Change labs aim to tackle complex problems – constantly evolving challenges with many dimensions and perspectives, where nobody is in charge, and which traditional top-down solutions cannot fix. By Becky Malby

Last June, patients and carers, managers and commissioners, nurses and doctors from South West Yorkshire Partnership Foundation Trust embarked on a change lab. Their aim was to create a roadmap for services where none existed before.

At the core of a change lab are three stages: sensing, presencing and prototyping. These terms sound esoteric but the point is to unleash creativity and intuition, then refocus it quickly into small-scale experimental projects which can grow into something bigger.

Sensing means looking outwards – letting go of assumptions and opening your mind to others’ viewpoints. It is also about gathering information, so participants took “learning journeys” to relevant services.

Sensing is a great way to weave together the disparate perspectives within complex systems. Centre for Innovation in Health Management associate Duncan Ross, who facilitated the change lab, says: “We are capturing the system through the participants – they represent it – and creating new relationships.”

‘You start small and can turn it around quickly. If it fails, you ask ‘what did we learn?’ and move on’

Presencing means looking inwards. Participants go their separate ways and think about what they have discovered.

Mr Ross adds: “Presencing is ‘what do things mean to me - what am I really passionate and energised to do?’ If we’re profoundly motivated to do something there’s much more chance of it being successful.”

Prototyping is a staple of the design industry, but not public services. It means getting small projects off the ground quickly, and can be summed up as “failing early to succeed early”.

SWYPT deputy chief executive Alex Farrell says: “You start small and can turn it around quickly. If it fails, you ask ‘what did we learn?’and move on. It’s not like our traditional approach to transformation – big project infrastructure and workstreams. Prototyping gave people this sense they could really change things. That created fantastic energy and enthusiasm.”

From doubters to converts

The Wellbeing Museum is one project that has emerged from the change lab. It is inspired by the local Museum of Mental Health, which contains exhibits such as padded cells.

Users who have found the museum therapeutic set up a website to tell their story. They are now seeking investment to update the museum with present day exhibits. Potentially, the museum could grow to become a powerful national resource.

Another project is Operation Demist, which helps people detained under the Mental Health Act for the first time understand what is happening. The prototype is a leaflet drafted by service users, explaining the essentials of being sectioned in plain English.

Ms Farrell says: “Once they’ve got the prototype right, there’s no reason why it shouldn’t be rolled out in other areas.”

CIHM brought the change lab to SWYPT after it was trained by Reos Partners, a social enterprise set up to advance social innovation. SWYPT’s change lab is thought to be the NHS’s first.

One of the most striking things about the lab is that service users stayed with it. Ms Farrell adds: “They were quite doubtful at the beginning. But they were all there when we drew up the prototypes because they could sense it was something different, something really focused on them.”

Change lab tips:

  1. Quadruple the amount of design and preparation time you originally thought would be needed.
  2. The mix of participants is critical. Take time to decide who you invite. Find a balance representing all parts of the system, and make sure everyone is enthusiastic.
  3. There is no shortcut to service user participation.
  4. Use a small facilitation team to support the whole process - learning journeys, deciding what you want to do, prototyping, and embedding.
  5. Work on something that engages and inspires because it matters to everyone.
  6. Certain core ideas make a difference, so use them all the time. For example, use the U-Process in each meeting as well as in the overall process.
  7. There is an ideal pace which maintains interest, empathy and motivation. The NHS tends to spread projects out too much. Take time to do a deep dive, rather than lots of shorter fragmented events.
  8. Build a commitment to proper feedback at each stage so that everybody learns, not just the people experiencing each part. Effectively capture learning as well as more obvious outputs.
  9. Constantly connect “me” with “we” – be explicit about what developments mean for individuals and the whole group.
  10. Provide continual stretch to inspire people to be ambitious together.
  11. Effective, resilient, cross-organisational peer leadership is essential.
  12. Make it happen – plan properly, working through every dimension, and be clear about who does what.

Becky Malby is director of the Centre for Innovation in Health Management

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