Steve Onyett on NHS complexity

Steve Onyett

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One of the biggest challenges in conveying the profound implications of complexity theory is its name. What could be less appealing to busy staff?

This theory is not new, but there is much that continues to flow from it - and it has major implications for what we are continuing to try to do in the improvement world.

Improvement and innovation consultant Paul Plsek has done more than anyone else to communicate the importance of complexity to the healthcare world. He draws on Brenda Zimmerman's metaphors for simple, complicated and complex problems.

Working with a simple problem is like cooking a meal from a familiar recipe. There is a reliable solution that delivers almost identical results every time with no great expertise required.

Working with a complicated problem is like building a moon rocket. It requires much higher levels of co-ordinated knowledge, expertise and experience to achieve the required result. A clear plan is critical and the process requires the rigorous co-ordination of a range of experts.

Working with a complex problem is more like raising a child. There is no blueprint; every child is unique and the outcome remains uncertain despite your best efforts. You have to allow children to take risks in order for them to be able to learn, and if you attempt to control them throughout their development their outcomes tend to be less positive.

Achieving improvement in the context of health and social care is complex rather than complicated. So it is more like raising children than building moon rockets.

Given that we are all parts of natural systems, this should not surprise us. But we resiliently continue to act as if we are building moon rockets. This is the management style with which we are familiar.

We have become used to the security of blueprints and spend a disproportionate amount of time sitting in meetings refining them when really we should be out there conducting myriad small innovations in a supportive environment and making sure we constantly learn from them.

Successful leaders in the commercial world have much to tell us. Percy Barnevik has a glittering career as a leading international businessman, regularly topping polls as Europe's most respected chief executive, and has now turned his attention to tackling global poverty. He is strong on multiple approaches and devolved responsibility and autonomy, albeit in a context that is strong on measuring outcomes and setting clear targets.

Working well with complexity involves experimentation and innovation and allows space for learning by doing. People need a clear but minimal specification of the task they need to achieve in order to allow space to exercise their creativity.

How often do you hear people around you say "it's not rocket science"? The next time they do, tell them it is more "not rocket science" than they could possibly imagine.