Have you ever wondered how many people have discovered their life’s purpose tracking tigers? When I first thought about it, I imagined that the number would be quite small. I figured that if your ikigai is what gets you out of bed in the morning, why would you choose something that could get you eaten for breakfast?
Then I reflected on all those adages about the jungle being bigger than the elephant, and the flea being able to trouble the tiger more than the tiger being able to trouble the flea. But I was still left with the uneasy feeling that anyone whose journey of discovery involves pursuing tigers must at some point be faced with an unavoidable challenge: Tracking A Tiger Is Scary (or ‘TATIS’ for short).
As I thought about the world that I operate in and interact with now – a world comprising health, justice and social care systems – I realised that my own journey of discovery was also beset with many TATIS shaped challenges. This is a world that by no means always Takes A Teenager’s Issues Seriously, and that finds it difficult to Talk About Trauma Informed Systems. Yet, what I have found is that everyone is seeking Transformative Approaches That Inspire Stakeholders that bring about Truly Amazing Transformations In Society.
So I decided I would write about these TATIS shaped challenges based on what I see, what I hear and what I feel about them as I work to help people navigate this morass of interconnected health, justice and social care systems in ways that work better for them and the wider world. I also write about my ever-present, slightly annoying but ultimately insightful and helpful travelling companion that accompanies me every step of the way along this journey of discovery.
Mine is a journey of discovery across a familiar landscape – one that I’ve known all my life but which is constantly evolving.
In this world, care homes, police stations, criminal courts, probation hostels, prisons and secure units are all historical landmarks. The systems thinker inside me, which in my case takes the form of a TATIS earworm that runs incessantly through my brain, logs these institutions as the physical manifestations of a landscape in which every social system is connected to another. Yet, as my earworm knows, across this landscape the internet of things seldom runs smoothly. Things that are in fact connected in and across systems are riddled with human disconnections and technical misconnections.
It is somewhere in between this connected, unconnected dichotomy that real life problems play out: things that have a serious negative impact on people and communities such as crime, reoffending, addiction and mental health crises. Hence there is a huge pressure to fix things fast. However, these are inherently complex issues that are hard to pin down, tricky to break down and difficult to double down on. Time and again, as one problem is addressed, another one that needs sorting is triggered or exposed, so taking action sporadically in haste doesn’t always work.
This is evident from the recent Gauke review on sentencing set up to address problems arising from a policy focus that has seen more people sent to prison and held there for longer and which has resulted in one clear outcome – prisons that are now full to bursting with prisoners. Yet prisons without voids will always be devoid of rehabilitative effectiveness, hence the recommended policy tilt towards sending fewer people to prison, requiring some to spend less time there, and reserving prison for those who commit serious and violent offences.
As the report acknowledges, creating more voids can never equate to achieving rehabilitative effectiveness. Perpetrators who become prisoners are also patients and parents so this problem can never be solved merely within the confines of the policing, court, probation or prison systems. Rehabilitative effectiveness must be viewed through a wider angled problem-solving lens.
I have a strong sense that my earworm is nodding in agreement at this point, as it contemplates how one assumed cause-and-effect relationship, namely ‘for those who commit crime, prison works’, can produce another predictable though not necessarily predicted outcome, namely, prisons that don’t actually work, which then triggers another, more substantive problem that needs solving, namely, how to achieve rehabilitative effectiveness in ways that are both affordable and sustainable.
My earworm enjoys lines of curiosity such as these, and wants to call time on a narrow, reactive sort of firefighting that isolates and compartmentalises strategic challenges and confines problems (and thereby the problem-solving capability) to one department, organisation or coterie of organisations. It wants the landscape to be viewed through a wider lens, making it possible to see things further upstream and spot a myriad of things happening at source. It thinks that this in turn will create possibilities for collaborative problem-solving, intervening early and de-escalating problems before they reach crisis point.
Taking on this Capraesque systems view of life, what quickly becomes really clear is the need to look further beyond the confines of existing service-level, departmental, organisational and partnership-related boundaries for solutions.
Subject matter experts, experts with lived experience, systems leaders, practitioners and researchers all talk about prevailing health, justice and social care systems that are ill-equipped to address the big, intractable issues that individuals and families are facing in their neighbourhoods and communities and that are felt at a really local level. These issues are inextricably linked to, and invariably the product of, health and justice inequalities, breakdowns in continuity of care, treatment and support, and neighbourhoods that are neither safe nor feel safe.
Meanwhile, policy makers and decision makers spend countless hours and gallons of ink ‘Whitehalling’ and ‘Whitepapering’ strategies, services and supply chains that are the product of market forces that don’t fully recognise the complexity of the social and local problems they are grappling with. These market forces are also not always contained and harnessed for public good, and miss opportunities to capture and leverage the power of integration, partnership, shared ownership, mutual aid and community – all vital components of sustainable change initiatives in areas of neighbourhood safety, criminal justice, mental health and addiction.
As I write this, my TATIS earworm raises another challenge: what if this unnavigable web of social systems that impedes access to treatment and support for so many people and communities were to be reimagined as a vibrant nexus comprising strong, sustainable networks, systems and communities of support and opportunity both online and offline?
This resonates with well-documented accounts that point to the crucial importance of social capital, rehabilitative capital and recovery capital when it comes to forging trust and confidence in communities, breaking through cycles of reoffending, and addressing life-limiting, long-term recurring conditions. It also resonates with reports that highlight the essential role that community-led and family-focused support plays in helping people to do well, get well and to stay well.
Yet my earworm encourages me to linger on what all this might mean for systems leaders:
Why is it that ‘soft’ notions of ‘support’ and ‘opportunity’ are so hard to talk about, align on, and implement in and across systems – particularly in the context of crime, criminal justice and addiction?
What if systems were viewed, from a strategic standpoint, as inherently supportive and full of opportunity?
Might there be scope to adapt the strategic focus that is given to signposting and pathway development and aimed at making unnavigable terrain more navigable to also encompass ‘desire pathways’ that follow the direction that people want to walk, where formally approved pathways haven’t been provided?
What more can be done to create more strategic space, focus and investment so that the potential benefits of community-led, family-led and peer-to-peer support, as well as mutual aid can be realised across systems?
Now, more than ever, I sense the strong appetite for more meaningful conversations about key concerns: concerns that are playing out online, in our schools, in our neighbourhoods, in our hospitals and in our prisons.
But my TATIS earworm advocates a type of engagement that goes beyond the exchange of antidotes and anecdotes, that has the potential to turn awareness into action and can convert problems that have people up in arms into solutions that embrace the needs of people and communities with open arms. Amid a maelstrom of pressurised, cash-starved, competitive and challenging operating environments, this call to action involves a collected form of realignment across boundaries – a realignment of visions, funding priorities, strategies, plans and impact measures from four seemingly separate but actually interconnected perspectives: policy, strategy, leadership behaviour, and operations.
My TATIS earworm envisions this realignment as being fundamentally nourishing and nurturing in a way that builds strength and fosters resilience. Whilst it would be an overstatement to argue that ‘strategyandsystems’ has become one singular word in the leadership vernacular, it is becoming increasingly difficult in the world I operate in to do one without the other effectively – especially if you’re looking to preserve, grow and sustain your organisation’s influence and impact long term.
At a time when health inequalities are entrenched, gaps in continuity of care are significant and workforce challenges are unprecedented, it seems that the appetite for effective systems leadership, cross-boundary working and collaborative innovation has never been greater.
Whilst cross-boundary partnerships and alliances are commonplace at strategic, business and operational levels, they are often confined to organisational objectives with little focus on the delivery of important wider benefits that can be felt across the whole system. Undeniably, this sort of work does involve some heavy lifting, and ingenuity is required to incentivise and enable busy organisations and departments to make space for rigorous systems-focused work. However, it is worth doing as it delivers positive, rewarding and wide-ranging results quicker than people might imagine.
The simple act of lifting stones and discovering what lies underneath them seems to create a movement. People lift stones together, not so they can be lobbed in an opposing direction or at each other, but in order to build bridges to understanding and to co-create action steps and pathways that break new ground and break through barriers.
As my work takes me further and deeper into this labyrinth of systems, the more I am reminded of:
The rewards that come from grappling with complexity
The importance of partnership and collaborative efforts and activities being targeted at system-focused outcomes
The power of meaningful collaboration across multiple boundaries, including between: social systems and people on the ground; sectors, organisations and disciplines; and headquarters and the frontline
The far-reaching and tangible benefits that can be realised when stakeholder and community involvement is fully leveraged in pursuit of propositions that are scalable, saleable and sustainable.
A large part of my work involves helping to unearth and leverage the innate and inherent ability of frontline charitable, not-for-profit, grassroots and kitchen table groups and organisations to drive systems change.
History shows that, given the right enablers, these groups and organisations can help address the key systemic, strategic and operational challenges that hold their communities back, stifle innovation, dampen effectiveness and impact, and jeopardise sustainability on the ground.
However, today, in the midst of a plethora of challenges, these organisations have to find new and effective ways of integrating their services with community-focused support networks, ensuring that the systems they are operating in are fully connected to the frontline, and enabling multiple voices to be heard and acted upon. This can be done through the collaborative design and development of initiatives and programmes but, increasingly, it has to involve working on the dynamics of collaboration in and across systems.
Here ‘relatedness’ (another TATIS earworm favourite) becomes the primary focus of leaders’ behaviours, so much so that this subject will be covered in detail in the next episode of this series of systems-focused articles. As well as expanding the number of partnerships in their network, my work involves helping leaders to home in on the systemic impact of the relationships they build and maintain. Relationships that offer real potential for sustained systemic strength are prioritised over those that are more transactional and parochial in nature because that’s where growth opportunities can be unlocked: growth in terms of revenue, reach and sustainable impact.
In the context of whether these two things: high-leverage systems-focused relationships and transactional effectiveness are mutually exclusive, my earworm invites me to reflect on the etymology of the word ‘tender’. This highlights the irony of a situation wherein the word ‘tender’ has been championed as the vehicle for driving competition and differentiation across systems when, in reality, the word has its origins in deep forms of emotional connectivity and collaboration.
I’m tempted to argue in favour of the healthy coexistence of competition and collaboration, but my earworm turns my attention to the commissioning environments we both operate in in relation to health, justice and social care, and the tendering interface between price and quality. This, in turn, makes me question whether, in these competitive commissioning environments, we are really capable of preserving the delicate, nurturing, and maturational meaning of the word tender, co-creating clever ways of rebalancing relationships across systems, and leveraging collaborations of vital strength, opportunity and sustainability.
At this point my earworm recounts how it had read somewhere that a tender is also defined as a small boat that plays a vital partnering role in relation to larger vessels. Put simply, the small tender can reach parts of the shoreline the ship can’t reach, making the tender and the ship inseparable bedfellows.
Applying the same logic to our world, I’m fascinated by the ‘strategicandsystemic’ (here deliberately one word) potential of the small groups that operate at the very furthest reaches of the social justice ecosystem. What drives my fascination is the game-changing possibility that if it can be accepted, based on evidence, that these small groups are uniquely equipped to engage and empower subpopulations and cohorts that are on the outer fringes of the ecosystem, namely those that are disproportionately associated with and affected by vulnerability and need, how can these groups be regarded as anything other than indispensable to that ecosystem?
Against this backdrop I am focused on exploring:
What it is about health, justice and care systems that keeps these small yet vital groups, hidden from view
What it would take to bring them out of the shade
Once in the sunlight, what needs to happen to hold them in full sight and at the top of people’s minds.
My earworm then alerts me to a tiger-sized TATIS shaped challenge that might be lurking around the next corner: the mismatch between what works for the wider ecosystem, what works for the markets that feed into and feed off it, and what works for the people on the furthest reaches of that ecosystem.
This is where policy meets money, and the distribution of money meets people, groups, organisations and communities.
And just as we start to contemplate the challenges along our next leg of our journey, my trusty earworm advises that at times such as this: Taking A Teabreak Is Sensible.
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