language of markets and privatization.

They are also demonstrative of the agile organization. Agility is related to what Otto Scharmer describes as an evolved geometry that devolves power from hierarchies to evolving networks of relationships, these are organizational models in which people, patients, physicians, clinicians, support services connect with each other in more meaningful ways in which they are all part of the process. So we move from the language of economies of scale to human centered ecologies of scale.

Explicitly, the thing that joins the dots is that Patients Know Best and Nova Scotia are both designed around the needs of humanity. Participatory learning and leadership are both constructed from the understanding that seeking change for the common good calls for involvement, collective intelligence and co-creation to discover and illuminate new solutions and wise actions.

John Berger wrote, ‘what we see is shaped by what we know’, and what we make is shaped by the language we have available to describe a new reality. If that language is lacking or deficient then so will be the outcome. And that is why Andrew Lansley’s Bill is in such disarray, as his framework for reformation is not based upon the language and literacy of social innovation, participatory cultures and leadership, it is based upon a language that has ultimately done so much damage to us.

What is missing is a literacy that defines a new form of leadership relevant to today’s world: the capacity to collectively shape and create our best possible future, and to release us from the cul-de-sac of our ‘industrial free markets are best’ view.

This is extracted from the book No Straight Lines: making sense of our non-linear world

Open Access book available via (this link)

Paperback and Kindle versions via (this link)

My argument is that better much better does not necessarily cost the earth.

Its is about a new literacy and logic in how we make stuff. This is a key part of the No Straight Lines Story.

Some interesting key points highlighted over at the p2p Foundation

1. Designed and manufactured a 4-passenger street-legal car that gets 100 mpg
2. The car was constructed using off-the-shelf parts
3. The car is entirely modular in design
4. They innovated a new process for carbon-fiber body construction that costs 1/360th the traditional process
5. You can pre-order cars now for less than $29,000
6. This is not just a one-off prototype. Currently they are manufacturing one car per week (yes, that’s the low volume manufacturing retail price). They are targeting a future price of under $20,000.
7. With no capital investment
8. Though accept donations
9. Everything is done through volunteers

Also read:

• The No Straight Lines challenge: be realistic imagine the impossible
• 6 challenges for a non-linear world
• The NEXT Silicon Valley is not a place it’s a platform
• LEGO CUUSOO – the WHAT’S NEXT for business in a non-linear world
• Patients Know Best: a new literacy for healthcare

In NO Straight Lines: I argue that we now have the possibility to truly transform our world, to be more resilient, to be more relevant to us both personally and collectively, socially cohesive, sustainable, economically vibrant and humane, through the tools, capabilities, language and processes at our fingertips.

The key to unlocking this opportunity, so we can design for transformation is through understanding the interlocking concepts of the six key principles of No Straight Lines, which our research shows are the 6 big challenges that organisations have to navigate to thrive in a non-linear world.

These are:

[1] How do organisations of all creeds deal with a more complex and increasingly ambiguous world?

[2] How do those organisations push through from living in an ambiguous world to one in which they can begin to design for adaptation?

[3] How do organisations learn to design for a more open world – which will be necessary for survival?

[4] How do organisations learn to design for a more participatory world?

[5] How do organisations develop a methodology for craftsmanship at a personal and more organisational level?

[6] How do organisations prepare for and design for transformation?
The six key principles of No Straight Lines, these are:

[1] Ambiguity [2] Adaptiveness [3] Participatory cultures and tools [4] Openness [5] Craftsmanship [6] Epic (designing for transformation).

What our research shows us that whether executed digitally or in our analogue world or indeed blended together – those organisations that have addressed these issues with conviction are the ones that have moved from being stuck in a world of concussive ambiguity.

Click here for NSL Store

Related articles

• Why Britain needs a mentoring eco-system for entrepreneurs (no-straight-lines.com)
• LEGO CUUSOO – the WHAT’S NEXT for business in a non-linear world (no-straight-lines.com)
• Celebrating Craftsmanship (smlxtralarge.com)
• No Straight Lines: making sense of our non-linear world (communities-dominate.blogs.com)

Some people struggle to reconcile Apple as a company with the idea of Open, one of the principles of No Straight Lines.

Apple is not open, it is in fact the complete opposite is the pushback – and so we go into big discussion. Which is good as part of the process of No Straight Lines process is to really challenge our perceptions, so we can move beyond them, where we can imagine and then create our best possible future.

For me, Open as relates to Apple, is about the curiosity of the craftsman – tinkering, learning through the felt fingering space of play.

In this way as Arthur C. Clarke wrote,

The only way of discovering the limits of the possible is to venture a little way past them into the impossible

So one has to be open to new ideas, tools, technologies, process and organisational capability. And we have wonderful products like the iPhone because Apple were prepared to play in the closed eco-system that was the old Telco world. (I know, as I was there).

Apple created for the first time a phone that was relevant to the world it lived in – whereas before then it was the carriers that played Nero to its empire. Consequently the products were dull. It was Jobs that ruthlessly forced that market to change.

Jobs also went to Nokia, and I am sure a few others, offering a mutual relationship with the iTunes eco-system and was shown the door. And I also know of plenty of innovative Japanese companies innovating over a decade ago in mobile/web who were also shown the same revolving mechanism. Whilst these behemoths went back to counting their ducets.

So my challenge is – who was open and who was closed? Who saw the best future potential for us, as users of products and services and who only saw “the money”, and were only motivated by how much money they could extract from our wallets whilst giving back as little as humanly possible.

Apple built an eco-system and a platform. It has created great products because it was OPEN – it may not operate under a cc licence, and it may come across as über controlling. But, there is much more to this story than rejecting Apple as a closed, tight lipped organisation.

Apple thrives on diversity, and to accommodate diversity one has to live in open knowledge eco-systems. The story of many organisations and even industries that die is because they lived in a closed knowledge system. Unable to change their perspectives of how they saw the world, and operated in it and so became disrupted – to the point of catastrophic failure. Open is about learning philosophically, instinctively, new literacies to create new and novel products and services that create value.

Now how many companies do that?

Marcin Jakubowski tells us how. In many ways this story is very much part of the story of No Straight Lines that I have been researching, evolving and developing over the last 7 years. You can find out more about No Straight Lines here and pre-register for the free browser book, or indeed lets us know if there are other formats of the project you are interested in.

Marcin’s story is at a very human level, but it also asks big questions about ‘WHAT NEXT’ looks like, economically and, organisationally. His story is about questing for a more sustainable and enduring world, something that Gabriel Branby also talked about.

Marcin asks the What If? question, but he is one of a growing band of people, and these questions are pushing harder and currently deeper into the consciousness of our everyday lives. and I think Marcin is a trailblazer but he is also connecting up to and creating an entirely new eco-system, a ‘human operating system‘ that wants to get stuff done in very different ways.

As Tony Judt argued in Ill Fares the Land, why is it that we struggle to imagine a different world to the one we currently have, when that world could be built upon a philosophy of a more humane sense of the world we live in?

First off less than 2% of Congress totaling 535 members, have professional backgrounds in science, whereas there are 222 lawyers.

When in 1987 the Federal Communications Commission removed the fairness doctrine of how difficult or controversial news was reported it open the door to more extreme punditry, take a bow Rush Limbaugh. And we have witnessed an increasing line of anti-science perspectives from Rick Perry, Sarah Palin, Michele Bachmann, with the whip held by Newt Gringrich.

And Otto argues right now science is under threat by anti-climate change organisations – between 2009 and June 2010 the energy industry spent half a billion dollars fighting climate change legislation. He writes that 96 of the 100 newly elected Republican members of Congress deny outright that climate change is real or are voting against it in one form or another.

That said Otto argues there are complex forces that are shaping the debate on public perceptions towards science, ‘the moral ambiguity createdafter the dropping of the Atom bomb and living in a nuclear MAD world’, or some of the terrible excesses of toxic pollution that killed and maimed ordinary people – coupled with the culpability of government, the effects of postmodernism on the one hand and the rise of fundamentalist religion on the other smashing into each other. A deep distrust arouse around government and science.

This is the volatile cocktail that combines – commerce, science, truth and politics and results says Otto on an assault on American science that is unprecedented. Though the Barack Obama administration does not get away with it scott free

President Obama’s not much better. Running strong on climate change in 2008, he has since totally de-prioritized it, apparently marginalizing his scientist appointees like Chu, Holdren and Lubchenco, all of them outspoken on climate change, and now appears to be moving ahead with offshore oil drilling, lower air pollution standards, poor carbon standards, and the Keystone XL oil pipeline. In a time when the science has only advanced further and the U.S. National Academy of Sciences says anthropogenic global warming should be “regarded as settled facts” — a time when China’s leapfrogging ahead on clean energy investments in the next economy, that’s not going to take America where we need to go.

Finally Otto refers to ScienceDebate2012 as he describes it, ‘a grassroots campaign for a presidential debate on science, technology, health, medicine and the environment’. Which was born out of Science Debate 2008 which was the largest political initiative in the history of American science.

We are on a journey from a linear world to a non-linear one (click here for more information) and we need good science to come with us. To attempt to shout down science, diminishes us all and limits the possibilities of our world.

For more information on Otto’s perspective read New Scientist October 27th 2011 (subscription required) or the Huffington Post- The un-American war on Science.

Shawn Otto has written book called Fool Me Twice: fighting thee assault on science in America

Why Andrew Lansley is not talking to people like Mohammad demonstrates why BIG GOV struggle with designing for a better world. Its not top down with lots of expensive consultants. Designing for transformation is flat, emergent and networked. And the clue is in the name of Mohammad’s company PATIENTS KNOW BEST. Better thinking, better world. Its about blending technologies of cooperation, with data, platforms and people. Designing around people, for people, not inspite of them.

Mohammad’s story is the reason a patient knows best is because they are the only one who goes to all the consultations. So Mohammad has come up with a simple program so a patient can access their health records.

I was taken by his post on innovation, constraint, and design, he quotes Dave Snowden, and Aydin Örstan.

It is interesting that Africa is innovating in mobile and tech in amazing ways – simply because of, the hunger to make for a better life, and, to use what is available to hand, even though constrained. Those that do not see Africa as a place to study for why innovation happens almost in spite of so few resources – are looking through the wrong lens. Steve’s edict for his own operation is, make a telco as easy to operate as a wordpress blog, I LOVE THAT. And also – be as open as possible Principle #5 in No Straight Lines.

So over to Steve…

Constraint and Complexity

Interestingly, about the same time as Ethan was writing about constraint, Dave Snowden was offering his own tentative rules of complexity in the 5 Cs of Complexity.  The first of which is, you guessed it, constraint.  He says that

Constraint is key to understanding complexity, it governs the transition between the three ontologies. Increase constraint and you create an ordered system; do that inappropriately and you create the conditions for catastrophic failure; remove constraint and the system is chaotic…

Understanding the boundaries and critical variables in the environment that you are operating in is the key to intervening successfully in any complex system.  Too constrained and there is no innovation, witness most development projects based on a logframe.   With no constraint, innovation also doesn’t happen because (I believe) that innovation is a dialogue involving people and things.  With no control, innovation is easily dissipated in many possible directions.

Innovation and Evolution

Aydin Örstan has a great quotation from François Jacob (The possible and the actual, 1982) in an interesting post on evolution.  François says:

In contrast to the engineer, evolution does not produce innovations from scratch. It works on what already exists, either transforming a system to give it a new function or combining several systems to produce a more complex one. Natural selection has no analogy with any aspect of human behavior. If one wanted to use a comparison, however, one would have to say that this process resembles not engineering but tinkering, bricolage we say in French.

 

No Straight Lines, argues that we have reached the nadir of the adaptive range of our industrialised world. Now faced with an unsustainable trilemma of social, organisational and economic complexity, we have entered an era in which the rules we have previously organised our lives around no longer apply. Leaving us with both a design problem and a design challenge which we must urgently solve. By describing an entirely new way for true social, economic and organisational innovation to happen, No Straight Lines presents a revolutionary logic and an inspiring plea for a more human-centric world.

Craftsmanship can and does manifest it self in many ways – we need to celebrate them all. This lecture from The Do Lectures given by the charming Nick Hand.

In an age of fast, there’s slow. In an age of quantity there’s quality. On a bike ride around Britain Nick discovered his appreciation of the craftsman and women of Britain. And how we need to keep these skills alive.

A video of my take on design. No Straight Lines more info.