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Future Search: When Consultancy Works For The NHS

03/01/2017 11:30
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You're pacing the ward, desperate to find space, only to discover some jargon-ridden management consultant hogging the desk with their templates, eager to advise you on 'new ways of working efficiently'. Seriously, 'eff-off!' It's reported that a whopping £640m of tax-payer money is spent on consultancy, but does it even work?

Well, a radically new approach to consultancy is transforming the public sector around the world. 'Future Search' is a principle-based methodology for enabling multi-stakeholder engagement around complex issues. It is a refreshing approach to managing whole-system change.

With support from the Perspectivity network, we recently spent three days in Ireland to learn more about Future Search. The training, run by co-founder Sandra Janoff, gathered 23 participants from as far as South Africa, Australia and the USA.

Why are problems so complex?

Modern day world problems are plagued with complexity at every level. But instead of dissecting and embracing complexity, we choose to solve them through traditional linear means (if 'x' then 'y').

The healthcare system, however, is far from linear. Thousands of healthcare professionals, hundreds of specialities, millions of patients and tens of millions of interactions - all mutually influencing each other in real time. Add to this, an ageing population, diverse demographics, growing inequalities, workforce strain and rising patient expectations. Department of Health's knee-jerk response:- "We'll train extra medical students!".

With multiple stakeholders (Government, CCGs, Trusts, GPs, Allied Professionals, Patients, HEE, Unions, etc.), each interested in their priorities, formulating plans that serve to please everyone is impossible. And so, plans are only made to please the electorate. Issues like teenage depression, suicide, childhood obesity and social care, are dealt with in silos. In areas that I have worked, namely Dudley, there is a huge disparity between primary and community services - we just don't work well together.

This is where Future Search comes in.

How Future Search Works

Sandra started by highlighting the fundamental principles that anchored Future Search:

1) Getting the 'whole system' in the room - ensuring every part of the system is reflected through the people present.

2) Explore the 'whole elephant' before seeking to fix a part. This prevents our natural myopic tendency of quickly converging onto a single idea or issue.

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3) Focus on 'common ground and future actions', not conflicts. The process does not try to change the minds of people. Instead of wasting energy on things that cannot be agreed upon, it focuses on things that can.

4) Self-managing groups - adding another level of management just worsens the complexity. Instead, it encourages self-managing groups.

The Issue

For the training to be real we selected an issue that most people agreed upon - "Healthcare in Dudley", or re-engineered to "Healthcare in Didley" for simulation purposes. For 60 hours, we worked on improving healthcare in this semi-fictitious city of Didley. Stakeholder groups (roles assumed by the attendees) included commissioners, GP practices, patients, local council and the hospitals.

The Process

Here is a very (very!) brief overview of the process:

1) Exploring a common past
It started by creating a collaborative timeline over the last 30 years on a paper wall with events on a personal, local (Didley) and global level. Everybody had the freedom to post their stories, in the end generating a common narrative. The rigour of studying the past to better understand a present issue is unheard of in modern management practices. In the immortal words of Bob Marley, "In this bright future, you can't forget your past".

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2) Visualising a shared present-day reality
After generating a common past, Sandra enabled us to translate our stories into trends - trends that were affecting our present reality in Didley. These included: increasing healthcare costs, reduced funding, increased patient expectations, increased diversity of demographics, an ageing population, increasing mental health problems etc. Rather than trying to justify and fight for our personal opinions, the group were inspired to authentically share and embrace differences.

The emphasis here was to build a shared common present day reality. Unless diverse stakeholders are able to view a whole system as a common reality, meaningful change is a far-fetch.

As a group, we highlighted the most important trends that were affecting the healthcare of Didley, thereby laying the foundation for the future.

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3) Creating a shared future worth living into
Using insights from the past and present day trends, the final task was to create concrete action plans for the future of Didley - the Didley of 2026. In self-managed groups, we developed concrete steps towards a common, created future.

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Summary

Future Search is radical - it embraces complexity. It is democracy in action. It is collaboration for good, for progress. It's a methodology for developing common ground.

The NHS is an unrelenting beauty, where the ego of top-down policy-making will never quite work. It takes a level of maturity to stop oneself from prematurely offering solutions without embracing the whole system. The future is uncertain. With massive re-structuring all over the country, including the new MCP model in our dear town of Dudley, how can we ensure that everyone is valued? How can we create a common future that everyone wants to live into?

Future Search in UK/Ireland is facilitated by Michael Donnelly. Contact him on Michael.Donnelly@perspectivity.org.

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