As part of a month-long NHS Modernisation Agency Improvement Knowledge initiative that we are helping to support, we organised an online seminar with Knowledge Management guru Dave Snowden on May 19 to provide senior people with a fresh perspective on managing change in large, complex systems such as the NHS.

The full audio stream of the session, including Q&A, is currently available here (type 'Dave Snowden' in the Name box and it should let you through) for computers with Real Audio player or Windows Media Player (more formats to follow soon when the conference people give us the files).

Dave talked about three things that are potentially very important to the future direction of improvement knowledge within the health service:

1. influencing change in complex systems
2. sense making, narrative structure and storytelling
3. social network stimulation

Dave began by using the example of different approaches to organising a twelve year-old's birthday party to illustrate why our standard approaches to managing complex systems such as the NHS can sometimes be wasteful and ineffective. We don't organise such a party by convening a design team six months in advance, setting objectives, creating a project plan with milestones and targets and then explaining to each child using powerpoint slides how desirable behaviours will be linked to rewards, followed by an after action review designed to derive best practice for the future. Instead, we use a simple system of boundaries (e.g. lines they must not cross) and attractors (e.g. a football, a game, a video) to influence, rather than manage, the behaviour of a large group of children. This approach does not pretend that we can fully control or even predict the outcomes of the party, but it gives us the best chance of influencing outcomes in a favourable direction with limited management resources.

This story suggests a radically different approach to managing change in complex systems than many currently used management practices, and it provided useful food for thought about the future role of improvement knowledge leaders in the health service.

He went on to talk in more detail about how we can tap into some very basic human behaviour patterns to help manage change, recognising for example that people tend to operate on a 'best first fit' principle rather than rationally assessing every possible option before taking action, and also that simple narrative structures are hard-wired into our way of thinking and communicating, which means narrative and storytelling can be powerful vehicles for influencing behaviour.

Finally, he outlined an approach of social network stimulation that he and others have used to build bonds and linkages between previously isolated groups of people, departments or organisations, in order to create the conditions for better knowledge sharing and collaboration.

It was a very interesting and thought provoking session that provides a fresh perspective on some of the key issues relating to the future of improvement knowledge sharing in the health service, and the feedback from participants has been excellent. Thanks Dave!

Further Reading:
http://www.headshift.com/archives/000715.cfm
http://www.research.ibm.com/journal/sj/423/kurtz.pdf
http://www.destinationkm.com/articles/default.asp?ArticleID=1013
http://www.ibm.com/services/files/etr_cynefin.pdf