Monopolising What Is Valued

Statutory systems are struggling to understand people’s lived realities. This belief has fueled our work from the beginning and it’s why we believe that what’s needed is a new way of working, one that acknowledges the importance of, and seeks to establish, a deeper connection between systems and communities. 

But how is it that people in systems have become so disconnected from the people they purport to serve? One way, I believe, is through the monopolising of what is valued. 

There was a clear example of that this week in The Lancet. The esteemed medical journal published a study that showed that when people are discharged from a mental health crisis team, they fare better when they’re supported by a peer. The idea of ‘better’ - ie what was valued - was defined as being less likely to be readmitted. 

This is a system-defined idea of ‘value’. 

I recall seeing some work from Toronto in which a primary care team spent time with people with multiple conditions and asked them what mattered. One of the things they said was having the option to be admitted. For them, it was a relief to know the option was there when things got bad. They were horrified to hear the health care system was looking to reduce admissions. 

The study in The Lancet concludes that peer support had some benefit but the results were weak. What the authors mean is that peer support offers some value to the system. But what of the other types of value that the work created? As Dr Anjali Taneja of Casa de Salud in New Mexico, USA, said over Twitter, “so much of peer recovery work is about relationships, accountability [and] trust”. Were these measured? Not according to what was reported in the study. 

Dr Taneja goes on to share how her work using community health workers (CHWs) was deemed as “unsuccessful” by evaluators and yet, as she says, “it wasn’t the CHWs’ jobs to reduce hospital admissions, they weren’t given resources to do so nor were they asked to do so! [T]hey were bettering the lives of folks”. 

Bettering the lives of folks. That’s not always the same as what the health care system thinks is better. These definitions of ‘better’ need to be debated ahead of research being conducted. In my experience, they rarely are, and so, by monopolising what ‘better’ is, systems - including research and esteemed medical journals - become increasingly disconnected from the people they purport to serve. 

As Clare Wightman of Grapevine (and a member of our Steering Group) suggested on Twitter, ultimately it’s about power. 

With regards to our work, we’re recalibrating what we want to do. The Steering Group is getting into a room on September 26th to make sense of what we’ve learnt and refine our focus. Yes, it’s about parity, trust and an equal voice for all (as we say in our vision) but it’s time we got more clear about the ‘it’. 

More on that in a month. 

 

Pritpal S Tamber

Founder, Beyond Systems

HBR, Q & The Tensions of Change

First and foremost, I’m excited to read the mini-blog from Matthew Bell, formerly of Shared Lives South West. Matt joined the organisation as CEO with the idea of bringing a more ‘participative’ approach to its running, effectively distributing control through the organisation, rather than being top-down. It would have been a great example of what we at Beyond Systems are advocating for - a way of working based on parity, trust, and an equal voice for all. 

It didn’t work out and over the next few weeks and months Matthew will share six 'tensions' that surfaced in trying to change an organisation. 

The fact that Matthew is sharing his experience is significant. It’s clear that top-down systems that create a them-and-us between themselves and the people they’re supposed to be serving is not working. But proposing a new model and trying to make it happen is very, very hard - especially when we’ve all been trained to believe that systems are managed top-down, that’s just how things are. 

Where is this kind of experiential knowledge routinely shared? In response to my last post, a reader commented, “What is needed is the equivalent of HBR in health care - a journal largely written by and about practitioners.” HBR is Harvard Business Review. Perhaps that’s the answer. A media brand that is respected and is able to share the realities of work, effectively through case studies. 

It’s with that in mind that our re-grouping continues. Earlier this week, I met with Beyond Systems’ organiser, Elizabeth Slade, and we kicked about what we might do next. We’re clear we want to pursue what this brand might do. And it’s also clear that we may need some financial support to develop our thinking. 

On financial support, we continue to face the realities of trying to raise funding through grants. We don’t have the right vehicle because, as previously mentioned, mine and Liz’s companies do not have an ‘asset lock’. And so, although there is interest in our perspective and what we’re thinking about building, our lack of ‘the right vehicle’ may simply scupper us. 

That’s stuff we need to discuss with the Steering Group, which is what we’re about to do. 

Of course, you may be wondering why we need to establish a media brand when Matthew was able to find a home for this thoughts? Perhaps that home, Q Health, is meeting the need. It’s not. It’s meeting a need - to foster continuous and sustainable improvement in health and care - but that’s radically different to advocating for new ways of working based on parity, trust and an equal voice for all. That, in our view, needs a home. 



Pritpal S Tamber

Founder, Beyond Systems

We May Need More Zero's

In academia, there’s a mantra: ‘publish or perish’. Academics have to publish their work, and the higher the ‘impact’ of the publishing journal the better. Publishing shows that they’re doing stuff, and publishing in high ‘impact’ journals shows that what they’re doing matters. 

In our work to date, we’ve come across many practitioners exploring what it means to work with communities on the basis of parity, trust and an equal voice for all. Few of them publish, if any. To all intents and purposes, the only way you’ll know of their work is if you spend time with them. 

This disparity in publishing is a bigger deal than people realise. In a world of finite resources, everyone has to make their case. Making one’s case is often facilitated by being able to point to published work. By not publishing routinely, the practitioners we hope to support are making their lives - and the lives of their colleagues - harder. 

Of course, not everyone can write. Having been an academic editor and publisher, I can assure you that many - if not most - academics are terrible writers. It may not be their proclivity, it may not be something they like, but with ‘publish or perish’ it’s not something they can choose not to do. Academics have no choice but to publish. 

Practitioners have the choice. And many choose not to. It may not be their proclivity, it may not be something they like, and they can choose not to. But the impact of this is that in a world in which people are looking for ‘evidence’ to back decisions and actions, academics have a greater voice than practitioners - and disciplines with large academic communities have the greatest voice of all. 

To address the imbalance, you have to get practitioners to write. But most won’t. And when they do, what they produce may not be worth the effort. And so, you have to help them. You have to find editorial and publishing resources to help them share their experiences, comment on the field, and through writing hold others to account. 

That’s not cheap. 

Running journals for academics driven by ‘publish or perish’ is pretty cheap, at least by comparison (which also fuels how many journals there are, and hence the perception of how much ‘evidence’ there is). And so, addressing the imbalance is not going to be cheap. 

That’s something we’ve realised in writing grant applications. The more we’ve thought about what’s needed, the more we’ve realised we need more zero’s at the end of the figure we’re asking for. That doesn’t mean we’ve given up, just that we’ve realised that to request something of the order we think is needed, we need to spend longer making the case. 

And so, that’s what we’re doing. Taking stock, thinking again, looking to re-group and bring greater focus (and zero’s) to the ask. Quite whether anyone will fund it, we don’t know, but as we’ve said before, we don’t want to do this work unless we can do it properly. 

Pritpal S Tamber

Founder, Beyond Systems 

Underwriting Collaborative Thinking

One of the key challenges to volunteer based work is keeping the energy up. That’s the challenge we - the Steering Group - are facing as we go through the slog of trying to get funding.  

For over two years we’ve worked hard to carve out time to get to know each other, share our perspectives, test each other’s thinking, and then find a core truth to the change we think is needed. We were lucky that the work was under-written by funding. That funding ended just before we secured the next piece of funding so we’re self-funding the gap (assuming we get further funding making this period a ‘gap’ not an end). In reality, that means we don’t have the means to spend quality time together.  

What makes that all the more important is that we’re all constantly evolving our understanding of the challenge. For me, that’s magnified by writing applications to funders and getting a sense of what might interest them. While we’ve decided not to bend our thinking to what a funder says just for its money, we also need to be pragmatic about focussing in on what ‘thing’ we want to do - and funders can get behind - to bring about change. 

I’m increasingly clear that the ‘space’ (defined by people working on the basis of parity, trust and an equal voice for all) is not only amorphous but also lacking the habit of sharing its experiences through formal publications. This process - of intentional evidence generation and evidence communication - is to my mind core to the ‘space’ becoming a true discipline able to garner respect from colleagues in different sectors. My view is that through that comes investment and growth (including further evidence generation and communication). 

We’re not all on the same page in this regard and that’s not surprising. Some of us have backgrounds in editing and publishing so we’re bought in to the need. Others don’t, and so need convincing. That isn’t a problem. To date, we’ve found that difference in our perspectives part of the tension of the space, part of what we not only need to hold but also help others hold. But it is a problem when you don’t have the resources to spend time together, deepen your relationships, and face those issues. 

One funder said to me last week that they don’t support ‘development work’. They want the finished idea to consider funding. Given our situation, it’s made me wonder how ideas get developed and how they get packaged for funding. Perhaps there are other funders that support development work but it does worry me that you can only enter this work, only engage these funders, if you have enough privilege to have done the development work on your own dime. Relying solely on the views of those with privilege is an exceedingly bad Idea in work seeking to have a social impact.  

Anyway, I’ve written about that before. For now, I’m grappling with how we keep our energy up when our respective focuses are naturally diverging. I think the answer is to plug away at getting the funding, including honing in on a focus that’s only part of what we agreed as a group, and then seeing who wants to carry on as we get to the other end.

It’s a little brutal but it may be the only way. 

 

Pritpal S Tamber  

Founder, Beyond Systems  

The Tyranny and Beauty of a Grant Application Form

I wrote a grant application for Beyond Systems yesterday. It's the first time I've written a grant application without being invited to, my first speculative punt. I was left with two thoughts. 

The first isn't great - applying for grants is an art form. I suspect that's not news to any readers but I was taken by how our plans struggled to fit into the funder's online form. It made me realise that writing an application for a grant is only partly about what you want to do; the rest comes down to how well you can make it fit a form. 

Of course, the form may simply be a reflection of the funder's priorities. In that case, a structured form makes all the sense in the world. And, in fact, if what I'm asking for doesn't fit into that kind of form, then perhaps I'm asking the wrong organisation. However, in this case, it was just about the form per se. I felt very un-skilled, almost too stupid to apply. 

The second is how the process of asking someone for money really makes you thrash out some of the uncertainties that you've been overlooking, whether intentionally or otherwise. That's not always a good thing - if you're dealing with a complex social issue like health, you cannot be certain about everything - but in this case it was. 

One of the things that I realised was that we're talking about wanting to nurture the field of practice but hadn't attributed any effort towards marketing. It's all very well us trying to nurture the field but if no one has heard of us, does it matter? I think there are enough echo chambers in this space already; I'd hate to give rise to yet another. 

On a related note, earlier in the week I spoke with someone running what I was told was a similar project to Beyond Systems. It wasn't - at least not yet - but what really struck me about the call was that every time I mentioned any aspect of our work, the person was able to say they'd done a report on it, commissioned some work on it, knew of it already. It was relentless. It didn't matter what I said. 'Been there, done that' seemed to be the message. And yet, I'd never seen their work once, despite being in this space for almost six years. 

I'd rather do less, and the work be known. And I'm intrigued by how a grant application form can make or break what you're trying to do. 

 

Pritpal S Tamber

Founder, Beyond Systems 

Can Only The Privileged Play?

Over the last few weeks we’ve found our desire to not be a formal organisation an issue. A few funders have expressed interest in our aims but said that we either need an “asset lock” or not be a for-profit entity with only one shareholder. Neither are currently an option for us. 

An asset lock is a mechanism by which an organisation ensures that its money cannot be used for private gain (more here). When you’re receiving philanthropic money, it makes all the sense in the world that the receiving organisation isn’t structured such that the money could be siphoned off by an inscrutable individual. We’re not even an organisation, never mind an organisation with an asset lock.  

The same reasoning applies to for-profit entities with only one shareholder. Myself and Beyond Systems’ organiser both work as consultants through our own for-profit entities. Mine only has me as a shareholder. So, all in all, we don’t have the right vehicle to receive money.  

That’s not insurmountable, of course. While we’re reluctant to create something new, we have people within the Steering Group who work in vehicles with the necessary structures. So, we could conceivably use them as our ‘fiscal sponsor’.

However what strikes me is how hard it is to get an idea off the ground. We’ve done a huge amount of work over the last two-and-a-half years to delve into a big issue and establish a vision to organise around. I don’t think there are many other groups out there that have worked this hard, and certainly hardly any that have done it with so little funding. But our ability to turn our ideas into a reality comes down to whether we can do the paper work. 

I spent this afternoon looking at another funder’s terms and conditions. With them, we don’t have the vehicle issue - yet - but just understanding the terms of the application took almost two hours.

That’s two unpaid hours, to be clear. 

Of course, many social innovators (I so hate that label) will shrug and say that’s life. But, as a relative newbie to the field, and as someone with a lot of experience of the start up world, I’m fascinated by how it’s only those with privelege that can play. Without the right vehicle - which we should be clear requires a certain level of education - and enough money in the bank to forgo making money today you’re just not welcome in this game. 

That has to be wrong.

I’m sure we have enough assets at the table to overcome all this - vehicles, education and money in the bank - but I can’t help wondering what the implications are for social innovation when only the privileged can play. 

And whether we’re just part of the problem. 

 

Pritpal S Tamber  

Founder, Beyond Systems  

The Need for Editorial Strategy

Yesterday, I drafted something for a funder who's expressed interest in our work but asked some (good) clarifying questions. In so doing, I got a little closer to what I think is really missing in the space we're trying to organise - an authoritative voice. 

My view is that there is already a lot of practice based on parity, trust and an equal voice for all, but it's too dependent on the blood, sweat and tears of a few highly committed people. When those people burn out, the projects die. 

To avoid that, they need to be properly resourced. And what would help them is if they could reference something broader than their own work, something that harnesses the knowledge from across the whole field of practice. 

I shared that view in a five-part response to a tweet from Julian Corner, CEO of the Lankelly Chase Foundation in which he shared his view (in a blog post) on working with complexity. In the post, he essentially says that relationships are what matters but also shares that he's not sure how that 'scales'. 

For me, it scales through followership and fellowship, both of which can be generated through an editorial strategy. In other words, a purposeful, narrative voice. 

I've also just got off the phone with an awesome social innovator based in California whose done work in Nicaragua. Her background is in journalism and we agreed that the issue is not a lack of good work, it's the fact that it's not written about adequately - by which we meant with a view to followership so that new approaches can be followed by others (or 'scale'). 

I'm not sure if foundations really understand the need for editorial strategies to grow a field of practice. It's a well-trodden (and very effective) approach in other scientific disciplines so why not the one anchored in parity, trust, and an equal voice for all? 

 

Pritpal S Tamber

Founder, Beyond Systems 

The Connectional and The Tedious

We've been asking for people to publicly support our vision and plans, partly to show to potential funders that we're not a madcap group of do-gooders; there is a genuine need out there.

In this update, I'm pleased to share what one new supporter wrote. What's below is from Ewan Aitken of Cyrenians, an Edinburgh-based charity that for 50 years has served the homeless and vulnerable transform their lives by helping them believe that they can. 

"Our systems are, at their core, transactional, focused on "fixing" the individual for the cheapest possible price. Real transformation lies in deep relational approaches, which touch where our human flourishing really lies, in meaning and purpose, which is by definition connectional.

"It is when we reach out to others we find our needs are met. It is in community we discover our individuality. It is in exploring difference we find what binds us as human beings. It is in listening to those in the toughest realities we discover new journeys to share.

"I hope this exciting network can be a catalyst not simply to change our systems but to fundamentally re-frame how to best bring change not just for others but for ourselves as well."

We thought it was a pretty awesome set of words and were pleased that Ewan gave us his permission to share them. 

In more tedious news, we've had three rejections from funders. One said they only fund communities directly. Another said they only fund work in their patch. And another said they only fund work in the 150 communities their trust was set up for. 

So be it. Let's hope some of the other funders are able to stretch beyond their patches and see the value of being in something bigger. 

 

Pritpal S Tamber

Founder, Beyond System 

Is There An Enemy?

The concept note (see previous post) is with a number of funders to consider but one of the things we've been back and forth with is whether there is enough of 'an enemy' in it.

All work seeking to bring about change has to organise around an insight into what's wrong with the status quo, and be organised in a manner that is likely to bring about the change. In essence, the insight informs who the 'enemy' is. 

Earlier in our work, we were clear that our insight was that the health care system is too focussed on a bio-medical definition of health. However, as the work progressed, we felt our view applied beyond health, hence we dropped this 'enemy' in favour of a broader one about the lack of parity between systems and citizens. 

We also felt that just the use of the term 'health' makes it impossible to escape the tractor beam of the bio-medical definition of health. Some of us have seen initiatives fail repeatedly because their understanding of health remains too narrow. 

So, all in all, we've dropped the 'enemy' of the bio-medical model and embraced a broader understanding of the problem. However, perhaps we've gone too far and potential funders cannot see enough of a thing to get behind. 

We shall see. What matters, we feel, is getting into a 1-2-1 conversation with funders. At that point, we can make this decision - the dropping of the 'enemy' - more clear. If the concept note achieves that, it'll have done its job. If not, we'll have got it wrong. 

 

Pritpal S Tamber

Founder, Beyond Systems 

Concept Note Sent to Potential Funding Partners

I've drafted the 'concept note' and Beyond Systems' organiser, Liz Slade, has reviewed it and signed it off. It's now with nine funders to consider and we're looking for the right person to approach in another six. Let's see how it goes. 

 The concept note

The concept note

The concept note is essentially an expansion of what's on the Our Plans page. We're seeking to raise £130,000 for the first year of work. We want to build a coalition of funders as we think they're as much part of the learning community as anyone else. 

We've shared the concept note with all of the supporters listed on the Our Plans page too. If you know them, ask for it (or ask us!). We've said they can share it. We're always keen to hear what we might do differently (although we have a pretty clear sense of year one). 

We're not sure whether to put the note online. It's just two pages (obviously it's backed by a more detailed explanation of how we intend to spend the money) and the salient points are on the site already. 

Let us know what you think. 

 

Pritpal S Tamber

Founder, Beyond Systems