Innovators and Pioneers in Systems Change

In Utah for Healthier Health Care Systems Now (January 11-13, 2012), we used the 2 Loops Model of Systems Change as one of the framing references for why we were gathered. It is a tool and a framing to understand the work we are individually and collectively in that shifts the shape of health care.  The two loops model looks like this:


The first loop represents the old system, the one we often name as the dying system.  The second loop represents the new system, the one we keep claiming we want, the one we think cannot emerge by fiddling with the old, the one we believe is needed to bring our current systems out of crisis.

The problem is, when we begin to think about the complexity of something like health care, where there are so many jurisdictions, so many players, so many interlocking systems,  trying to imagine what this new system or systems could be becomes paralyzing.  The conversation often becomes philosophical and theoretical.  It largely comes from an intellectual and cognitive place focused on all the things that need to shift that are outside our circle of influence.

Some of the frustration in being innovators inside of systems is that the systems begin to push back on the work in small and large ways, leading to the exhaustion, frustration and disillusionment so many leaders in health care experience.  This is all part of the old narrative.  Of course this showed up in our conversations in Utah to greater and lesser degrees depending on the questions, depending on who was in the conversation at any given time.  Any time we were in that conversation, thinking about the new system, it didn’t feel like a new conversation.

So, how could we be in conversation about Healthier Health Care Systems Now without  focusing on the second loop or the new system?  Well, by remembering who we are – pioneers and innovators in health systems – working under the first loop – in the in-between spaces – championing the new or being championed.  We began to focus in on and explore new questions: Where are the edges of my work?  What is the new territory I could begin to walk when I go home?  How can I draw on the resources in the room to expand my thinking, even turn it upside down and on its head – like the person who relies on gift economy in her practice, for her livelihood?  What more becomes possible in generative spaces with other innovators?  This was a different conversation, in tone, texture and energy.  This one did not come from the head. It was embodied in a whole new way – the beginnings of a new narrative of health.

The awareness of the old narrative and of the stuck places infiltrated us in the best of ways at the end of the first day of our three day gathering.   Someone suggested what we needed to do was create a vision of the new.  Ordinarily I might agree.  In this case though, that didn’t feel right.  It felt like it would take us further off track given that our roomful of people were geographically stretched from coast to coast across two countries with countless “systems”?

So, without taking our eye off the intention of shifting the narrative of health, we refocused on innovating and pioneering and guerrilla tactics of  hosting, collaborating and co-creating, engaging those around us in this journey that is health.  We didn’t leave with a specified vision of the new system.  We left heartened in our respective journeys, knowing the way to the future is through new processes, deeper conversations and finding our way with as many of our friends and colleagues as we can attract, engage and embolden along the way.

As we continue to shine the light on the experiments already underway, the successes, the challenges and the “failures”, and tap into the individual and collective resilience that is fighting to emerge, we can remember it is a journey that will shift and change as we go.  We remember life actually wants to help and it wants to heal. If we focus on how to expand our individual systems of influence and share those stories with our friends, our collective system of influence automatically begins to expand.  What seems like isolated work informs pockets of work elsewhere and we grow an energetic field that is part of the new, part of the second loop and is fueled by everyone stepping into innovative, courageous and pioneering ideas and projects.

I still can’t see what that second loop is for health care – other than it is about health and it is healthier.  I’m not sure anyone who showed up for this conversation can see the second loop either.  But I am absolutely sure that the innovators and pioneers are already prototyping what’s possible, what’s new, and in this work more and more of the new and the new narrative will show up.  I am reinvigorated by what’s possible, by the people who continue to explore these questions, who challenge the status quo, despite possible personal risks in doing so and know that there are better and more healthy ways to engage health care.

I and my hosting mates are committed to convening more of these conversations with people compelled to be in them to grow the field.  We envision large gatherings of people convening in new ways, continuing to innovate our way into the new system(s) so that maybe one day we will wake up and see in front of our eyes what we once thought impossible – a new generative system of health resilient enough and healthy enough to be sustainable in unexpected and beautiful ways.   If we take our eyes off the urgent need for something that feels impossible and put it in the places where possibility thrives… well, what more is there to imagine or say?

Steve Ryman, Tenneson Woolf, Kathy Jourdain, Marc Parnes



2 loops of systems change

Healthier Health Care – Now! A Little Taste of What’s Cooking

We wondered what would happen if we invited friends from across North America to convene in Salt Lake City, Utah around the question of Healthier Health Care Systems Now?  We were amazed.  We began by sharing who we are – the innovator and pioneer in us that  compelled us to come to this conversation.  Then we shared the exciting work we are engaged in.  We talked about the “system” and discovered “it” was never A system and “it” was not about health.  We moved from talking about systemic issues that felt as philosophical as we know they are real and moved into embodying the conversation, coming from a place of deep connection to ourselves, each other and the work that continues to call us in the worlds we work and travel in.  The insights, themes and cool learning are just beginning to percolate for each of us.  More, much more, is cooking.

It was beginning to cook before we even arrived in Salt Lake City.   We discovered healthier health care was such a compelling question people went to great lengths to get there.  Some initially said no and then found a way to come.  Others felt the question so urgently they used vacation days and airmiles to get there.  One person even crowd funded her flight.

Twenty-six of us arrived on January 11, 2012 – physicians, naturopaths, other practitioners, administrators and consultants from heath, public health, dentistry, acute and long term care from Nova Scotia, Ontario, Alberta, Ohio, Minnesota, Winsconsin, Illinois, Texas, Oregan, Washington and Utah.  Everyone an innovator or pioneer already working diligently on shifting the shape of health care within their spheres of influence.  We all brought stories of change and deep and compelling questions. We made instant connections that inspire us to go deeper and to keep at it.

This will continue to simmer and cook for quite some time to come.  I will have more to share here about this conversation at the beginning of 2012, curious to see how it might grow as we convene a community of practice for those who were there, those who wanted to be and couldn’t make it and those who begin to find their way to this particular conversation in their own way.

You can find snippets of harvest on Twitter by searching #HHSUtah.  Thanks to Amanda Fenton, who was with us from afar, for stepping in and compiling our tweets @Storify.

I offer here a little taste of a quick and fun harvest at the end of day 2 as we went around our circle and each of us added a line to the unfolding story of our journey together. I didn’t catch every word, but it will give you some small essence of the experience, recognizing some references are very specific to our experience, and it will have to tide you over til the next post.

“There were a bunch of hooligans in a house by the mountain.  They thought of themselves as pioneers, radically re-engineering, brought together by living systems that taught them how to transfer what they are learning and experiencing into what they are doing now – open to possibility.  In sharing, they saw new connections and unique opportunities.  They described them as opportunities to change and blow shit up.  These hooligans had so much to think about, they sat in circle, played, visualized and created on many levels a new vision of what they were yearning for – simplicity, wellness, with open heart toward the future to bring this new narrative to everyone.  Envisioning systems that bring forth vision and health, letting go of the old to release into timeless universe.  They pondered next action.  In the middle, they went deep into the cellar to share unique fonts and forms of creativity.  They came together to discuss the topic but it was more than the sum of its parts – human nature – own beauty, higher power and purpose run in each of them and each other with gratitude, although we do fear discovering in horror on FB the shaking moments, with brains exploding in chaos, guerrilla gardening and permaculture parties.  But then, a pause for reflection and even more to emerge.  Finished.  No shame.  Amazing thing, working hard to create something different.. but in the end, they were different, a community – and in their differences they found their common humanity from which to go back to the places they came renewed, reinvigorated, inspired to innovate on!”

With gratitude to all who were there, all who held the rim of this gathering from afar and specifically to my fellow hosts Tenneson Woolf, Steve Ryman and Marc Parnes for an experience that will be long remembered, in a gathering where the new narrative of health was activated, the field of innovation in health care where we meet was amplified and shifting the shape of health care in our spheres of influence has been accelerated.