Value of Agile: Does this kind of group work?

A report from the front line: A Sprint / Agile workshop.

By Simon Bell

There were about 50 of us attending the Agile workshop, nice hotel, good venue and the 50 represent a good gender and age balance. From young Post Docs to senior Professors, a mighty array of mind power and some very successful people. We have been told that the winning project will receive funding or a very good prospect of it. A useful means to gain funding for good ideas?

Agile Illustration

We were gathered in an unruly mob and the workshop began with talks which were (purposefully?) not very informative. Little was really clear, but we were provided with the notion of the Sprint and Agile processes (which were constantly mentioned). The approaches were presented as something of a silver bullet answering all need and yet fun and quick. Agile was promoted as a means to achieve the induction of innovation. This was not questioned by those gathered at the time. We were all too polite?

Then it all kicks off. The first group work is unstructured creation with pens, paper, Post-it notes and Lego. This is a whole group exercise.

Problems emerge right away. By the way, the notion that this is a problem is a problem. I have a feeling that the process was intended to cause most of the mayhem and doubt it sowed. The unhappy learning maybe was also intended? Who can say, the territory of bluff and counter bluff between expertise and inanity remains unchartered.

The access to the tables of ‘stuff’ was too limited, we were clustered three deep and our ability to access Post-it notes, write on them and put them down for others to read, to read other people’s ideas and make connections was too brief and too crushed. No time to ponder, talk and make.

The gregarious and noisy personalities took over, all other types were lost and either milled around, collected like dross around noisy orators or wandered off in a hopeless kind of way. What follows was a disorganized milling around into groups. This inevitably resulted in clustering around alphas (all males so far as I could see) and that felt (and looked) gross. The egos of the dominant rose and rose, all others were left to look on as a kind of audience to sprint-celebs.

What is it that we were supposed to be doing again? Noise takes the place of thought. Poor group formation follows. This is because there are too few tables for small groups to form around, we cannot disaggregate and as a result some of the groups are huge conglomerations.

The forming groups are noisy and led by dominant types again. Much confusion is in the room and the first sense of panic in what is concretizing as a mob is tangible. What is evident in the room psyche are thoughts like: “I may not fit”, “How do I get my stuff in?”, “where is my space?” The more disgruntled delegates I subsequently find are thinking thoughts like: “what a waste of my time!”, “when can I leave?”, “what the hell is the point of this?” As I say, these thoughts are not just mine but come from many others I speak to subsequently.

At some unintelligible ‘point’ in the proceedings we are stopped, go back to our chairs and are asked to listen to a ‘provocation’. I am not sure how we are provoked at this point. The talk is largely the reminiscence and successfication of those who have won big in the past. It is a kind of public preening, presumably intended to make us all feel that we too can be a success. When this is done there is more milling around and trying to find a ‘sale’ for your idea. The original exercise with which we started the day seems lost and redundant. Quite how anyone is supposed to have got an idea from this is obscure to me. Again, I feel panic. What is my idea? How has it emerged from what I have seen and heard? I have no idea and am empty and clueless. Now I do feel truly stupid.

The selling of ideas process is achieved by the individual creation of mini posters which we are supposed to hold to our chests and then, mill about, reading each others ‘chests’ in what feels like a kind of inappropriate, voyeuristic sandwich-man activity. I should note that this feels like a very undignified and rather belittling process to me.

The facilitators seem to think it all tremendous fun and a great way to pass the time. I am aware of acute embarrassment in the room, and it is not just me. If there is an introvert at the event, they have surely left by this time or died of shame. But, maybe this incarnation of the sprint method does not recognize the value of quiet thinkers to provide any good ideas? What follows again is desperate clustering around big, confident themes and, again, commensurate big, confident (at least loud), middle aged, males; the sprint-rock-stars.

If we are looking for new ideas, I doubt we will find them. What we are doing is playing to those who are outgoing, powerful, confident and have already got ideas.

At last I find someone staring at my chest who looks more worried than me. We go away from the rest, find a quite place and have a comradely chat and, when we have conversed and come to agreement about how we are to play this game we join up with three other confused looking people who are similarly perplexed. We agree that we will try to work up our ideas into a plan. I think our plan and our work together is good but it was the only good 15 minutes of a very long day.

The worst was yet to come. The final provocation occurred and a ‘panel’ of the great and good (are they really?) told us that we were underperforming, not meeting the brief, wasting money and well, not much good really. How they know this I am not sure. How does this evaluation impact the room? Well, clearly it is a contrived piece of provocation presumably intended to infuriate and prompt us to action. The facilitators seem not just to misunderstand the difference between the conditions for rapid creativity and chaos, they also misunderstand the difference between provocation and insult. I thought we all ground our teeth and were too well mannered (or shocked) to respond. One or two eloquent colleagues shot back but one could see that in this Kafkaesque situation all response was seen as expected moaning and all complaint as weakness. There was no room to move against the system.

Day 2. Yes, there were two days for the process. The second day went a lot better than the first day. Mainly because we have got over the hump of being ‘challenged’, ‘provoked’, and ‘threatened’. Most of the second day was spent being left alone. Do we see wisdom at last? Thoughts emerge in the silence and not the scrum?

To do small team work was a kind of bliss. Did I begin to love my jailer? Our small group of refugees from the first day organized and facilitated ourselves and did our best to ignore the official facilitators of the event. We came up with a project which seemed interesting to us. This emerged despite and not because of the process.

As a final note, the last part of the workshop was for each team to present the combined work to the self-professed ‘experts’ in the format of a ‘Dragon’s den’ performance.

I left.

A useful antidote to this kind of thing can be found at the Bayswater Institute Wisdom in Groups event.

Artwork © Rachel Furze

A wall means you are stuck. Can we get around this?

By Simon Bell

I have been writing about the use of mindful stories as a means to help us, in groups or alone, to get over some of our mental issues and concerns. Here is a new one which also makes use of a picture. The following story is one I wrote some years ago but one which resonates with elements of the idea of being ‘stuck’. The story also makes use of a drawing in pastel by the Artist Rachel Furze.

As with previous blogs, find time in your day to read and think. You will need about 20 minutes.

I suggest that you place the story in a mindful setting. So, settle down in a comfortable place and take a few seconds to control your breathing, focusing on the in-breath and the out-breath. Give this a couple of minutes.

When you feel calm and your breathing is steady, read the story and look at the picture and let them seep into your mind, and then, when you feel ready, look at the questions which follow:


Picture in your mind the Everglades, or any kind of a swamp.

Swamp Illustration

Interesting word, ‘swamp’.

It is a word full of evocative images. It’s used a lot by authors and screen writers, no doubt because of its powerful imagery and mystique. For me it conjures up a range of images and perceptions drawn from childhood.

To me, a swamp is a place where water is the powerful, dominant medium. Here tracks are hard to find, pathways are constantly changing. This sense of trackless space, with the difficulties of both wood and water to navigate provides me with the basis for the swamp principle.

What is in the water? What lurks in its brooding darkness, and unfathomable depths? Unfathomable? Surely the water is not that deep? The problem is the depth cannot be assessed, it’s an unknown. And how far does the water extend? There is a primal feel about swamps and limitless, still water. Was there a time when we knew swamps intimately? Is there some kind of human race-memory of the primeval swamp? The watery place where all kinds of dramas were experienced by our ancestors long ago?

A swamp is quiet. Still water and quiet landscapes where the vertical dimension is dominated by trees. In this swamp-form there are cathedral-like corridors of vast trees. Trees masquerading as pillars in some vast, green fairy hall where the dappled blue-sky shimmers through a ceiling of leaves, supported by an invisible wall of limitless trees.

It strikes me that a swamp is an easy place to be lost.

Despite their powerful aura of mystery, swamps obey the seasons just like everywhere else. The trees give up their leaves each autumn, and the smell of warm, humid decay arising from the floating, rotting detritus is another ruling sense arising from the first impressions of swamp. The legacy of the swamp lies rotting in the water at its roots. Feeding the new growth. Its decay is the life force for the new system.

The floor of a swamp is not the reassuring solidity of stone or even the yielding, sprung cushion of leaf-strewn grass. The floor laps darkly to the bowls of the trees, thickly, oozily, oily dark and impenetrable water. In places the deceit of firm land is complete. For watery acres the surface appears solid, covered in green algae, masking the insubstantiality which lies beneath. But the deceit is easily broken as some bulk of unknown size and intention moves in the medium beneath and the floral covering is swished aside to reveal the reflective black of the true flooring.

OK, here are the questions for you to consider:

Question 1. What is the main meaning of the story?

What message or core or essential meaning does the story hold for you? There may be many meanings which occur to you but for now try to prioritise just one.

When you feel clear on this, hold it in your mind and read the next question:

Question 2. How is this meaning of relevance to you?

How does the story impact on your life and your challenges right now? Why is it important to you at this point in your life? What element emerges as being most relevant?

Again, give yourself time to think of your response and when you feel prepared try the next question:

Question 3. Think about what is the main value that you can draw from this relevance of the story. What does this value bring to the concern you identified earlier?

Don’t rush your response. Take time to think about the value. The word ‘value’ is an interesting word. What do we value and what of value is here? When you are set try this:

Question 4. What insight does the identified value provide for you?


Question 5. What action might you engage with as a consequence?

Give yourself a little time to let the ideas which come from the story and your review settle down. This is key, giving yourself time to let things happen on the inside. You may like to look at the questions later today, just to remind yourself and to reconsider some of your early-thought-responses. Each time you reconsider you may get to a deeper level of meaning and this could result in new ideas. Enjoy your day. 

Walls of the body and Walls of the mind: a good idea?

By Simon Bell

I have been suggesting the use of short stories as a means to engage individuals and groups in a considered appreciation of their context, issues and concerns. Take a look at earlier blogs on the news section of the site. Here is another one for you to try. This one focuses on the issue of walls. These seem to me to be of particular concern to us right now.

You will need about 20 minutes in order to engage in the process.

I suggest that you place the story in a mindful setting. So, settle down in a comfortable place and take a few seconds to control your breathing, focusing on the in-breath and the out-breath. Give this a couple of minutes.

When you feel calm and your breathing is steady, read the story and let it seep into your mind, and then, look at the questions which follow:


“At least it’s nice and warm”. And it was true. It was nice and warm. The insulation had done the trick. Marvelous stuff. It had really been a terrific purchase. The advertisement had promised a lot, but they were really not disappointed: ‘Stop all those terrible drafts’, ‘Keep out the odious odors’, and ‘Why put up with it?’, ‘Just shut them out and shut them up!”. These had been four of the most powerful headlines which had finally encouraged them to part with their hard-earned cash and get properly insulated with ‘Insular Abyss’. To be insulated was just so cool (no pun intended). The world was such a cold place nowadays. Since the ‘Event’, temperatures had been tumbling year after year and, well, a person had to take care. This was just a great way to do that. It felt terrific to be able to say: “I am insulated”. Of course, they did not get out much nowadays and had to rely on social media as the primary, well only, means to let the neighbors know. Come to think of it, the neighbors were not really the kind of people who they wanted to be in touch with right now. Actually, it was a good thing that the insulation was what the saleswoman’s avatar had called ‘Deep-cavity-abyss-filling’. That meant that the insulation was not just a way to keep out the cold. It was also guaranteed to keep out all of the other stuff too! It insulated “cross-spectrum” and: “deep social”. Great. No more need to listen to those whining voices and opposing views. And the awful smell! Was that because of the Event as some said or was it, well, you know. Personal? Anyway, safely insulated there was every chance that they would never, ever have to listen to, see or smell that kind of thing again. Or look at things which they did not want, or like. Or even maybe not like or maybe not want. Better to be safe than sorry. And, at least it’s nice and warm!”

Question 1. What is the main meaning of the story?

What message or core or essential meaning does the story hold for you? There may be many meanings which occur to you but for now try to prioritise just one.

When you feel clear on this, read the next question:

Question 2. How is this meaning of relevance to you?

How does the story impact on your life and your challenges right now? Why is it important to you at this point in your life? What element emerges as being most relevant?

Again, give yourself time to think of your response and when you feel prepared try the next question:

Question 3. Think about what is the main value that you can draw from this relevance of the story. What does this value bring to the concern you identified earlier?

Don’t rush your response. Take time to think about the value. The word ‘value’ is an interesting word. What do we value and what of value is here? When you are set try this:

Question 4. What insight does the identified value provide for you?


Question 5. What action might you engage with as a consequence?

Give yourself a little time to let the ideas emergent from the story and your review settle down. I wonder how it will affect your day? You may like to swing through these five questions two or three times. Each time you may get to a deeper level of meaning and this could result in deepening senses of relevance, value, insight and action.

Flourishing with Groups – A Mindful Story for Group Self-Enquiry

By Simon Bell

The Mindful Stories were originally written intended for use in group contexts. They are a device for prompting a group which is managing some change process or event to begin to think about this issue by externalising the key feature(s) to a fiction or story which can in turn prompt new lines of thinking.

Try this group act of Mindful self-enquiry.

Assuming that you have some authority over the process, gather your group – you will all need at least an hour to run through this exercise.

When the group is settled and prepared to listen (a little time spent in mindful silence is very helpful) read the following story to the group. Read clearly but in an engaged and engaging manner. Try not to sound preachy.


A vast blue-sky is nailed like a dirty cloth over the burnt landscape of rolling dunes, rocky outcrops and withered vegetation. The sun, not a sphere but a painful centre of brighter and brighter sharpness hangs vertically overhead, slit in the cloth, blazing down painfully on the captive panorama which has forgotten the feel and touch of rain. The burning heat flat-irons everything below and the tiny dots of occasional, lonely, circling birds, high overhead show no inclination to explore the lifeless enormity. Best to circle and circle and move on to some place where life may at least have potential.

In the centre of our view there is a discordancy to the endless backdrop of heat, haze and limitless aridity, of people-less, life-less, point-less land; a pole.

You have seen them in a thousand locations. They are the familiar of roadside and street corner. Ranging in ranks over hillsides, cascading in profusion over suburbs, stalking up steep ravines and lost in ubiquity on the cities main drag. They carry the cables and dishes which bring the power and news, Netflix and HBO, telephone and Skype to the lives of billions. They profuse from their birth home in the industrial north, all the way to the hopeful south, the rising east and the meditative west. They are everywhere.

So, why not here?

In all the places of the fractured world, this is one not instantly consistent to the idea of pole. The place is too empty of life, too distant from interest, too desolate of content. Pole means many things totally inconsistent to the context here revealed. Pole means activity and action, people in vehicles and yellow jackets, instruments of mechanical agency, rhythmic noises of artifice and a purpose to fulfil a project, a process a task.

Purpose, project and task are anathema to this place.

And yet the pole remains, a contradiction to context and a jarring contrast to the natural, burning chaos all around. Perpendicular with precision, it seems to look out with authority over the surrounding land. Somehow the pole is the centre of it all, this latest addition, new and tarry, dwarfed and absurd; it seems to dominate the meaning of all else that provides the backdrop for its enduring verticality. An un-deviating seven metre line in a line-less place, stretching to eternity.

When the story has been read, allow a minute or so for the ideas to settle and merge with the busy thoughts of the members of the group. When you feel ready, ask the group for responses to these questions:

In general terms, what do the members of the group consider to be the main meaning of the story?

The group will provide a number of insights here but find a way to choose just one for now.

How is this meaning relevant to the current situation facing the group?

What does the meaning say about the current situation facing the group. When you have some clarity about this consider the next question.

What value can the group gain from this relevance and these thoughts?

Value here may mean, ideas about the group’s situation, a prompt to do something or an idea about what might be important to avoid.

What insights emerge in terms of the value and the group’s tasks?

At this point the group can flesh out the value thought as an insight to action. This usually means that the group decides upon some priority to tackle next.


What action does the group wish to explore as a consequence?

Deciding upon an emergent action is often the trickiest part of the process. What can, should and could be done in the light of the insight?

It is almost always good to finish the consideration of the story with a period of silence and mindful ‘letting go’ of the outcome. It is surprising to me how often and silence and ‘sign off’ at the end of a thinking process can provide a potent catalyst to what ever follows.

If your group repeats the exercise it can be helpful to see if the initial meanings and interpretations for action change and deepen. Keep an action plan if action is now suggested. Certainly, note down the responses to the questions from the group. Return to these answers periodically and see how the response changes. Responses and actions can be monitored and assessed over time.

Keep your Spirit Level – A Mindful Story

By Simon Bell

At the Bayswater Institute we make use of short stories as a means to engage individuals and groups in a considered appreciation of their context, issues and concerns. We find that stories provide a powerful means for self-examination. The fictions engage a kind of back-door to the things that concern us. They can provide a powerful means to start a conversation with yourself about the things that may be upsetting you or just causing you angst.

Here is an example for you to try.

You will need about 20 minutes in order to engage in the Mindful Stories process.

I suggest that you place the story in a mindful setting. So, settle down in a comfortable place and take a few seconds to control your breathing, focusing on the in-breath and the out-breath. Give this a couple of minutes.

When you feel ready, let your mind wander over the issues of your day, the thoughts of the moment and your main concerns. Try not to hang onto any of these elements, just try to let your mind wander, like a bird flying over a great landscape of trees and mountains. All of it is important but it is all below you. Stretching out. No single element is necessarily more important than any other part.

When you feel calm and your breathing is steady, read the story below, The Walk. Read it carefully and try not to judge the content too quickly. Let the story seep into your mind.  and then, look at the questions which follow:

The Walk

“You regularly walk. You like to walk and there is always a good reason to indulge yourself. A walk can be for a variety of reasons. You walk maybe to work or to see friends.

Today the route is well known to you, held in muscle-memory and repeatable almost with your eyes closed. Parts of the walk are really pleasant. Vistas of park, trees, well-thought out housing developments with good combinations of different kinds of dwelling. The people you see seem to belong and to know that this is ‘their’ place. You do not feel like a stranger. You are sharing their neighbourhood, but it might as well be your own. A walk among familiar homes.

But, parts of this particular walk are more mysterious. At times your leisurely pace quickens. In some parts you walk a little quicker. In these districts you have not looked around, tending to keep your eyes in front. You have not looked down all the side streets, but you have glimpsed dark and curious buildings and there are shops which seem to have no obvious purpose. There is one shop in particular.

It is on the corner of a particularly shady side street. Is it even a shop? Well, when it first caught your attention you noticed it because it stood out in strangeness, darkly against the shadow. it has a shop window and a shady, glass door but there is no writing above the window and the interior is so dark it is hard to make out anything in the dim light.

You don’t know why but one day you are a little ahead of your schedule and your curiosity is peeked. Deliberately turning down the side street you stand in front of the glass frontage. Now you are here you notice that there seems to be a blue flickering light deep inside the interior and, as you shade your eye to look more intensely, you can see weakly lit the outlines of mysterious shapes. Statues of curious design, mirrors reflecting back the blue light onto paintings or hangings, tables littered with un-guessable objects and stands providing space for shadowy curios. You would like to go in but you are not even sure it is a shop let alone if it is open. You hurriedly retrace your steps back to your habitual path.

Each time you pass you ask yourself if you will be brave enough on this occasion to stop and enter, each time you don’t.

Then, one particularly dark and dreary day, when the rain is saturating, as you pass, you see that that the shop door stands open. Without thinking you turn from your usual route and enter.” 

Now, take a moment to breath and reflect and, with the story still fresh in your mind, read and consider your responses to each of the following questions:

Question 1. What is the main meaning of the story?

What message or core or essential meaning does the story hold? There may be many meanings which occur to you but, for now just think of one.
When you are ready. Read the next question:

Question 2. How is this meaning of relevance to you?

How does it impact on your life and your challenges right now. Why is it important? Again, give yourself time to think of your response and, when you are ready try the next question:

Question 3. Think about what is the main value that you can draw from this relevance of the story.

What does this value bring to the concern you identified earlier? Don’t rush your response. Take time to think about the value. The word ‘value’ is an interesting word. What do we value and what of value is here? When you are ready try this:

Question 4. What insight does the identified value provide for you?


Question 5. What action might you engage with as a consequence?

When you have considered what you might do next, spend a couple of minutes just breathing and thinking about nothing at all.

See what changes this day as a result of thinking about the story.

Resist the nudge in 2019: Becoming GroupAware

Post By Professor Simon Bell

Making the Connection

Wikipedia suggests that ‘Nudge Theory’ “proposes positive reinforcement and indirect suggestions as ways to influence the behaviour and decision making of groups or individuals”. The problem seems to be that the reinforcement can work in any of a number of directions and some are surely not healthy.

Increasingly our experiences are mediated by the groups, teams, communities and associations we share. And, also increasingly, these groupings are online.

Recent experience in the polity of the USA and the UK (among others) indicates that groups of all kinds are being nudged in directions which may well not be healthy for wider society or even the sustainability of the groups in question.

Nudging has been weaponised.

At the Bayswater Institute we have a profound respect for groups and associations of all kinds and, deriving our inspiration from the work of Harold Bridger working at an earlier time of world hazard (the 1940s) we have developed ways for groups of all kinds to achieve wisdom in groups.

Wisdom in Groups, making use of Bridger’s ‘Double Task’, encourages groups to become GroupAware.

See: GroupAware

Here is a short, subliminal story which might provide a clue:


Welcome to M world

I live in M-World. You live in M-World too. In my M-World I don’t exist. In your M-World I exist but you don’t. In your M-World you don’t exist. I don’t meet me in my M-World and you don’t meet you in your M-World. But I meet you all the time and you regularly bump into me too.

We are strangers to ourselves in our M-Worlds. That is just the way of it.

When you and I are at our best with each other we leave our M-Worlds and come together for a while, we meet in another place. Let’s call it S-World. S-World is very, very similar to M-World. It is really, really close, closer than the hundredth of the width of a butterfly’s wing. You could not put a piece of paper between M-World and S-World. But they are so very, very different and they occupy very different places – they are an infinity apart.

In M-World I am isolated, my perspective is stranded to itself, my thoughts are my own and my journey is the journey of the solitary.

But, when we meet in S-World I am part of a community, my perspective is confronted and completed by yours and others, my thoughts are shared, and my journey is not so lonely.

The problem seems to be that S-World is hard to find. But is it?

Oddly people who need each other find each other effortlessly in S-World. All M-World separation disappears, the needy are united in an instant. When the need is great, in an instant they are all moved to and share in S-World.

But people, even really, really clever and talented people who do not want to need each other can never find S-World, not even if they are all together in the same room, sitting right next to each other for hours and hours and hours, looking right at each other. They remain in their M-Worlds where they do not even meet themselves.

Wisdom in Groups 2019

Wisdom in Groups – Leadership, Strategy and Teams

Post by Professor Simon Bell

In a fractured world where it seems that people are pulling further and further apart, where we find it hard to understand each other and where conflict seems likely to break out at any moment, we present Wisdom in Groups.

Wisdom in Groups from the Bayswater Institute.

You can think of the Wisdom in Groups event as a ‘headspace’, where beliefs and assumptions are renewed and refreshed.

Uniquely, Wisdom in Groups contains and implements the Double Task approach development originally by Harold Bridger. Double Task provides clarity both about the work we do and the way we do it. The outcome of applying Double Task is what the Bayswater Institute refers to as ‘Group Aware’. A person who is GroupAware is more reflective and more capable, better able to manage the overt and covert challenges of life. Wisdom in Groups is intended to help people to feel stronger and more resilient. It can mark a step change in our understanding of ourselves as leaders.

In all the turmoil of the contemporary world, maybe to be truly GroupAware is the most powerful gift that an organisation can provide to its people.

Peter Drucker came up with a saying ‘culture eats strategy for breakfast’ and we see this in many of the organisations we at the Bayswater Institute go into. Using Double Task with leaders and teams helps us to work together on strategy and culture at the same time, so that changes, introduced are firmly rooted in the reality of the present, and lead to better outcomes in the future.

Understanding how and why the NHS adopts innovation

Post by Dr. William Maton-Howarth

Adoption of innovation in the NHS

The adoption of new technologies and innovation in the NHS is a challenge, with many barriers along the way from early stage development to full scale implementation and delivery of all of the potential benefits.  The BI were commissioned by the NHS Innovation Accelerator (NIA) in March 2018 to undertake a rapid study focused on improving our understanding of the organisational processes involved in adopting innovative developments.  A report on this work has now been published providing new insights into how decisions are made within NHS organisations.

NHS Innovation Accelerator Case Studies

Through in-depth case studies of nine innovations our research has explored:

  • How and why organisations take up an innovation
  • The enabling factors which facilitate the uptake and embedding of an innovation
  • The impacts of adopting an innovation on organisational practices

The approach we adopted included an examination of eight theoretical perspectives in the  literature on innovation adoption.  These were then used to guide our interview questions as well as providing a lens through which we analysed the data gathered from the interviews.

Innovation Adoption Theory

In capturing these real-world case-studies we have gained new insights into how the organisational context plays a significant part in adoption and we highlight in the report a number of recurrent themes relating to the effective spread of innovation across the NHS.

Our analysis is organised into three sections:

  1. the adoption journey,
  2. the adoption network, and
  3. common tasks in the adoption journey.

Key Adoption Themes

Some of the key themes emerging from our work include: the complex nature of adoption; the dynamic and non-linear process of adoption within organisations; the need for mutual adaption and iteration between the organisational context and the innovation to facilitate adoption; the facilitating role of multiple champions operating inside and outside the adopting organization; and the interplay of push and pull factors that supports implementation and builds the capabilities of both the adopting organisation and the innovator.

NHS Innovation Accelerator report “Understanding how and why the NHS adopts innovation”

The Past, Present and Future of Sociotechnical Systems Theory

Bottom up and Middle Out Approaches to Electronic Patient information Systems: A Focus on Helathcare Pathways

Wisdom in Groups – WiG 2019 & WiG Intensive – NOW BOOKING!

WiG 2019: 5 days: 8th–12th July 2019
Royal Cambridge Hotel, Cambridge.
£2,500 per delegate (£1,200 non-residential).
Please book early.

WiG Intensive: 3 days: 1st–3rd July 2019
Royal Cambridge Hotel, Cambridge.
£1,500 per delegate.
Presented for the first time, WiG Intensive is intended as an advanced immersive event for the alumni of earlier WiG or the Bayswater ‘Midhurst’ Conference. Again, please book early.
The WiG Intensive three days builds upon your experiences of WiG and advances into areas such as: reading the group, understanding the unconscious in group work and refining your skills as a Double Task, GroupAware practitioner.

Digital Change in Health and Social Care

Digital change in health and social care – a report by the King’s Fund

Reviewed By: Dr Adam Hoare

Digital change in health and social care King's Fund Bayswater Institute
Digital change in health and social care

This report by the King’s Fund, presented at the Digital Health and Care Congress 2018, usefully draws out some of the challenges in adopting and scaling digital health and care interventions through consideration of five significant case studies. It begins by recognising some of the unique challenges of digital change and goes on to identify some key themes. The report is a practical and timely contribution to the practical understanding of digital change and not only references some of the work that The Bayswater Institute (BI) members have been involved in for many years but raises many of the issues that the BI come into contact with on a daily basis.

The report recognises several challenges around large-scale digital change. The negative memories around the National Programme for IT (The Implications of e-health System Delivery Strategies for Integrated Healthcare) and the inability to undertake such change whilst under pressures of current demand on resources being key issues.

The Evidence About Managing Digital Change

The report references the Wachter review (Making IT Work) which identifies the need for change processes using digital technology to be ‘adaptive’ and ‘technical.’ That “Adaptive change is change that relies on human behaviour for its success.” At the heart of this challenge lies approaches that are central to the BI way – action research and sociotechnical systems. Action research involves iterating towards a solution and sociotechnical systems thinking recognises that the solution is a collaboration of people working with technology. This recognition represents a significant departure from the “big-bang” approach to system change where it is assumed everything is known up-front. It signifies a shift to more “test and learn” thinking that underpins so much successful innovation in other industries and endeavours.

The report goes on to recognise the productivity paradox identified by Brynjolfsson (Beyond the Productivity Paradox.) That efficiency gains accompanying widespread digitisation is often absent in the traditional indicators. Our work indicates that it is often necessary to expand the range of indicators and evidence to understand how new practice is being enabled and what that means. This means that the evaluation approach must evolve with the intervention.

The work of Prof. Eason (a member of the BI) is discussed with regard to the tensions between top-down and bottom-up approaches in digital innovation (Bottom-up & Middle-out Approaches to Electronic Patient Information Systems.) The benefits of a middle-out approach are recognised in trying to link front-line change to national standards and frameworks. The work of Eason goes on to recognise that large-scale digital change is challenging and frequently fails (Getting the Benefit from Electronic Patient Information that Crosses Organisational Boundaries – Final report NIHR service delivery organisation programme)

In considering the barriers to successful digital change the work of Greenhalgh is cited (Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies ) which distinguishes between complicated and complex interventions. Complexity in this sense arises from systems that are interconnected and dynamic and produce emergent behaviour. Too often solutions are assumed to be complicated and fail because they do not address the complexity. In discussing the use of telephone triage in primary care the report refers to the absence of clear evidence of benefits but that some practices improved their ability to cope with demand. The same intervention in a different sociotechnical implementation could yield completely different results. Further, the originally identified benefit may not always be the useful benefit found in practice. This complexity again goes back to the need for a “test and learn” approach. This situational complexity and lack of a one-size-fits all approach underlies the challenges of the Whole System Demonstrator which saw the intervention as fixed and tried to generate an economic value (or QALY) for the intervention. Although the value of telehealth in reducing emergency admissions and better managing patients is generally recognised (Reduced Cost and Mortality Using Home Telehealth to Promote Self-Management of Complex Chronic Conditions: A Retrospective Matched Cohort Study of 4,999 Veteran Patients) it is highly situationally dependent and cannot be implemented as a black box approach as it is a sociotechnical intervention. The report reiterates that digital change is adaptive and does not lead to static states for testing – it evolves.

The report goes on to explore five different digital interventions across very different sites and applications. It identifies five key themes that are highly correlated to themes we see recurring in our BI work.

Leadership and Management

A key theme here was that personalities count. Often, selecting the right person to lead on a particular aspect was central to success. This is reinforced by the observation in the report that technology implementations should not be seen as IT projects but as a cultural change that is highly dependent upon good leadership. This leadership is most effective when clinically driven. At the BI our experience shows that many digital projects are approached as linear implementations that do not seek to learn or understand what is working and what is not. The need to build collaborations, often across organisational boundaries, is underestimated. In our work we regularly see digital projects pigeonholed as IT and lacking in the attention to culture change and leadership identified in the report.

User Engagement

The report recognised that a common approach across the case study sites was to recognise user engagement not as a single event but as a continual collaborative process involving users of the technology. The work we did at the BI in the BOLD-TC (Better Outcomes for People with Learning Disabilities – Transforming Care) project was based on just such an ethos involving not just the front-line practitioners across health and social care but also people with learning disabilities and their families. The move to a more collaborative, ongoing engagement with users is essential if services are going to evolve.

Information Governance

The case study sites focused on cultural rather than the technical aspects of information governance. By creating the right environment for partners to come together and solve the problems of sharing data it was found that collaboration, in general, was increased. Leadership and approaching information governance as a framework rather than trying to solve each problem as it occurred led to sustainable approaches.


It was identified that the right supplier could act as a facilitator for change by coordinating actors and change processes. Our experience at the BI is very similar. The ability of a supplier to see all of the challenges being addressed by the organisations coming together in pursuit of a common digital solution puts them in a key coordinating role. By providing each of the stakeholders in the intervention with valuable reporting and evidence specific to their needs they can act as the glue that binds the intervention. However, this requires an open supplier that sees the long-term benefits in building trust and collaboration. As the report points out choosing suppliers is a significant contribution to the success of the approach.

Resourcing and Skills

For the project to succeed the resources and skills need to be there, over and above what is required to keep the engine of delivery going. For large-scale digital interventions this is challenging in the current environment. Recognition was given to starting small and evolving solutions in a phased way. This was particularly important when crossing organisational boundaries. Trying to do too much at once absorbed resources and slowed progress. Our experience reflects this. Developing solutions that can have an impact on day-one but evolve over time to cross boundaries is essential and, again, part of the ongoing “test and learn” approach.


Although not a separate heading the importance of evaluation was noted. Significantly, the importance of evaluating success and failure was recognised. One of the quotes equated randomised control trials with a lack of rigour recognising that iterating understanding and learning was essential. At the BI we are committed to evaluation that engages with complexity and evolves with the intervention to develop learning and understanding. This requires formative evaluation and an understanding of the challenges the collaboration partners are facing.


The report is a significant contribution to understanding the challenges of implementing digital change. The use of case studies that demonstrate both the barriers and how they were overcome is the most useful way to share learning and understanding. At the BI we hope to see more of this kind of sharing and a move to learning “what works for who and under what circumstances.”

In my work with Airedale NHS Foundation Trust we addressed the issues of one-size-fits-all, the black box view of technology and the need to embrace complexity. Beginning in 2008 as part of the Assisted Living Innovation Platform (ALIP) we worked with Airedale NHS Foundation Trust and partners to use video in the home to address a range of care scenarios. Over a period of eight years Red Embedded Systems Ltd. developed the v-connect service. We developed a communication platform that could facilitate a range of care scenarios including video calls through the TV and delivery of educational content. We implemented interventions for long-term conditions, social care interventions such as virtual visiting, support for people with renal failure and remote support for people with learning disabilities. We integrated ambient monitoring, remote physical measurements, evidence collection and reporting (A Socio-technical Approach to Evidence Generation in the use of Video-conferencing in Care Delivery and Factors Affecting the Move to an eSystems Approach to remote Care delivery.) Many of the challenges discussed here were addressed in working with a broad range of partners in care delivery. We overcame barriers in all of the key themes identified but failed to make the commissioning case in every situation. Digital interventions have the potential to prevent and reduce current activity in the care system. Better educated and managed patients are more independent, and this reduces the need for care. For people with learning disabilities, remote support enables them to live more independent and confident lives. Prevention reduces need for care, independence and confidence all reduce the amount that the current providers are paid. This raises significant issues for leaders and for culture change. Often the right thing to do for the patient or client is the wrong thing for the financial standing of the organisations involved. This requires leadership at the policy and Governmental level. The focus of this report is on how successful digital interventions can be against the resource and skills challenges in the current climate. Imagine how successful they could be if there was a strategy and funding to facilitate a market in solutions.

We can only hope that future initiatives such as the Industrial Strategy Challenge Fund on Healthy Ageing (Industrial Strategy Challenge Fund: for research and innovation) and the recently announced £487m Transformation Fund for Healthcare will begin by taking notice of what we know and not try to reinvent the wheel.