Health Complexity Research Projects

This project captured key contributory elements in the regeneration process in Redruth North. It identified what worked in the regeneration process and what didn't work so well, as judged by the participants in the system.

The researchers engaged with the participants in the process and have a particular interest in any findings, which might be transferable to other communities undergoing regeneration. To read more about the findings of this research download the report below.

CREST report with findings from the research (Doc 347 kB)

Sport England commissioned the Health Complexity Group and the Connecting Communities C2 programme to consider how best to increase engagement in physical activity within challenged communities.

It consists of the delivery and evaluation of C2 initially at a regional level and then to consider the engagement of any interested sub-regions in this work.

To date, the C2 programme has been delivered to people who share an interest in the regeneration of challenged communities. The programme was tailored to meet the needs of Sport England and its partners.

The HCG conducted exploratory research interviews with all seven leads of the County Sports Partnerships (CSP’S) who were to attend the regional level programme. To explore the issues, barriers, triggers and motivations of participants which would be used to inform and development a tailored C2 programme

The evaluation side of the project aims to:

• To describe and explore the delivery of C2 to Sport England, its partner organizations and its key strategic stakeholders;
• To explore the immediate impact of the programme on participants and presenters;
• To identify challenges to the successful transfer of theoretical understandings and skills to the workplace;
• To support and refine the ongoing development of C2 to this audience;
• To identify lessons that may be transferable to other areas.

Final report (Doc - 239 kB)

If you would like any more information please contact us.

Pursuing Perfection is an international initiative to radically improve the quality of healthcare. It began in the US in 2001 by Institute for Healthcare Improvement (IHI), and it was piloted in the UK by the NHS Modernisation Agency in four health and social care communities, Bradford, Central Norfolk, Lambeth & Southwark and North & East Devon. Three further communities - Luton & Dunstable, Northumbria and East Lancashire are taking forward the full initiative as non-funded Associate sites.

A "perfect" health and social care community can be defined as a place where there are:

• No avoidable deaths or disease
• No harm
• No unnecessary pain
• No waste
• No delays
• No feelings of helplessness
• No inequality

"Why pursue perfection? Because that way you will achieve as much as you possibly can. If you aim for the top and get halfway there, you've got something which will still make an enormous difference to patients. If you only aim halfway and don't get there, patients are going to lose out." Dennis Molloy, Patient, Chair of Lambeth Breathe Easy Group.

The data will be gathered using qualitative research methods of interviewing key informants by purposive and snowball sampling and the observation of key meetings. Analysis will be on three levels, thematic, through the lens of complexity theory and from a philosophical perspective

Read more about the findings of the research by downloading the report:

Creating the conditions for transformational change (Doc - 316 Kb)

The Artemis Programme took place in the Devon Mental Health Care Trust over the course of a year in 2003. Artemis was explicitly designed using principles from complexity theory, and aimed to be concentrate on experiential development rather than professional development. The research sought to determine the impact of the programme on the participants, and on the culture in the Trust. A further question concerned the potential applicability of Artemis to other health and social care settings. The main thematic findings from the research will be presented, and there will be ample time to reflect on these findings, and to determine the value that could be gained from interpreting the findings from the perspective of complexity theory. For further details on the finding of this research please contact the health complexity group.

The Boscastle Flood Rescue Operation: Are there lessons that can be transferred to the National Health Service?

On the 16th August 2004, the small town of Boscastle in Cornwall flooded. Heavy storms caused 6cm of rain to fall in two hours in the Boscastle area. Seven rescue helicopters were scrambled to winch people stranded on rooftops and in cars to safety. Buildings and cars were washed into the sea, and arrangements were made to evacuate up to 1,000 people. No one died in the Boscastle flood and this has been attributed to a number of reasons. Firstly, the incident occurred in daylight, at around 16:00 hours when many people were at work and the majority of people were not sleeping. Secondly, the incident was very early classified as an emergency and emergency procedures took over. The emergency team was coordinated by the police in the 'gold control' team with others from health, the military and the emergency services who normally made the strategic decisions. The 'silver team' was made up of middle managers and the 'bronze team' comprised the frontline crews - for example, the ambulance staff, the fire fighters, the police men and women, and the Royal Navy crews.

Although there are clearly different 'rules' that apply in emergency situations, we at the Health Complexity Group were interested in whether the National Health Service (and indeed Social Services) could learn lessons from the way that the Boscastle incident was managed so successfully. Are there transferable lessons? Could the NHS and Social Services raise their level of care in non-emergency situations? Are there simple rules that governed the Boscastle operation and can these rules be transferred to other situations, particularly to health and social care? This short study asks the following questions:

1. Are emergency situations by definition, 'singularities' where all agents 'act' in the best interests of the person or population at risk, or are there transferable lessons for non-emergency situations in health and social care?
2. What conditions, in a rapidly changing situation, were present at Boscastle, and what constraints were removed to enable a successful operation?
3. What was the 'spectrum of power': where did the power lie, and was this designed or emergent?

The specific aims of the study are:

• to describe the Boscastle operation from the perspective of the key 'players',
• to identify what, if any, simple rules were in operation,
• to extract any transferable lessons for non-emergency situations.

A constructive enquiry into the South West Peninsula Strategic Health Authority's work in delivering the Long Term Conditions Agenda

Improving care for people with Long Term Conditions (LTC) has risen up the political agenda. A number of political and policy drivers have ensured that this agenda has been in large part, 'driven from the top'. However in many ways, this agenda is also 'bottom up'; there is seen to be a need at a local level to reduce the burden on people with long term conditions, a need to reduce inequalities, and a need to encourage the effective use of healthcare resources. In addition, some argue that there is good alignment of patient need, clinical motivation and financial virtues in delivering this agenda.

The South West Peninsula Strategic Health Authority's (SWPSHA) move towards focusing on the LTC agenda occurs as the relation between Strategic Health Authorities (SHAs) and Department of Health (DH) organisations working on service improvement and innovation enters a period of reconfiguration. Prompted by the Arms Length Bodies Review , and based on feedback collected from SHAs, a new Institute for Learning, Skills and Innovation (temporarily known as the NHS Institute) will replace the Modernisation Agency (MA) and the National Health Service University (NHSU) on the 1st of April 2005. The strategic vision articulated by the DH on behalf of this new organisation entails the development of networks of innovation and knowledge, which enable the creation of new methodologies for service improvement alongside a responsiveness to the local needs of healthcare organisations. With this new framework, the role of SHAs becomes crucial. They will function as the connectors of the centre, represented by the NHS Institute, with its national priorities, and the local; they will enable the identification of local needs, and the communication of these needs to the NHS Institute, while at the same time, facilitating the most effective networks to be established with the NHS Institute to ensure that local needs are responded to successfully. It is within this context that the SHA will be seeking to determine its precise role in working towards the local delivery of the LTC agenda.

This study, commissioned by the SWPSHA, will focus on the SHA (the 'intermediate' layer) in terms of its delivery of the LTC agenda, as well as reflecting on where the SHA gets its ideas (the 'triggers') and on how PCTs and individual practices translate these ideas. This study has the following aims:

• To determine if the SWPSHA has a role in helping to deliver the LTC agenda, and if it has, to identify what that role is,
• To determine the strategic vision regarding the delivery of care for people with long term conditions and on how the agenda can be met,
• To explore how the strategic vision is implemented across the SWPSHA,
• To determine where the LTC strategy resides within the SWPSHA, how it has been developed, and whether or not PCTs have ownership of the strategy and strategic vision,
• To explore how the SWPSHA communicates this LTC programme of work to its stakeholders and how it is perceived by and operates within, its stakeholder organisations,
• To reflect on any new operational relationships that have been formed as a result of this strategic vision and this new way of working,
• To determine the extent to which the SWPSHA's programme of work is being successful in delivering the LTC agenda.

This research sought to understand 'What are the processes and strategies that have been used by the Devon and Cornwall Workforce Development Confederation (WDC) to create an environment where successful change can flourish and be sustained?'.

To read more about the findings of the research download the Modernising workforce report November 2003 (doc - 251Kb)

This project was an evaluation of the Making it Better for Children, Young People, Parents and Babies consultation which was planning for Re-Configuration of Healthcare Services in Greater Manchester, East Cheshire and High Staff. For more information on the consultation go to the archived copy of the Making It Better for Children website.

Connecting Communities (C2) Experiential Learning Programme. This 4-day residential course was designed to re-energise, inspire and offer new learning, backed up by on-site visits, to effectively demonstrate ‘what works’ and stays working in challenged communities across the UK.

C2 is a cost-effective way of reconnecting both local residents and frontline service providers to jointly improve health, well-being and local conditions in disadvantaged areas via the co-creation of a ‘People and Services Partnership’.

This is achieved by using the practical C2 7-step, evidence and asset-based approach, which has been used successfully in communities in the South West and nationally since 1995. 

Designed and researched by a frontline Health Practitioner and GP, together with researchers from the University of Exeter Medical School, C2’s track record consistently demonstrated the power to break through longstanding barriers to achieve profound and lasting change within hard-pressed communities across the UK and is now active in over 20 neighbourhoods nationally.

C2 leads to strong, self-managing communities where residents are at the centre of decision-making supported by local service providers and results in high levels of community self-organisation and engagement, leading to long-term transformative outcomes in health and social wellbeing.

The 7-step method

The approach can be described as a process of building community solidarity from the ‘inside out’ through a series of specific steps, while simultaneously building agency solidarity from the ‘outside in’ via the setting up of co-producing, problem-solving, People and Services Partnership.

The course provided:

• A basic grounding in the concept and 7-step approach using resident and agency tutors drawn from established partnerships.
• Site visits to link C2 theory to the reality at street level.
• Post-course follow-up support in relation to practical application.
• A unique C2 7 steps ‘ Handy Handbook’  for use both on the course and in your local project

Who applied for this programme?

Community frontline service providers which may include Local Government, NHS, Housing, Education, Police, Fire Service, residents and volunteers.

What new skills and knowledge did this programme deliver?

As well as enhancing your own personal leadership and improvement knowledge this course will give you new insights to:

• Recognise and work with the strengths within a challenged community
• Co-create enabling conditions needed to release community and agency capacity
• Listen effectively to enable residents to articulate a clear vision and develop a strong collective voice.
• Appreciate the ‘invisible’ values needed to enable communities to self-manage.
• Understand the power of a ‘Peoples and Services Partnership’
• Appreciate the outcomes, sustainability and impact they have in  C2 communities

Approach and methodology

The principles of complexity theory inform our work, and we seek to test these principles on the findings of our ongoing work. Complexity theory provides a ‘sense-making’ framework of how organisations and individuals interact, relate and evolve within a larger social ecosystem and offers a different approach to managing organisations and communities through developing enabling conditions which allow self-organisation leading to transformational change.

Our research offers rapid, real-time feedback, which helps to make sense of projects being undertaken by practitioners and can shape the future development of these projects. This rapid feedback is supported by summative research which offers theoretical, evidence-based, explanations as to why the change processes occur in the way that they do and also why approaches do and don’t work as well as giving insight into the best way to tackle complex issues through new ways of organising, thinking and working.

We have collaborated with those involved in both policy design and implementation and have worked with all tiers of the public sector central government departments and agencies, regional bodies, strategic health authorities, local health care organisations, local police, education institutions, community groups, residents’ associations, user involvement groups.