What becomes apparent when you examine the patterning of systems or structures?

July 2022 was a wake up call for the NHS, as unprecedented extreme heat overwhelmed the datacentres at London’s Guys and St Thomas' Hospital Trust, shutting down all their digital services for several weeks.

In response, NHS England began the development of a virtual model of their entire digital system, with the intention that NHS staff could use this to investigate and improve the resilience of their own services. Alongside this work, they commissioned me to examine the possibility for transformational change rather than incremental improvement.

Working with the Positive Tipping Points methodology, recently developed by the team at Exeter University, I helped NHS England understand where the most powerful levers for systemic transformation lay.

A pattern limited to BAU possibilities

By drawing on the wealth of research into relevant climate risks, both the NHS’s own investigations alongside industry and government studies such as the Climate Change Risk Assessment, I mapped the potential for risk onto the measures in place, or proposed, for improving resilience.

This revealed a clear pattern, whereby most attention was devoted to technical solutions. This didn’t just add further complexity to a system already compromised by complexity, it also overlooked the more powerful social and cultural levers for system change. It became clear that the modelling was limited by these technical blinkers to change that remained in the realm of business as usual, rather than the transformation demanded my the rapidly changing climate.

With the aid of this finding, the model was improved, to give greater weight to socio-cultural measures. In addition, we developed a proposal for a broader programme of culture change to accompany the roll out of the model, called Holdfast; an immersive workshop designed to improve the intention and agency of NHS staff.