Attaching the System to more of itself : Why we need connections to truly bring about change.

Pauline Beirne


This week the Allied Health Community in Children and Young Peoples Services in Scotland are showcasing the transformational change and improvement culture we have worked through over the past 4 years of Ready to Act (Scottish Government, 2016). We will talk about individual services, showcase the value of AHPs in achieving the full range of policy and organisational deliverables. We will also highlight the critical work of all of Allied Health; it is such a great way to begin the last part of Ready to Act and an opportune time to reflect on the changes that that it has taken us through.

In this blog I want to share the learning and reflect my own personal leadership learning achieved through partnering with the wonderful AHP CYP leads and practitioners in Scotland, by coming alongside their communities, and spending time listening to families and those in services asking for support. Most importantly I want to suggest that we need to learn from what has been tried and tested in CYP services across the wider AHP community wherever you work, whoever you work with and whatever their age.

I have attended several events over the past couple of months which have caused me to think about change, transformation and the cultures of practice and leadership in Health, Social Care and Education. Each of these events set out to bring about change in the system, to achieve health, learning and wellbeing outcomes for Children and Young People (CYP) or adults being admitted to hospital (I do attend adult service events from time to time when trying to model the need for learning and connection!). The thing that strikes me is that we are shouting at ourselves here! How can we bring about change in the system when we have only invited one part of the system to that change conversation?

If we want to change admissions and discharges in acute settings, what can we learn from CYP services that might help? How can we learn what others know if we only invite the same people to the same events? Collaboration is not talking amongst ourselves about how can we make things better! It needs us to creatively think about what others in the system, in other systems, and more importantly communities, bring to the discussion. Most critically, we need to realise we can never truly know what our communities need to make change a reality in their day to day lives, if we construct the solutions for change without them.

Hilary Cottam in her wonderful book ‘Radical Help’ says “The answers to our challenges do not start from within organisations asking how existing services can be improved!’’ This then surely means that in order to understand what and how to change within complex adaptive systems (that’s our organisations in real language!) we must invite a range of diverse experiences and real world learning to collaborate together to influence and inform what might work and what change might be an improvement. We cannot improve attainment and learning outcomes for CYP by simply talking together as teachers and educators. We cannot strengthen developmental outcomes for CYP by bringing together early years workers and educators in isolation from those who are knowledgeable and skilled in nutrition, speech language and communication, physical activity and executive motor function. We cannot understand adult distress without tracking back to those working to understand behaviour as communication in our children. And critically we cannot understand how to achieve great health and wellbeing outcomes for CYP without connecting with those people living their lives in our communities.

Cormac Russel ( says “we must go beyond any individual’s gifts to consider how these come together to create broader changes for the common good within a community’’. This cannot be achieved if we continue to think in silos, seek solutions that solve individual problems and system challenges.

Complex change needs connectedness across and between organisations. It needs radical challenge of how we think about health and dis-ease and di-stress. It needs genuine collaboration and innovative ways of coming alongside those asking for support. It also needs new ways of using our finite resources.  I understand that we need individual CPD to make sure we are efficient, effective and safe  practitioners, that is a given. Where we are discussing big issues, big challenges that we are all facing such as achieving best possible health and wellbeing outcomes for our CYP their parents families and carers we should always be connecting the system to more of itself (Myron’s Maxims).

I truly believe that in the AHP CYP Community in Scotland we are trying to innovate and to think differently about how to achieve the best possible health and wellbeing outcomes for CYP. I also recognise that we need to try a radical test of change with partners across health, social care and education to create communities of expertise with the community as the guide. We cannot interrupt the intergenerational cycle of limited opportunity and poverty through a refer, assess, treat model. In 2020 we need to create opportunities where people with shared ambition for CYP in Scotland can come together wherever they are working in new ways, creating hubs with communities. We need to take the learning from CYP and try it out in other areas with different communities.

I am looking forward to reading the blogs from our AHP CYP Community this week and again in February and to meeting with people to talk radical help and change in 2020


1 Comment

  1. Here, here Pauline! I very much enjoyed your sentiments. I too am a big fan of Cormac Russel community strength based perspectives. All too often i found myself in the past in situations where we were talking to ourselves, self-congratulating each other ( sometimes comisserating! ) in echo chambers with little outside influence to change the conversation. Stepping into different spheres: third sector, business sector, new clinical fields and mediums of practice has brought me new skills and perspectives to bring to the AHP table and has been a great tonic for me personally.
    As Cormac once said- let’s create hospitable communities that welcome the stranger at the edge!

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