"Hi, I'm Amy and I used to be a physiotherapist". It was a sentence that took everyone's breath away. In 10 words this physiotherapist had set the scene for a story that was forever going to change the way the leaders around the table thought about their system.
For Amy went on to describe an experiment in which she, as part of a team including GPs, Nurses, OT's, Social Workers and care homes, had truly been liberated and transformed lives as a result. In this experiment, outside of remaining legal, all rules were to be suspended. No existing criteria or protocols were to be applied. No permissions to access budgets, no targets, no referrals, no lean tools, no process mapping, no hierarchies - none of the usual paraphernalia of the system to get in the way of making the right decisions for the person. Instead the team was going to focus on using their skills, building relationships and understanding the person in the context of how they lived their life and pulling the necessary support when it was needed. What mattered to the person was all that mattered.
Although there were countless examples she chose to speak of one person in particular whose story typified their approach. He was a young man with a young family whose life was irrevocably changed in an instant as a result of a freak accident that left him tetraplegic. Amy was helping him around what was going to be his new home, aware that the team was selecting people to be part of an experiment.
She was already concerned when, on arriving at the new home, they were greeted by an elderly woman. Not a problem in itself, but her patient was in his mid-thirties and this was a home for elders. The system had decided that this was where he was going to spend the rest of his life. The look of desperation on his face when the implications of this had sunk in was bad enough, but it was when she couldn't fit his wheelchair through the door to his room that she decided that he was going to be part of their experiment. She wanted to know if there was more that could be done to give this man the life he wanted rather than the life the system had designed for him.
Through the process of understanding, Amy and the team began to see how the system had medicalised his problems to such a degree that they had completely lost sight of his other, natural needs in living a good life. Not one functional assessment had considered his desire for a career, or his concerns about money which was creating anxiety which, in the opinion of the psychiatrist, would most likely result in him becoming depressed. Not one functional assessment had considered his desire to be active. Not just by being merely moved around but truly active and participating in things that were important to him. Not one functional assessment had truly understood his desire for family and personal relationships that had gone so disastrously wrong since the accident.
Through understanding him they began to understand themselves and each other and how, important as their skills were, there was more to helping and supporting him than the focus on mechanical, technical or medical issues.
They began to understand what it meant to be in an experiment where none of them had roles. Not flexibility within their existing roles, but no roles - at least not in the way they had traditionally viewed them. Instead they brought skills to the team and used them or pulled them in from others dependent on what their patients needed at any particular time. At first it was confusing. So used had the team become to writing referrals for one assessment or another it was hard to trust their instincts and just do what was right for someone when they needed it. So common was the process of seeking permission from managers to spend even the smallest amounts of money that it took time for the team to believe that they could JFDI - just do it.
But as time went on their confidence began to grow - in themselves and in each other. They began to see just how much their judgement and experience was restricted by a system that required them to fill in forms, seek permissions, justify and attribute their decisions. They began to see just how self serving the system was, with different rules for accessing different pots of money, all with the intention of controlling expenditure but, in reality making things more costly end-to-end over time. A pot of "Red" money here, a pot of "Blue" money there - when what they needed was "Purple" money.
It took them some time (and encouragement) to believe that by focussing on creating value for their patients they were not only doing the right thing but it was also cheaper. And more rewarding - both for the staff and their patients.
For, in this case they were able to provide this young man with a life that would never have been possible under the old system, far more rapidly than would conceivably been the case before. They didn't wait for protocol to allow them to get him in a specially adapted wheelchair for him to race the physio and OT around a running track. They didn't wait for approval to provide him with basic amenities, like a cup he could drink out of himself, because of concerns about who would pay for it. And they didn't wait to see what boundary of the system he had crossed over and watch carer after carer become involved in his care - they just did what was needed to help him.
The outcome? For the person - hope. And a belief that there was a better future. And as a result a young man moved from being a person in despair of what the future held to a person who had something to live for. No need for medication for his mood. No need for counselling. The team was his drug of choice.
For the team - reward and revelation. Reward from being able to use their skills and directly see the difference their engagement was making. Revelation from realising just how much the system got in the way of actually creating value for people and giving them a good life.
And for the system, reduced costs as people are taken off the flightpath to dependence, the level of carer input reduced and the number of repeat visits reduced; improved morale of staff and a much better patient experience.
The leaders Amy spoke to were CEOs and Executive Directors of all the main organisations in the local wellbeing economy. An audience that, before the experiment started, she admitted to feeling somewhat intimidated by. By the end of the experiment she had so much to say that she felt the leaders needed to hear that nothing was going to get in the way of her telling them what she had learned.
By experimenting with the Vanguard Method she had experienced first hand what it was like to be truly liberated. She had begun to realise how convention was getting in the way of caring and creating value for people. She understood that the role of her manager was now to act on the system conditions that got in the way of creating that value, not create more barriers. And she discovered that the skills she had as a physio were useful but didn't define her and her relationship with patients or other professionals.
"Hi, I'm Amy and I used to be a physiotherapist" she said "and when my presentation is finished you will understand why I am not going back to the old system".
It was breathtaking, it was inspirational and it was truly liberating.