You may be asking why we have a picture of a water lily in a piece about the importance of systems design? Back in my school days we had a thriving pond with flora and fauna including exquisite flowering water lilies. However, it was not always this way. The pond had been a recent addition to the school, and before the water lilies would flower the pond conditions had to be just right.

In my work across the public, private and charity sectors I’ve met leaders striving to make a difference but often these leaders feel like they’re pushing water uphill and eventually get worn out by the system. In the same way as the water lilies, leaders need an environment that enables their flourishing.

There are a number of good practices which begin to cultivate these conditions. Here are 5 of these practices based on research, evidence and painful experience:

  1. Relationships first – build deep, lasting relationships based on trust first, these will carry you through the tough times.
  2. Managing the tensions – understand the difference between problems that can be solved and interdependent issues which can only be managed e.g. supporting the needs of the patient AND the local population or reducing total cost of care AND improving patient outcomes.
  3. Translating concepts to reality – use design criteria to translate conceptual strategies and outcomes into the practical features of the future system. Used consistent criteria when designing multiple levels of a system.
  4. Organise around purpose and meaning – design the system, organisations, services and teams around purpose and meaning – in the public sector this means organising around the citizen to fulfil their needs.
  5. Engage, engage, engage – Invest in engaging the whole system from the beginning, empowering and giving everyone equal voice, throughout the process including handing over to the new “business as usual”

I’d love to talk about these and your own insights. You know where to find me. Nick Richmond,

22 - Model of Care design Group - Meeting 2