The Joy of Wading: Leadership and Team Working In Swampy Conditions
| DOI | https://doi.org/10.1108/13619322200400031 |
| Date | 01 September 2004 |
| Published date | 01 September 2004 |
| Pages | 35-41 |
| Author | Steve Onyett |
| Subject Matter | Health & social care |
The Mental Health Review Volume 9 Issue 3 September 2004 ©Pavilion Publishing (Brighton) 2004 35
his article is a shameless smorgasbord
of ideas on leadership and team working that I have
found exciting and helpful in pursuit of service
improvement. They make sense in the difficult,
conflicting and complex health and social care
environments that I live in. They describe what works
when trying to make progress in the swamps we know,
rather than providing more exhortation to fly with
eagles.
I do not mean to be pejorative when describing our
environments as swampy. It is true that swamps are
places where progress takes effort, movement meets
resistance, there are hidden predators, and you fear
disappearing under with barely a ripple. But swamps
are also beautiful, fascinating places teeming with forms
of life in constant and complex interaction and co-
evolution with each other. Understanding and working
well with this complexity is important. Complexity
theory is about looking at how change occurs in nature
to inform how we might improve outcomes in the
systems we work in. Constant evolution and adaptation
is key to survival in changing environments. You have
to be changing even if you feel like you are staying the
same when the world is changing around you. As
Leonardo da Vinci observed: ‘Those who take for their
standard anyone but nature – the mistress of all masters
– weary themselves in vain.’ Some things just are the
way they are and we need to deal with them as they are.
Plsek and Greenhalgh (2001) described complex
adaptive systems as ‘a collection of individual agents
with freedom to act in ways that are not always totally
predictable, and whose actions are interconnected so
that one agent’s actions change the context for other
agents’. Oft-cited examples from nature include
colonies of bacteria, flocks of birds, termites, bees, and
just about any collection of humans – multi-disciplinary
teams, for example. Some of the key features of
adaptive systems are that they are continually adaptive,
Tpotentially self-organising, co-evolving with other
systems, and unpredictable in detail but with patterns
that can be discerned through action and observation
(ibid).
Three legs of the service improvement stool
Systems can be described in terms of structures
(concrete attributes), processes (a sequence of events)
and patterns (phenomena) (Capra, 2002). Within a
system, these patterns are what we experience as
culture – the norms for the way things are done, the
values, beliefs and attitudes in play, the meanings,
narratives and sense-making that characterises what it
feels like to belong (Mannion et al, 2003).
Take the local implementation of the integrated
Care Programme Approach (ICPA) in mental health as
an example of a complex system. It has structure in
terms of teams, paperwork, people and computers. It
has processes that involve users, their social supports
and staff with these elements of structure (eg referral
and assessment processes and how information is
collected and shared). It also has a culture which is
more difficult to describe and make conscious but
which will influence whether ICPA is implemented as
an improvement. Is it seen as a benign process for
helping people navigate complex systems, a way for
practitioners and their managers to cover their backs, or
the dead hand of bureaucracy extinguishing therapeutic
initiative and autonomy? Who owns it? Who is it really
for? Has the process been mapped with users and their
supports at the centre? At local level these questions
have a profound impact on what actually happens.
Edwards, Hadridge and Plsek (referred to in Plsek,
2002) shared the following reflections on the impact
on improvement of these three aspects of systems. We
experience seemingly endless changes in structure
whether it is obviously needed or not. This is often
The Joy of Wading:
Leadership and Team Working
In Swampy Conditions
Steve Onyett
Senior Development Consultant, NIMHE
Inaugural Lecture
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