Wicked problems and thinking more systemically about new models of care

The biggest challenge today for many leaders involves dealing with very complex, systemic problems and what can feel like impossible dilemmas. It can feel overwhelming trying to balance multiple stakeholder groups, financial pressures, demand for quality improvement,  the wrath of senior leaders, raising safety standards and conflicting values, all at the same time. In short, they are confronted with what leadership professor Keith Grint calls a “wicked problem.” These are problems that are messy, have no one solution, occur when there is increasing uncertainty and a pressing need for wider collaboration.

Systemic wicked problems go beyond the capacity of any one person to understand and respond to, and there is often disagreement about the causes of the problems and the best way to tackle them. Wicked problems are also difficult to tackle effectively using traditional thinking i.e. that the best way to solve a problem is to follow an orderly and linear process, working from problem to solution. Resolving wicked problems requires changing the way we think, balancing overly rational approaches, using innovative ways of team working, trying new behaviours, time to step back from the chaos for richer sense-making and more authentic conversations.

To think systemically, beyond our local situation, we all need imagination to understand the other parts and connections of the wider system that we don’t experience directly,  that we may have an impact on and yet may be out of our control.

When lots of factors need to be considered in decision making, visualising the bigger picture, for example, how a local health system interacts with the wider systemic context, can help a leadership team explore how their decisions might impact different parts of the system. A team can then make sense of how things connect and see an overview that clearly shows the complex interrelationships that are difficult, if not impossible, to represent in words. Gathering a whole team's individual views into one big picture that represents a shared perspective in a way that can transcend personal differences and bring together their collective thinking.

As an example we recently we worked with an NHS trust exec board who were facing a wicked problem. As well as the business-as-usual agenda items, and the pressure to deliver their new strategy, it was critical that they found a more creative way to explore the different dimensions of a new strategic partnership with two other trusts. This involved exploring new organisational forms and to deliver new models of care. Their awaydays often felt hectic and had many tacitical agenda items to cover. The trust’s OD Director wanted to shift the conversation about difficult strategic decisions and be more systemic in their thinking.

The challenge

”Our fundamental challenge was how to look after our own trust and considering our own community needs, while at the same time looking at what is best for the wider patient care system. We need to be answerable to local communities and at same time need to make strategic decisions for whole health system.” ...“The sort of questions the Executive board were asking themselves were: What new organisational form will enable us to deliver better healthcare? How can we deliver systemic change that improves the quality of patient care and reduces costs at the same time?” Trust O.D. director

The OD director brought us in  to support her to change the conversation with her board using our Visual Dialogue methodology.  A Visual Dialogue is a facilitated conversation that can support leadership teams to have better quality meetings when they are struggling to make sense of complex problems. The conversation was facilitated to focus on their big picture of the “wicked problem” which was created out a a series of 1:1 interviews. We listened carefully to what they said and encouraged them to speak from a personal perspective.

The picture helped to shift the way the team discussed their challenges by showing the complex interdependencies and  relationships between critical factors and how they affect each other to. The facilitator kept the group's attention focused on the picture and what’s most important and created a safe space to test the level of consensus on critical issues. The session encouraged the  team to think and talk more creatively, systemically and long-term, beyond their personal situations and agendas.

The Big Picture of the board’s wicked problem

What happened?

“Our board members often have their own bit of the system to sort out and prefer to break complex problems down into the smaller parts that they are more comfortable with, that are within their comfort zone. Though that might only result in one piece of the system working well."

 "The Visual Dialogue session shifted the quality of the conversation and using the picture encouraged them to think more systemically about local issues the process changed the level of questions they were asking, and so challenged their thinking to a new level."

"It enabled the board to think and talk more systemically, beyond their own personal points of view and level of thinking, about wider issues and how these impact each other."

 "It created space for the board to test their level of consensus on partnerships, and go beyond personal values to consider the greater good. They could explore the ethical dilemmas involved and get beneath the commercial and transactional focus of their role, down to a transformational one where they were getting an idea about if they had shared values and talking about values based leadership. Ultimately the session was as much about about building relationships and uncovering personal values as it was about solving operational issues."

 "The quality of the conversation was more strategic, fluid and creative, it stopped them getting into detail too quickly. The Big Picture kept the conversations from getting too operational, too quickly, and forced broader thinking, it kept them strategic. It stopped them deconstructing the “problem” down to something they can control and manage."

"The big picture allowed me to keep them uncomfortable in a non-threatening way.  It kept them in a place of looking at the interdependencies. The big picture showed most of the system, so the  board could see they are facing an intractable problem, which can’t be solved with an action plan, and there is no commercial solution currently. So it encouraged them taking a broader view while keeping it personal - bringing alive the things they have to consider and deliver on."

"The Big Picture was like an interdependence map - you can’t look at one isolated element without seeing connections and consequences. Everything is there in the picture - it showed the complexities of the environment in one place - which papers can’t do. And it helped in understanding the complexity in a way they couldn’t have done reading board papers. It stimulated thinking about potential consequences out side of our normal boundaries as it can be difficult to move out of your own familiar lens/way of understand the world.  The conversation raises consciousness that you can’t take actions in isolation, it stops you thinking that you can acts on things alone. “ If you make a decision here- it makes you think- what’s the impact there”. It stopped disrupted their linear thinking by bringing to life all the complexities involved in running the trust."

 "Having a picture made it easier for people to declare openly that they didn’t understand “that” [pointing at something specific in the picture]."

"The Visual Dialogue session allowed the board to challenge each other and opened up a different conversation and a different space to think in. The Big Picture didn’t provide answers, but it forced systemic thinking.”

julian@delta7.com, 07790 007 560