09 Tom Inns: Healthcare system design

I'm not totally sure I understand, but I guess every time I'd opened a book or opened an article on the topic of systems design, it seemed to get really complicated and really jargony really quickly. and you managed to avoid all that. So I thought it'd be good to dig into it a bit more on the podcast.

So why don't you start by just letting us know how you got into the systems design game. how did you start and how did you end up here?

And that I think was the kind of beginning of my journey. I think you've probably, you've been on a very similar journey, Kevin. and, I met you at that kind of point when we were in those different directions. So when I finished art school, I in lots and lots of projects, which were what happens when you put a designer into a complex situation. So I was involved in projects, which were, how can you improve welfare of farm animals using a design approach? How can you reduce the amount of plastic?

Waste in horticulture using a design approach and very quickly those projects they were they became about visualizing something very complicated and The kind of design role in it was always trying to bring together in order to solve those problems.

They're wicked problems It's what you know, Dick Buchanan calls a wicked problem you have to assemble this kind of collective brain of people with expertise and In my mind, design's really good at acting as the kind of facilitator, as the bridge, as the visualizer, design's got process, design's got methods, and so it quite comfortably into that world of challenging problems. And in order to understand problems, you have to look up a little bit and see the system.

Designers always tend to look down a little bit and see the product or service, but in order to understand the system, explain it, get everybody to Get involved in the challenge. You've got to visualize it. So I think that's where that journey began. And, fast forward X years, and, I've, had all sorts of different roles. Gone down an academic path, so I did a PhD looking at what happens when you put a designer into a business, and what impact does it have on innovation and so on.

But it's always been, Part of my practice, if you like, in all the roles I've had, that kind of seeing the bigger picture and facilitating people through a discussion around the bigger picture. So I think that's where my interest in systems has come from. But I completely understand where you're coming from. I, I've got a of unread systems books on my bookshelf.

I dip into them and like you, analogies to radiator systems in your house and so on, they're interesting, but they're they're not terribly inspiring.

now. Systems, design crops up in so many different domains that, it comes up in biology, it comes up in climate change, it comes up in urban planning and economics, software engineering, so many different areas Is there a commonly held method or approach?

So in healthcare, are, yeah, there's lots of systems in play. And if you, use the right mapping approaches, you can begin to see them and make sense of them. if you're in a corporate world, there will be systems in play. They might might not be immediately apparent to you, but if you use some of the kind of system mapping methodologies, they will in a sense appear. yeah, that those things do exist.

so wherever, whatever sector you're in that there's a system to be mapped out terms of how you create those maps. Yeah, there are there's a whole series of different methodologies and approaches, but in principle, They are looking, you're mapping out flows of things. It might be flows of people, flows of materials, flows of value, flows of money. you're mapping them out as they go from the start of the system through the system and back out again.

you might be mapping relationships between people, loops, causal loops, what's influencing something else. you might be peering into the system, looking at it through different lenses, looking at, what are the events that we can see on the surface? What's lying behind those events? What are the trends? what are the structures that are influencing the system? What are the mental models in the system? So that idea of paths, relationships, and Some kind of hierarchy.

They're the three principle ways of peering into a system, exactly how you map it. There's so many different kinds of approaches to mapping these things, just as there's no unified approach for doing service design maps is that everyone does in a slightly different way. And. In a way, a surface design map is an abstraction of reality, isn't it? And that's what a systems map is.

So I don't think it's really, books make it really complicated, but I don't think it's that far out of reach of a design mind, a systems map. it's just looking at that a little bit more than we normally do.

have you. And, there's definitely going up to a more helicopter view. I guess there as well, but you mentioned, service design. So while you've mentioned that, is system design just another name for service design or is there, what's the difference,

but if you're taking a systems view, you are looking at all of the strands that a kind of organization might be running and you're you are, getting that kind of visual overview of what they all look like. and then you might then kind of. zoom in on one strand one kind of service and kind of make those alterations But before you do it, you're thinking well, actually Where should I put my efforts? Where should I put my resource? What is the aim of this system? Which strands should we look at?

and you are a service designer just playing around with the strand you there's a there's risks in what you're doing. So you know, if you imagine pulling that tiny little bit of the cobweb, that, that kind of strand, it distorts the cobweb. So if you don't understand the system as a service designer, how do you know that you're actually, what you're doing is not disrupting the whole system? How do you know that you're actually, what you're doing is, The best possible thing.

How do you know what's going on upstream and downstream from you? So I think that's the relationship between the two. It's the service designer. looks at the tree and the system designer looks at the wood. So you can see the wood for the trees kind of thing.

It's that kind of relationship between the two things, obviously they blur there's a kind of blurring between the two, but it's just that kind of business of looking up and seeing the bigger system, which I think is the key differential, some of the kind of mapping approaches that there's kind of similarities to them.

the system as it's experienced by the user above the surface, or you could map what's going on underneath the surface in terms of how the system runs, that you can go through exactly the same layering. In the work I do in healthcare, what I do, which to me as a designer is obvious, but it's quite revolutionary in healthcare, is I map out very often with kind of the people I'm working with, what does their healthcare system look like?

in terms of the of all the patient pathways in that kind of particular healthcare system that's looking for a kind of design input. So we create what really effectively looks like a kind of tube map. It's the best way of describing it. It's a kind of, where the kind of Piccadilly line is the cardiology line, the Jubilee line is the respiratory line. There's the circle line going around in the middle. There's zone five, which is where all the general GPs are. Zone one is the center of the city.

That's where the kind of main hospital is. We can create this kind of map of all of these relationships as seen by the service user, who is the patient. And that's a slightly different representation to what a service designer would have created. Service designer would probably have focused on the Piccadilly line or one line, but The system map of the same thing is that kind of whole tube map. I, it's difficult kind of vocalizing this on a podcast. I

And, the innovation is not just in one place. It's a kind of coordinated portfolio of change across the system. a sense, that's how it all sounds like common sense, but in reality, that doesn't, that's not how most systems actually work. So again, going back to the healthcare example, which is one we all know, very well, because we all experience it. healthcare doesn't work terribly well.

As a piece of system design, because, we have primary care, which is GPs, which is what you experience in the community. And then you can get referred to secondary care, which is hospitals. And those two kind of worlds are not terribly connected. They're not running on the same digital system. no one in secondary care really knows where you've come from.

they don't know really where they're discharging to you to, so they don't know how to get you out of the hospital if you've got particular needs. So you end up staying in hospital longer than you need to. Did you really have to come to hospital anyway? Could you not have been treated at home?

So you can see in, in that thing we experienced day to day, the healthcare system, you can see all sorts of ways in which that is failing as a system, because it's not being looked after terribly well at system level. and, heads are not being knocked together in terms of aligning how it works, and I think the same thing in a corporate world. is probably not quite as complex as health care in many ways.

and, it might have, there might be more alignment in how it works, but I suspect actually, even in a kind of quite sophisticated corporate culture where you have silos of people and expertise, you have disconnect. And that's where kind of understanding what the system looks like is really important. really powerful. So are examples of good would look like and what bad looks like.

to me, the classic example is in healthcare, to go back to that one is, we all know, the politicians obsession four hour waiting times in accidents and emergency departments, it crops up on the news all the time. We switch the news on and we see ambulances queuing outside accident emergency departments. And we all say, Ah, isn't the NHS broken? And then people come along and they try to, find a solution to that.

And I've been to healthcare trusts where of the solutions are things like, let's build a tent in the car park outside the accident emergency department, and then we can offload patients the tent. And then that will mean the ambulances can get away. And then somebody else comes along and says, let's buy more ambulances. And we'll have more ambulances dropping off people outside the accident emergency department. The reality is those two things.

building the tent and buy more ambulances no difference whatsoever to ambulance discharge times and the four hour wait because the people are not understanding the bigger system and how it works and you know what's going on downstream and upstream from that particular point. and what are the mental models of people actually going into the accident emergency department? So that's, yeah, that, that's where systems thinking comes in, I think.

When you ask the same question of the Norwegian healthcare system, they say, yeah, the aim of the system is right care, right time, right place, and educate the patient. just by adding in that extra Three words into the whole overall aim of the system. It completely changes the way the system works So, you know when you go and see a gp the gp gives you the right care right time right place but also says Kevin, how can we prevent this happening again? what can we learn from this?

How can I act as a kind of educator for you? And then when you go to your outpatients appointment, you get given the leaflet about how to avoid this happening again. So the whole system has got that kind of built in thing that we will empower you the patient. Another little thing about the, this kind of Scandinavian healthcare system in the UK. You as the patient have no access to your health care record.

it's a, every time you go to the doctor's, someone makes a note about you and writes some notes, but you never know what's in that drawer. It's not in a digital folder, you can't get it downloaded onto your phone. But in Scandinavia, you are the owner of your health care record. So you, get told what the test results are. You get told you've scored 6. 7 for the test, the blood test or whatever, the last time you had your blood test.

And so you you're empowered as a kind of service user in the system. but just shifting the system dynamics like that has a profound impact on how the system works. And that's where kind of understanding the power of systems. I think it's really important.

Inside the system, you're altering the power balance and that we're going down a bit of a healthcare rabbit warren here, but it applies to, I think it applies to anything that we might be working in, even if we're in a corporate world, really understanding what is the aim, what is the aim of the corporation? Sure it's here to make money, but what, do, what is it we're trying to do and how does that kind of influence everything we are delivering it? It's going back to that kind of.

It's just aligning around that, having a system aligned around that kind of strategic of the organization, I think. So that, that's where, perhaps that's an interesting, that you have strategy, you have design and perhaps systems, the thing in the middle, which kind of helps deliver. things across the organization. There's a thought.

It's a, it's this kind of representation that we can then use as a kind of platform to solve the problem. So we, we create the boundary object, we create

usually when I'm working in healthcare, it's about creating an ecosystem map of healthcare pathways, or, it might be relationships between stakeholders in a different type of organization, but those visual representations of relationships and pathways don't really tend to exist.

So I come along and start with a, work with a kind of small group of people to create a draft representation and then we roll that out with we usually do it online in Miro and so on but we roll that out with more and more groups of people in the organization to Get buy in to that's what the that's what the challenge looks like and we all add a little bit Everyone adds in a little corner into it So it's like embroidering a kind of rug or something you You slowly develop this visualization of what

it looks like. So everybody then agrees that's what the thing looks like that we're trying to tackle and everybody's bought into it because they've had their opportunity to hack something as the designer. I have to, work out what the rules are going to be for visualizing this. it's quite simple things, what colors are we going to use? How do we show a stakeholder? How do we, what does a line mean on my system map? What does an arrow mean?

So we have to I usually construct some kind of legend, if you like. And then we use that as a set of rules to visualize the thing. And it, it's a, it's an iterative process. It needs tidying up. But anyway, that's really. Not that different to what you'd expect. What we do in design when we're doing a service user journey map, because, before you've actually mapped out the service user journey, you don't really know what it's going to look like.

You don't know how long the piece of paper is going to be, and you don't know how many layers they're going to be in your map. You sometimes think, Oh, we have to need to have, we need to split our touch points into five different categories. as a designer, you're always altering your kind of mapping methodology, the same for doing this. So that's step number one. Step number two is then to let's all sit down and work out what are the challenges in the system.

that's where you can take this kind of system thinking approach. What are the events? What are the things we see day to day that kind of flag up a challenge for our way in A and E. We then I then say to people, what dates do we have? What do we know? What are the trends in this system? What's going up? What's going down? what we know about the kind of underlying structures and what do we know about the mindsets that. have created this system in the first place.

we can you can get people to review what's going on at the moment from all sorts of different perspectives, that's gives you this kind of rich understanding, and then you get into right, what are some of the solutions? And, there might be a design solution. It might be, let's re rework that service, but the, the interventions you might make into a system and improve it. that, that you're probably looking to for a portfolio of interventions in different parts of the system.

of them will be familiar design things, but it might be, let's shift the policy on that or let's When an educational campaign in that corner of the system, so it's perhaps a little bit broader than we normally think of when we're coming up for a design solution. And then you think, how are you going to roll out those interventions. And there I use things like, how might we statements for framing, framing those problems. So in a sense, I'm just I'm just following a design process.

It's, if you want to call it a double diamond, we do discovery, we do define the problems, we do develop solutions, we do implement solutions. So I'm starting with a systems map, the boundary objects, but I'm just running that double diamond design process if that's the one people like, at a kind of systems level rather than down at the product or service level. that's where system thinking meets design thinking, I think.

of the current state that you can then use to, identify, points of weakness or whatever, or opportunities for improvement.

You're always, usually you want to move the system on, but you usually do that by system shift. it'll always be through probably some kind of portfolio of iterative improvements, but the sort of to be system, your perfect system can act as a kind of pole star. to guide you. So going back to your question, no, we we create the, as is system map, whatever the system is. and then we annotate it. we use it as a kind of something that we can annotate to mark up where the challenges are, and so on.

But then you can actually run a session where you say, what would the perfect system look like? And most systems, interestingly, people have never really been given that opportunity to actually visualize. a better way of doing things and although it's Something which is as I said very difficult to actually enact because you can't close the existing system You can't close the nhs down and then reopen the new nhs on monday.

It's not it's too complicated Actually giving people The, empowering them to actually think of the perfect system. It does shift the way they think about things, actually. It can be empowering. The other thing I find is that if you co create the map, it's, people find that, the psychology of that is, and you'll have found that in your own practice, the psychology of that is hugely empowering for people when they can actually see what it is they actually do and communicate that to other people.

They take ownership of their, roles in a really interesting way. And, it, the psychology of it is really engaging when you're working with a group of people to give them that sense of ownership of what they do. people love contributing what they do to the system map because they love to see themselves in the map.

That the patients had to wait that long in the outpatients clinic and I had no idea that it took them so long to navigate their way through the hospital car parks and, navigate their way through the system. And I had no idea that the, the GPs didn't know how to refer into my clinic.

So that there's often huge surprises for people who are working inside the system because quite often we kind of work within a silo and we generally don't know what's going on to the left and right of us, even when we're, Quite senior in a system. It can be particularly when the system is quite complicated. So it happens all the time. there's really interesting revelations.

particularly, if you're co creating with a large group of people who don't necessarily meet each other and connect very often, you'll get all sorts of revelations coming from that sort of discussion.

For the board game, you can almost put peg figures around the system and actually then, just based on real human experience, begin to understand what the challenges are, because often it's humans who join up the system, that join up with the kind of silos in the boxes. So their experience is really key. Obviously, you can't map every single element. Human journey that ever was.

So you might need to put people into genres and use personas and so on, but that's an incredibly useful way of uncovering challenges, but also the challenges experienced by, people working in the system. It's also really useful to think about those challenges through a kind of. Some people call it kind of an iceberg model. You look at the events, the things that we spot in the system day to day, but then you dig below the surface and say, what are the trends below those, behind those events?

see events on telly, on the news, but in a sense, really what's important is that going up or is that going down? There's been a terrible stabbing somewhere, but is the rate of stabbing going up or the rate of stabbing going down? That's a really important thing. So we can start looking at data and what data tells us about challenges. we can then look at the system and say, what are the systems and structures behind the system? And what are the challenges with those systems?

Are they not talking to each other? And then you can think about, what are the challenges that, what's the baggage everybody's carrying around? What their mental models. So we can look at day to day events. We can look at experiences, we can peer into the system through other lenses, but we get a really good sense of the challenges, the shared challenges in the system, incredibly important.

We then, obviously, we need to go back and perhaps refine what's the aim of the system based on that information. So it's an iterative process. we then go into the next step four, which is, okay, that's the system. Those are the challenges within it. Let's now ideate. And, develop some sense of what the improvements could be. And rarely is there one silver bullet. There's rarely one thing that you can do to the system which will transform it. You'll have to make variety of interventions.

You might need to sequence them. and some of them might be, useful piece of terminology is adaptive. They might be where you empower a group of people in the system, give them an aim, and they, of generate solutions in their part of the system. So almost from the bottom up, some of them might be transformative where you're a bit more like a Monty Python foot and you, say, this is going to change. We're going to shift policy here. We're going to, change something at a high level.

So there could be adaptive changes or transformative changes. again, if we're looking at adaptive changes, one of the things I found really powerful is to, Almost kind of these are challenges in the system. How can we overcome them with, I I'm a great fan of using how might we statements to create almost little mini briefs. So how might we have this impact on the system for the benefit of these people to deliver this impact? So we're not we're not necessarily.

Coming up with the solution there on there at that moment. But we're setting up a series of mini briefs for people to go away and explore. But anyway, can generate big portfolio of, improvements. They then need to be sifted. and so we need to do evaluation on them, just in perhaps the same way, but that's a design, that's a design challenge. what are the criteria for making choices? I'm quite obsessed by criteria for making choices. when we think about design, we tend to.

I think always over focus on the creative bit coming up with lots of ideas, but the clever bit and design is always how do you filter them down into. so that's where you've got to have really good criteria. we we generate our solutions that way. and then we, hopefully we then have a kind of priority list of things we're going to do, but it's always a list of things. There might be five or six interventions we're going to make across the system.

takes you into kind of final step, which is delivering impact. And, if we're taking a system view, usually we are, We need to deliver a change in a slightly different way to what we do day to day in the organization. So we've got to choreograph and curate, perhaps new interdisciplinary teams in the organization to take. Ownership of a Might We or a particular part of the system. you're probably going to have to start spinning several groups like that.

So what you're really interested in is collective impact. And, that means you've got to have a kind of framework in place in the organization to, enact that. And there's some really interesting writing on collective impact. I can give you some references for that. Kevin to put in the show notes, that kind of model of change. So it's it's a, what is your model of change in the organization's key thing?

Okay. So those are the, those that, that, that kind of rather abstract, but those are the stages that I work for, the steps I work through.

how do you integrate those insights into your process, your workshops or what have you.

And then you try and bring all of that data in from these different sources, and usually it's a little bit incompatible. there's usually quite a lot of data on one bit of the system, but not another bit of the system. Depends on what the system's tracking. But then it throws up this question. It becomes almost like one of the how might we questions. How might we collect data in a slightly different way so it's actually meaningful? actually can drive decisions. But data is fascinating, I think.

And I, again, it's the kind of slight, art side of me. I always call it, people in data hate this, but I always call it painting data onto the map. I almost see it, I do, but I do see it like painting, it's like you have a painting, you have a kind of sketch and then you put the colors in, but to me, that's what happens when you map data onto one of these maps, it brings it alive. and, It becomes quite interesting.

And, that's where, if you have all of the data in your system app, you're coming into the world of systems engineer wing, where you can create a sort of digital twin of the system to you know, to model changes and so on, then, that's way above my pay grade, but that's what, a systems engineer will do for you.

So there's usually, you can usually piece together the flow rate data, but that's all that tells you is. much water is flowing through my hot water system? It doesn't actually tell me whether the radiators are hot or cold it just it's just a dial that says yeah The water is whizzing around the system really well and the most important thing in health care is you know What actually is the outcome? But what is the quality of that for that particular person?

were they cured as a result of doing that and did they live for another? 10 weeks or deliver another 10 years kind of thing. So the system's mapping lots of flow data, but it doesn't really give the outcomes data. And I suspect that's super true. if you can take that straight back into a corporate environment, you will have lots of data performance data, which is to do with.

Yeah, tracking the numbers through the system, but perhaps an awful lot less, which is perhaps a little bit more qualitative. but it sparks that entire conversation, which is a really important one. and, in healthcare, that's a massive conversation at the moment because everyone's looking at value based healthcare now. One of the things about data I always find really interesting is, how often people are not looking at future trends.

in any, again, almost in any scenario sector, you can, once you've got the system map, you can say, is that going up or is that going down and how quickly and, this, I think this comes right the way back into your bread and butter in terms of, the research work that you do, you're very interested in kind of future scenarios and what's going up and what's going down. And quite often I find people are quite blind to that.

They're usually dealing with the here and now rather than future proofing their system. And, in healthcare, you can see that in black and white in front of our eyes. the number of people with multiple long term conditions is going up. We've got an aging population, the number of 80 year olds is going up by 5 percent per year. we will peek out on that, but the system's not itself for those quite radical shifts, which are entirely predictable.

if you're in another sector, you can, there's huge amount of data about trends. Some of it might be a little bit more speculative because it's not quite so demographic, you can really bring that, that trends data into a system map, I think. And then it becomes really interesting.

so with something as massive and complex and unwieldy as a health system, how do you How do you validate, system design interventions, as you call it, or do you just, or are some of them, you can, it's just a change of process, so you can just try it out for a bit and if it doesn't work, go back to the old one. how do you address that sort of test and learn, approach in your context?

and so you you can't make an alteration, which is going to be mission critical. So there's that kind of methodology. But inside that as well, there is this kind of very well defined. approach, which is called a test of change. So you you go in and you will prototype the alternative system almost perhaps at quite a localized level. It might be for a period of time. You might say for that, we're going to rerun how that clinic works for five or six weeks, and we'll do it as a test of change.

We'll gather the data in the before, and we will quite systematically see what the impact is. And actually, I think that's quite interesting, what happens in CalSci. They're really good at doing that. On a good day, they're very good at doing that. And that's the test of change. So it is a kind of form of kind of prototyping. suspect that in the corporate world, I do a lot of work in higher education and universities. Universities are appalling at doing that.

They can't, they don't know how to do that. that's not an inbuilt kind of improvement methodology. And I actually, I think in the corporate world, I, when I've worked in with more commercial companies or in the third sector, that doesn't really exist as a kind of mindset that's how we're going to do things. and I think that's super interesting because, the, design thinking has a bias for action. It does imply that you create a lo fi prototype of something to test something out.

And. think we can probably do far more of that way of working when we, if you take that systems view in, in a kind of, in a design project and find really not necessarily mocking up a, it's not, some of these things are not changed where you're going to change a kind of thing like an app or a service or a product, but, just to change the way a little bit, run a little bit of the process and isolate in a way. So that kind of test of change model is the way

And effectively, they're the users of the change. and how they're going to be affected. You can take you can take a design approach to that. And you can rehearse what the change is going to be and almost build know, a paper prototype of what it's going to look like and then, take it through a process of user engagement to try and refine the change, refine the policy and so on. Because, yeah, quite a lot of transformative change ultimately is a policy change in an organization.

Yeah, so I think you can, but it's probably a slightly different process.

So I'm kind of, I'm doing the system design thing, but I'm also facilitating a process and I think we really do underestimate the craft in facilitation. I know you do a lot facilitation. I know you're an excellent facilitator and you write about it a lot, so it's something you're quite passionate about. my facilitation expertise comes through 10, 000 hours. it's like theatres of thinking, isn't it? Facilitation to be an excellent facilitator. You've got to design the props.

You've got to do the choreography. You've got to, organize the stage. You've got to, you've got to organize the drinks. the interval, you've got to be the narrator, you've got to be the critique, you've got to take the photographs, you've got to, you've got to deal with the hecklers. and you don't, you can't do that instantly. that's learned through practice.

and we don't actually, we don't, in design school or whatever, we don't pay anything like enough attention to that skillset facilitation and how you learn that through practice. So that's piece of craft number one piece of

But when you take that facilitation role on, it's your job to get the team you're working with To solve the problem it's, you're herding a team, over a bunch of different, barriers or whatever to get to that solution because they've got the knowledge and expertise to do it that you couldn't do it yourself.

It's about synthesis. It's, there's so many kinds of skills that come in that design world, which other disciplines don't really have. that's where, that's design's role in the collective brain. if I do something second piece of craft really important and that is the building the system maps you know that I said I used to like mapping things when I was a kid and all the rest of it. So I've always been in that mind of kind of mapping things out, visualizing things. And that is a craft.

How do how do you have the confidence to put your pen down on the paper, draw the line, tell somebody that's what the line represents, bring them into the story, and then put the other lines in place, and a huge amount of the craft for me for that is having a conversation with people and seeing the structure of the problem. that to me is a craft, really spotting the structure, and then working out what are the set of rules that we're going to use to visualize that problem.

that's a craft, I think. So it's the, that's the one piece of craft, and then the facilitation is the other piece of craft.

And I used to give them to these kind of management school students. And I used to say, here's a piece of A3 paper. read that case study and then draw me, what does, how does that innovation system in that company work? And they would agonize over it, but they'd all come out with this kind of visual map. we'd look at how does General Electric do reverse innovation? There's that fantastic Roberto Verganti wrote this fantastic Harvard business review case study about how Alessi works.

how does Zara fast fashion works? You can It's written down on the page in words, and you get that kind of, that written description. But once you've read the written description, you can draw it out as a set of boxes and a set of relationships, and I think that's the kind of beginning of learning how to do that

craft.

Interestingly, what I would say to you, and I'm this is just I'm kicking around at the moment because I've taken on one or two projects which have a little bit of a stretch for me in terms of the sector knowledge, what I've discovered is that, if I'm given, I've got a project that I'm running at the moment, which is looking at, it's again, slightly in healthcare, but it's looking at, pharmaceutical waste and the medicine supply chain and farmers, big farmer and how it works.

and I've got to map all of this kind of material out. you know, I spent Two eight hour sessions on chat gpt just Having this kind of very vibrant conversation with it pulling out key information Getting it to run little maps for me little diagrams and all the rest of it and in that kind of in that kind of 20, 48 hour period, I cracked it really about how that worked. And I think that's, I think that's super interesting because I couldn't have done that without chat GPT.

I was thinking this is, this will make me sound very pretentious, but I was thinking, does AI enable you to be a polymath again? know when it comes to some of those bits of some of those knowledge domains because you know chat GPT I use it.

I use it in an intelligent way to me It's an it's like having an intern working with me I can just go and find out about that Please go and find out about that question, but it answers the questions Instantly and you have to you know, you've got to have a structured mind to ask it the right questions and sure.

For a number of years and you kind of just, you know, how things work and, you've developed a vocabulary that you can recall, rather than, if you've just learned something over a couple of days, you're not going to be able to recall it all, in the heat of a workshop,

yeah.

of maps, it's almost rather than a written report, it's much more I don't know if you remember, probably of that age, Kevin, like my good self. do you remember when a map wasn't something in Google? It was actually the Times Atlas, which

But what I always try to do is try and present it back in a kind of webinar format as invite those people back. I always say to them that, this is, you are the owners of this is your material, this is your world that I've mapped out, it's not my world, so I must give it back to you. Absolute number one pet hate. all workshops is when you give up your time to go to a workshop and no one gives you back any feedback about that workshop. just think that's rude.

And, you've got to give people back and show them where they're thinking came into the process. So I always try to insist on having some kind of webinar thing, a 90 minute session, 45 minutes. This is feedback and then 45 minutes of discussion. Yeah, with that, with the collective group as much as possible and record it so it can go out to other people.

in a sense, you've got to have that as your kind of link into the organization. And yeah, the Miro board will sit there unless there is, a team of at least two or three people who are really pushing it through and have the agency in the organization to push it through. But if you've got that, yeah, I think I have seen them change. there's a great quote from Eisenhower is not necessarily one of my heroes, but he has this great quote. planning is everything, plans are nothing.

you know, will quite unfold as you kind of planned it. But it's the act of planning, which is the incredibly important thing because it surfaces the issues. And I'm a kind of great believer in that. And one of the things I found quite remarkable is the, those people that I've worked with have kind of, implemented, I almost call it system shifting change, where they've made or five interventions over a period of time. They then seem to have quite big shifts in the performance of the system.

That's where it gets really interesting, actually. Yeah.

So it's more of a coaching role than a mentoring role. And so I, I very rarely, they might come and ask me to come and map out another part of the system, another system or something. But, yeah, my aim is always to upskill people with this kind of, gentle bits of methodology and get them to practice it so that they can learn the craft. you know, can't learn design thinking from the playbook. You've actually got to It's like learning recipes from a cookery book.

You can't, someone said to me, this quote Kevin, you can't learn to swim in a library. yeah, you've actually got to do it. you can get the swimming book out off the shelf, but you can't actually learn to swim unless you go to a swimming pool kind of thing. That's,

yeah.

how often do you see the opportunity for that in, in the work that you're doing and what, and are there any characteristics of a system where you say, that's begging to be automated? What, what are the telltale signs, that, that, that flag up that's a good opportunity.

And a lot of those are digital companies that are coming up with, replacing an existing system with a kind of digital product or service. And usually it's a kind of AI enabled product or service. So going back to your question, absolutely. when you see the system as a whole, you can it. The whole thing is probably ripe for automation a greater or lesser extent.

And, usually that's yeah, I think historically when we were talking about automation, we were often talking about creating a. a digital version rather than a paper version, if So using, digital functionality to kind of data, store it and so on. But I genuinely see that, AI will, it's getting there and it will accelerate. It's, it is going to have a profound impact on how you automate a system back to your question about, where do you see that happening?

Wherever you have to Wherever you're triaging something or making a decision, sorting something, putting it into lanes or whatever. and you're doing that kind of with the touch of a human at a moment, you can automate that task and you can automate the flow. And machine learning, which is the kind of other element of AI where you're harvesting data and over time you're training your kind of machine learning element of your system to make predictive decisions. Machine learning will.

have profound impacts on the way these kind of systems work and, and the way you make decisions. So is, is probably the a significant driver of improvement, greater efficiency, innovation in these systems. But again, it depends how you there's ups and downs in that you in a lot of the systems I'm dealing with, they're all a bit dysfunctional because, and people, they're very short of resource. that's on a good day, actually, that those kind of AI augmentations are actually releasing people.

To, deliver a much higher quality service. So we're not getting necessarily getting replaced by machines. We're just optimizing what we're doing and then the machines are optimizing what they're doing. But I think that's massive.

She wrote an awful lot about kind of ecological systems. That was very much her thing, but she wrote some amazing books. She's got an amazing book called, what's it called? systems thinking book by Daniela Meadows, thinking and systems. And that's like very much a primer and it's really well written. And I think that's a fantastic book and kind of legacy, it's been packaged.

there's a website called the Donella Meadows project, or I'll give you the URL, which has got some really useful resources, references to her books and so on, and there's some quick guides to systems thinking there. And actually she was way ahead of her time. if we look on LinkedIn, I get lots of LinkedIn posts about regenerative design and things like that. The Donella Meadows was doing this 25 years ago, 30 years ago.

And, there's a lot to be had from just reaching back to the origins of systems thinking. And, Daniela Meadows explains these things really clearly. There's some people have begun to write books, about how do you glue the world of design thinking and systems thinking together. Some of those are really interesting one. there's a good one I've got here. It's, Closing the Loop Systems Thinking for Designers by Cheryl Kebaba. I think that's how we pronounce her surname. I've recently read that.

I think it's quite good. I think quite good. It's beginning to make those links. I think there's a little bit more refinement that needs to be done. But those are two interesting sources. there's the, another really interesting group is the systems innovation network is run by a very enthusiastic team. Josh Colchester is one of those team members here in the UK. It's quite an international network and they, it's quite an open source sort of group and they have quite a lot of pop up events.

I went to their systems innovation conference in London in September. They've just run a systems innovation day.

For, the public sector in London, I think they had about a hundred people come along, they're incredibly accessible events, and I love them because you go along to those events and you can go along from almost any discipline just hang out with people who want to find out about systems, and you will have the most amazing conversations because you will rub up against people from the corporate world, public sector, Transcribed all with that kind of thirst for knowledge or with quite a lot of sector

knowledge trying to piece it together. So if anybody wants to Dip their toe into the systems world look up systems innovation network, and they'll probably be an event them to distribute them In different countries in different cities, so they're a really interesting place to go to and I'll put some give you some information about call patient ecosystem mapping and the work I do.

So if anybody's interested in this, particularly from a healthcare point of view, I'll give you some resources for that too. Yeah,