top of page
Facilitation
System convening · Healthcare improvement · Facilitation · External review
Stress-testing a national approach to change - with the system it was designed to support
Healthcare Improvement Scotland needed an independent review and national symposium - involving a cross-section of system stakeholders - to understand how the emerging 'Scottish Approach to Change' should become more practical, credible and collectively owned.
What the client said
Working with The Future Works on the Scottish Approach to Change symposium and report was a valuable experience. The brief itself was complex and, at times, emotionally intense given the scale and importance of what we are trying to achieve across the system. Throughout, they were far more than a transactional partner, they built trust with us and created a space where we felt both supported and constructively challenged in order to achieve what we needed to.
The symposium struck the right tone, enabling a wide range of voices to be heard on a complex topic and generating very rich insight. The final report interpreted all of this insight clearly and is high quality, engaging and practically useful - it is already being used in senior conversations and helping to shape the next phase of the work.
Clare Morrison - Director of Engagement and Change, Healthcare Improvement Scotland
The challenge
Healthcare Improvement Scotland had developed the Scottish Approach to Change: a national approach intended to support more effective, people-centred change across Scotland’s health and care system.
The ambition was significant. The Approach brought together established disciplines - including quality improvement, service design, engagement and strategic planning - into a more coherent way of understanding and leading change.
It recognised that change in complex systems cannot be delivered through technical methods alone. Behaviours, relationships, learning and the meaningful involvement of people all shape whether change takes hold.
The Approach was intended to offer rigour without becoming prescriptive, and to be accessible beyond a specialist improvement community. But this created some important questions:
-
Was its purpose and distinctive value clear?
-
Could people understand how to use it in practice?
-
Was it flexible enough to work in different contexts without becoming too abstract?
-
What leadership, workforce and organisational conditions would it require?
-
How could it become genuinely owned across health, social care and the wider system - not perceived as another framework belonging to one organisation?
-
What might cause it to become a tick-box exercise rather than a different way of approaching change?
Healthcare Improvement Scotland did not want to launch the Approach and simply invite endorsement. It commissioned an independent external review to stress-test the thinking with the wider system.
The challenge was to create a process in which people could offer honest, constructive challenge - identifying what was valuable, what needed strengthening and what could prevent the Approach from being adopted in practice.
What we did
We designed and led an external review combining research, stakeholder engagement, national system convening and practical sense-making.
Building an independent picture:
We began with a review of the developing Scottish Approach to Change and the evidence, thinking and disciplines underpinning it.
Stakeholder interviews enabled us to explore how the Approach was being understood by people with different experiences of change. We examined where there was enthusiasm and alignment, where questions remained and which tensions needed deeper exploration with the wider system.
This initial work informed both the content and design of a national symposium held in February 2026.
Designing a symposium for challenge, not endorsement:
The symposium brought together around 50 practitioners, system leaders, academics and third-sector representatives from across health, social care, education and the voluntary sector.
We deliberately designed the event as neither a launch nor a showcase. Participants were invited to examine the Approach critically and constructively:
-
What felt valuable or distinctive?
-
What remained unclear?
-
What would make the Approach useful in day-to-day practice?
-
What conditions would enable or prevent its adoption?
-
Who needed to own and shape it?
-
What risks might emerge as it moved from concept to implementation?
The design created space for individual reflection, small-group exploration and wider cross-system dialogue. Facilitation principles drawn from Deep Democracy helped surface areas of agreement alongside tension, uncertainty and less-heard perspectives.
This was important because an apparently positive consensus could easily have obscured the practical and political questions beneath the surface.
Turning complexity into practical learning:
We captured and analysed the discussion alongside the earlier interviews and document review.
Rather than reducing the insight to a list of comments, we looked for recurring patterns, significant differences and the underlying implications for the next stage of the Approach.
The resulting final report brought together:
-
headline findings from the external review and symposium;
-
the strengths participants saw in the Approach;
-
the questions and tensions that still needed to be addressed;
-
clear asks for its future development;
-
and provocations intended to support further reflection and action.
These asks included the need for practical examples and case studies, peer learning, a clearer articulation of the Approach’s value, attention to leadership and workforce capacity, stronger cross-sector collaboration and safeguards against its use as a mechanistic performance framework.
What changed
The review gave Healthcare Improvement Scotland a clearer, independent understanding of how the Scottish Approach to Change was being received beyond the team developing it.
It confirmed a strong appetite for a more holistic, human and learning-centred approach to change. It also clarified what would be required to make the Approach more credible and useful in practice - greater clarity about its distinctive contribution, practical examples of how it could be applied, visible cross-system ownership and serious attention to the conditions needed to support people using it.
The symposium created a rare space for people from different sectors, disciplines and levels of the system to examine those questions together. Some participants felt the event itself modelled important qualities of the Approach by bringing in diverse voices and enabling open, critical dialogue. The event received an average rating of 4.5 out of 5.
The final report transformed a wide range of perspectives into a coherent set of findings and asks. It gave Healthcare Improvement Scotland a practical basis for refining the Approach, engaging senior and system stakeholders and considering how to support its future development and adoption.
It did not establish that the Approach had already been adopted or created impact across the system. It provided something essential at an earlier stage: evidence about what the Approach needed to become if that ambition was to be realised.
Our final report was taken to Board level to influence strategic decision-making, and the recommendations were practically applied by Healthcare Improvement Scotland and other stakeholders.
Our 'special sauce' on this project
This work required more than good event facilitation. It involved holding a politically sensitive conversation about a national approach being developed by an influential system organisation. Participants needed to feel able to challenge the work honestly, while the process still needed to generate insight that Healthcare Improvement Scotland could use.
Our contribution came from combining five areas of expertise.
1. System change and complexity. We understood that the success of the Approach would depend on more than the quality of its content. Ownership, power, relationships, leadership behaviour, workforce capacity and competing organisational pressures would all influence whether it became part of practice. This enabled us to examine the system around the framework, not simply the framework itself.
2. Independent review and constructive challenge. Our external position gave the process credibility. We were not invested in securing endorsement of the existing model, so we could ask difficult questions, test assumptions and create permission for participants to do the same.
3. Inclusive facilitation that could hold disagreement. We designed for more than participation. Deep Democracy-informed methods helped us hear dominant and minority perspectives, surface tension without allowing it to derail the work and avoid manufacturing a false consensus.
4. Understanding of change disciplines. Our knowledge of quality improvement, service design, engagement, systems thinking and organisational change enabled us to work across the different traditions the Approach was attempting to connect. We could recognise both their contribution and the practical tensions involved in bringing them together.
5. Research, synthesis and sense-making into high-quality outputs. We combined evidence from documents, interviews and the symposium, translating a complex body of insight into clear findings, asks and provocations. The report preserved nuance without becoming vague or unwieldy.
Participants described the symposium as feeling “different” and “truly inclusive”. That was not incidental to the work. The process needed to embody the kind of change practice the Approach was advocating: open, participatory, curious, relational and willing to learn.
Our distinctive value was using research to design a purposeful system conversation, then turning that conversation into practical intelligence capable of shaping the next phase of a national approach.
bottom of page