Adaptive spaces for an emerging future: insights for health and care

Q’s Exploring Adaptive Space group organised a Zoom session to help health and care practitioners working on improvement projects to deepen their practice in creating ​‘Adaptive Space’. 

Hosts Gareth Evans from Betsi Cadwaladr University Health Board, Q Community Manager Matthew Mezey and Healthcare Improvement Advisor Diane Ketley share their insights, drawing on the work of the pioneer of complexity leadership and adaptive spaces approaches, Professor Mary Uhl-Bien. 

The session was also a chance to build on the three rewarding Zoom calls that Q had previously held with Professor Mary Uhl-Bien, who pioneered this approach following her ten-year study into what enables successful change in health care, and other organisations.

Gareth Evans, Senior Organisational Development Manager at Betsi Cadwaladr University Health Board gave a concise introduction to Adaptive Space and the work of Professor Mary Uhl-Bien. 

Adaptive Spaces could be anything from a Design Thinking or Liberating Structures-based workshop, to a Lab, hackathon, Community of Practice, pitch-fest or online group. 

They can be space that brings people out of their silos and daily operational performance demands. 

This enables ideas to flow, new connections to be made and allies to be found. In addition, prototypes may be challenged and iterated in a kind of ​‘organisational playground’.

Healthcare improvement adviser Diane Ketley shared the key messages and themes from a virtual conversation with Professor Mary Uhl-Bien and follow-up opinion pieces. 

She also highlighted the upcoming NHS Horizons’ spread and adoption report, which uses Mary Uhl-Bien’s work.

The NHS’s first national skills-sharing timebank, Hexitime, closely followed the path to success uncovered by Professor Uhl-Bien’s research into how successful change happens. 

Q community manager Matthew Mezey explained how it began in a very small, insular, high-trust innovation pocket.

However, as can be a common experience, the project team couldn’t find support from senior leaders. 

At that point, Hexitime was still a crude idea – not yet a timebank. The adaptive space of a Q community Open Space session and a second Q‑brokered meeting of members with overlapping interests, enabled the ball to really start rolling. 

New allies were found, the initial idea was challenged and the concept was transformed into a tech-savvy time-bank platform. 

A core team was created to take the project forward. They applied to Q Exchange for funding and widely popularised Hexitime across the network. The idea would later become the winner in the first vote to gain Q Exchange funding.

As Professor Uhl-Bien’s model predicts, Hexitime was able to build a kind of momentum known as ​‘network closure’. 

This is where an idea that was pushed to iterate and develop in a highly socially connected adaptive space grows a network buzz and becomes unstoppable.

The group discussed the question: ​‘What have you learned from Adaptive Spaces you’ve set up or been part of?’

A ​‘chat-fall’ method of encouraging everyone to feed back concurrently in the chat box was used to gather comments and experiences.

Participants shared the following insights.

• ‘Our group talked a lot about the importance of shared purpose; the need to not try and solve new problems with old solutions or structures. We talked about how stuff is messy and difficult in the middle.’
• ‘Identifying who is best to be in the adaptive space network is crucial to succeed.’
• ‘Create a belief and work with the willing.’
• ‘My reflections are on the roles of ambiguity / power / psychological safety especially on supporting people with ​“feeling comfortable being uncomfortable” also people can struggle with the complete freedom of adaptive spaces given the practices they are accustomed to.’
• ‘The messy middle can be generative!’

The same method was used to explore ideas of how to best enable these spaces, which generated the following insights.

• ‘Recognise and be responsive to zones – comfort, uncomfortable, growth, fear.’
• ‘Feels like there is a real need to create a safe environment for any of these discussions – not always easy to do in practice.’
• ‘Next step – in the LS community we are interested in creating ​“surgeries/​clinics” so practitioners can come to the group and work through their challenges with these adaptive spaces.’
• ‘Seeing this link to patient/​service user outcomes and conversations.’

Participants were also directed to the Human Learning Systems website for some good case studies.

This was the first community conversation hosted by the group and it felt like a positive start with lots of good conversation taking place in the break-out rooms and ideas being offered and exchanged in the chat.

The timeframe for the session was tight at an hour and it felt like there were so many generative topics being raised that we could have continued on for longer to get a little deeper into some of them. 

Getting the flow and the structure right was also something we reflected on as facilitators after the session had finished; perhaps these would be things to consider for a future session.

See the pioneer of complexity leadership and adaptive spaces approaches, Professor Mary Uhl-Bien in conversation with the Q community’s Matthew Mezey and Diane Ketley below.

Professor Mary Uhl-Bien also gives a penetrating overview of her findings about the characteristics of successful and unsuccessful innovation in health care and elsewhere in our Zoom call for Q’s Closing the gap: developing improvers for a complex world group. Watch it below.

Read more from Professor Mary Uhl-Bien on how to catalyse innovation in your organisation in this Sloan Management Review article.