When the System Loosens: Recognising the Window for Change

Sometimes a system becomes more changeable before it becomes more settled.

In a short passage from a Horizons NHS conversation, complexity-leadership scholar Mary Uhl-Bien describes how intense pressure can loosen normal organisational boundaries and create an adaptive space. It is a useful way to understand why some changes suddenly become possible, and why that opportunity may not remain open for long.

 

Watch the 60-second “Adaptive space loosened up” clip on YouTube.

What an adaptive space really does

Adaptive space is not simply permission to move faster. It creates enough freedom for people, ideas and local knowledge to connect. That makes emergence possible: a response can be developed through the system, tested in practice and adapted as it travels.

Mary Uhl-Bien’s longer teaching on complexity leadership describes the tension between the entrepreneurial system, which pushes towards novelty, learning and growth, and the operational system, which must produce reliable results. Organisations need both. Adaptive space allows the tension between them to be worked with, rather than allowing one side to shut the other down.

Most people like the idea of innovation. The lived reality is less comfortable. Innovation involves risk, unsuccessful tests, repeated learning and time. Ideas are not usually the scarce resource. The difficult work is helping a useful idea cross local boundaries, meet resistance, change in response and become part of everyday operation.

The creative jolt

Adaptive spaces can sometimes be designed deliberately. During observation for her master's work, Sarah Phillips saw organisations introduce pool rooms and table-tennis tables. They created an initial jolt, a little competition and permission for people to relate differently. But the novelty often faded and the spaces were ignored.

The furniture was not the adaptive space. The useful part was the temporary change in human connection. Sarah calls this a creative jolt: enough movement, pressure or play for people to become curious, speak across ordinary boundaries and see something new together.

The strongest examples often arise naturally. In an emergency, clinicians can be particularly effective at connecting, collaborating and taking decisions across role boundaries. That is not automatic, and pressure can also produce frustration or protective behaviour. Enabling leadership means noticing the opening, protecting enough space for people to contribute, and avoiding the temptation to overload clinicians just because the system is briefly more responsive.

A cannula change can be a complexity event

A new cannula is not, by itself, a complex system. Changing a cannula across a whole organisation can be a complexity event because it perturbs many connected parts at once: procurement, stock, policy, infection prevention, educators, supervisors, local leaders, ward routines and the clinicians using the device.

The COVID-19 response made large disruptions feel more familiar, but genuine complexity events are not ordinary. They disturb established relationships and can briefly make the system more open. That opening should not be mistaken for a reason to remove governance. It is a chance to bring the right people together, learn quickly and create connections that will hold after the immediate transition.

The window is time-limited. Access to clinicians will still be difficult, some people will be frustrated and operational pressure will continue. The aim is to make the most of the interest that exists now, without adding another burden. A short survey, local conversations and visible idea routes can give people more ownership over how they learn, what support they need and what should change next.

Complicated is not the same as complex

The Cynefin framework helps make the distinction. Some parts of a device transition are complicated: technical specifications, procurement routes, stock movement, approved instructions and formal training can be examined with expertise and planned. The wider implementation is complex: behaviour, relationships, workarounds and unintended effects become visible through action and feedback, not through a plan alone.

That is why a single standard package cannot carry the whole change. The shared architecture can be prepared, but each organisation still needs to co-design how it will work locally. The practical pattern is to identify what already works, diagnose the local system, co-design the transition, rehearse and test it, evaluate what happens, then adapt and scale.

Sarah has described an Integrated Care System as a complexity bed: many connected organisations, pressures and perspectives interacting at once. Innovation huddles and challenges can help the system see that condition for itself. They do not manufacture good ideas on demand. They amplify connection while interest is present and give promising ideas a route into testing and wider use.

The vein as a strategic infiltrator

The vein is a strategic infiltrator. A small, everyday clinical practice can make the wider learning system visible. A device transition gives people a reason to gather around something tangible, then notice the connected questions about access, technique, support, equipment, documentation, feedback and local policy.

VeinTrain uses that moment to make each contact count for learning. The initial switch can be supported across the organisation, while short digital teaching remains available at the point of need. Locally observed questions can then guide additional micro-teaching. Clinical governance, competency decisions, supervision, scope of practice and policy remain with the employer.

This does not replace in-person learning. It allows face-to-face time to be used where it adds most value: practical judgement, supported rehearsal, masterclasses, ultrasound and locally relevant best practice, rather than repeatedly using scarce classroom time for material that can be made consistently available online.

VeinTrain provides reusable learning and implementation architecture, then works with the organisation to adapt it. Additional locally relevant learning can be scoped within the agreed licence and governance arrangements. The aim is not a manual imposed on the system. It is an organisation-led learning process that can be deployed, observed, improved and scaled.

A survey and idea route can also invite clinicians into future device decisions. Suggestions can enter an innovation-hub process, be made visible, tested against evidence and operational need, developed with the people affected, and either progressed, adapted or stopped. The best ideas gain support because the system has had a part in shaping them.

Explore the illustrative HALO whole-hospital demonstrator. It is an unlisted preview using a fictional hospital and synthetic data, not a commissioned deployment or live dashboard.

A mirror, not a manual

What helps change become something people can actually use? In this short reflection, Sarah Phillips names three human conditions that technology cannot supply on its own: space to reflect, dialogue rather than directive, and a mirror rather than a manual.

Watch “Reflection, Dialogue and Feedback” on Vimeo.

For VeinTrain, this is part of the thinking behind HALO: capability grows when learning, local leadership, evidence and implementation are connected rather than treated as separate activities.

Read the related article on why NHS system integration takes time, and what that means for implementation and training. You can also continue exploring Leadership and Transformation, or read the David Nabarro systems-leadership perspective.

Source and evidence note

VeinTrain evidence strength: Level 3, supporting expert commentary and implementation reflection, not clinical guidance.

The Mary Uhl-Bien material is used as supporting expert commentary. The VeinTrain film is Sarah Phillips’s implementation reflection. Neither establishes the effectiveness of a specific clinical intervention.

VeinTrain’s co-design sequence is also informed by Sarah Phillips’s documented NHS system co-design work. That material is used as implementation provenance and does not imply endorsement by an NHS organisation or Integrated Care System.