Post-Graduate Assessment Feedback Sheet

Student Number / Name:

1125665

Module Code & Name:

BU7730 Creative Thinking & Problem Solving for Managers

Assignment No.:

Submission Date:
Grade-band for each Task assessed against relevant Generic M Level Criteria

Generic M Level
Marking
Criteria
Evidence of critical reading of a
range of relevant literature
Formulation of coherent argument
that goes beyond the reiteration of
existing views
Interrelation of concepts and
appropriate methodologies from
published sources and, where
relevant, current practices with a
coherently expressed personal
viewpoint.
Demonstration of the ability to
apply, extend and / or evaluate
concepts and methodologies to an
identified problem or issues
Evidence of undertaking research
work, where relevant, in such a way
that it is planned, implemented and
interpreted with due regard for
evidence, appropriate modes of
enquiry and the communication of
its outcomes.
Use of key theories and concepts in
the discussion of relevant issues
Conclusions and interpretations
reached cautiously and discussed
critically, with acknowledgement of
alternative interpretations and related
to earlier theoretical arguments.
Coherent and articulate written work
that acknowledges academic form.
Within word count limits
Assignment Learning Outcome(s):

Develop a critical awareness of

and analyse wicked
organisational problems that can
be tackled with the aid of
creative management thinking or
soft systems methods

Apply a creative thinking or soft

systems method to a wicked
problem in an organisational
setting.

Critically evaluate the postimplementation effectiveness of

applying a creative or soft
systems approach to a wicked
management problem in an
organisation setting

Assignment Tasks or Necessary Component/s of the Task/s [NCT]

(assessing the Assignment Learning Outcomes: see left-hand column)
Outline of the perceived problem situation: recognise problems that
can be tackled with the aid of creative thinking methods

10
%

Critical analysis with justification: creative/soft thinking method(s)

considered to help gain insights into problems and evaluate which
one(s) is best for chosen purpose

30
%

Application of the creative/soft thinking approach: appropriateness

of the use of the chosen creative thinking approach adopted - based
on apparent usefulness of findings.

35
%

Conclusions: reflection & critical evaluation of ideas/insights that

have been generated & suggested ways to systematically set about
overcoming resistance to new ideas in organisations.

25
%

<40

40+

50+

60+

70+

Quality and Presentation of written work ** including Referencing of sources ++

Priority for Improvement: Firstly, please see Typical actions required to improve below.

First Assessor:
Second Assessor:

Weight

Provisional* Overall Grade:

Second Assessors Comment (Applicable only if your assignment is in the 2nd marking sample)
Second Assessors Suggested grade:

Table

* All grades are provisional until the meeting of the Awards /

Progression Board.

What my grades mean (full details in your Programme Handbook): your work shows one or more of the Characteristics listed for your grade
bands :
Grade
:

Task & Assignment Characteristics / Performance Criteria: >>>>

Typical actions required to improve your future work:

< 40

Fail: Unsatisfactory work evidencing misunderstanding or limited understanding of key

concepts / Limited application of concepts / Limited focus on the task/s set

40 +

Pass: Satisfactory work demonstrating acceptable understanding of most key concepts /

Some awareness of key debates / Over-reliance on sources / Certain gaps or weaknesses or
errors in understanding / Limited reading / Some application of concepts to practice

50 +

Good work demonstrating understanding of concepts and theories based on reading beyond
class notes with personal analysis & synthesis of reading / Good awareness of key
debates / Some minor gaps in understanding or errors / Competent application of one or
more theories to practice
Very good work demonstrating full understanding of concepts and theories based on
reading beyond the basic texts and using analysis, synthesis & a degree of criticality of that
reading / Engaging fully with debates / Few & minor gaps or errors / Strong application of
theories
Distinction: Excellent work demonstrating thorough understanding based on extensive
reading and analysis and synthesis of that reading with good critical awareness / Resolving
debates / Strong, critical application of theories / Provision of innovative solutions

Careful reading & working to comprehend class notes + set texts to understand
concepts / Applying concepts to understand practice / Addressing the exact
task/s set.
Re-reading & working to fully comprehend class notes + set texts to fully
understand concepts / Explaining source texts through your own words /
Understanding key debates / Applying concepts to understand practice / More
focus on the exact task/s set.
Further reading of literature & analysis of that reading to extend understanding
of theories and eradicate gaps and errors / Further use of your own words to
show understanding / Deepening understanding of key debates / Stronger
application of theories to interpreting practice.
Further depth of reading of literature & synthesis of that reading to extend
theoretical grasp / Working to resolve debates / Fuller application of theories to
practice & policy.

60 +

70 +

Further breadth of reading of literature & criticality of that reading / Further

application of theories in the critical evaluation and creative extension of
practice & policy.

** If the Quality of written work is graded at less than 50, your written English is a problem and you must work with an LSS Tutor to
improve it.
++ If your work is graded at less than 50 it is likely that you need to improve your referencing as your work may show some signs of plagiarism.
You must cite all your sources both when you quote sources directly or draw upon sources indirectly, using the correct APA format and give a full
reference list at the end.

Assignment
CREATIVE THINKING AND
PROBLEM SOLVING FOR
MANAGERS

Module: BU 7730:
Module tutor:
Student:
Student number:
Number of words:
Date:

Creative Thinking and Problem Solving for Managers

Steve Reoger
B1234567
4927
25th May 2015

Introduction
This paper sets out to consider a case study in the use of a creative thinking or
systems approach to a chosen problem situation within the posture and mobility
service of HELP University Health Board (HUHB).
The paper will further evaluate the extent to which the application of the chosen
methodology was appropriate to the perceived problem situation based on the
reflection of the exercise undertaken and the solution identified.
Background to the problem situation
HELP University Health Board (HUHB) provides a full range of primary, community
and acute hospital services for a population of 676,000 people across North
Wales. It employs around 18,000 staff and has a budget of 1.1 billion. The
purpose of the organisation is to plan, secure and deliver healthcare services in
the North Wales area.
The posture and mobility service provides wheelchair services to the population
who have a permanent or long-term impairment. Commissioning responsibility for
this service is undertaken an all Wales basis by the Welsh Health Specialised
Services Committee (WHSSC). The service is commissioned and funded under a
service specification, which allows for essential posture and mobility health needs
to be met but not any social or recreational needs.
Each month the service receives about 400 referrals some of which require a faceto-face clinical assessment prior to equipment delivery (complex cases) and some
that dont (non complex cases). Users gain access through a referral from a
clinician, most usually a general practitioner or a community-based therapist. The
service consists broadly of three groups of staff; administrative staff that manage
referrals and ordering of equipment; clinical staff that assess and identify correct
equipment and rehabilitation engineering staff to provide expertise when specialist
seating is required. They are distributed over two hospital sites.
In addition to this the activity of receiving, repairing, modifying and delivering
equipment is undertaken under a contract by an Approved Repairer. Equipment is
sourced from several wheelchair manufacturers who are based predominately in
Europe and North America.
The service is perceived to be a problem area for HUHB because of a number of
factors that repeatedly arise. These include:

Long waiting times for some complex patients.

High political interest at Welsh Government level including a service review.
A large number of complaints about the service.
Concerns over its resource levels.
Complexities in the service procurement and supply chain.
Previous attempts to change have perceived to have failed.

The different perceptions that exist within the stakeholders as to what the
problem is.
Disagreement between staff groups as to their roles.

This situation can be recognised as having some of the characteristics of a wicked

problem where this is defined as:

There is no definitive description of the problem. What the problem is

depends upon which of the stakeholders you ask, e.g. more resource
required, being more efficient.

Wicked problems have no stopping rule. Having no definitive problem

means there is no definitive solution. Past solutions offered, for example
simplifying the referral form, seem to expose new aspects to the problem.

Solutions to wicked problems are not true or false. The judgment on

whether a solution will work is likely to vary depending upon the
stakeholders values and goals.

There is no immediate and no ultimate test of a solution to a wicked

problem. A simple decision is not going to appease all views; solutions are
often difficult to measure.

Every wicked problem is essentially unique. The interaction of the social,

cultural and political contexts means that although access times may be an
issue in other services within HUHB the particular blend of stakeholders
with the particular service delivered ensures the problem is bespoke.

The problem situation in the posture and mobility service has social, political and
environmental aspects to it and thus supports its identification as a wicked
problem. It is therefore the basis of the case study explored within this paper.
Selected technique
The basis of all the approaches to dealing with wicked problems are fundamentally
the same and most, or all, involve the various stages described in a generic
problem solving model below:
Figure 1 Adapted from Hicks (2004)

The mess

CULTURE
Data gathering

Constraints
Politics

Problem identification
Ideation

Selection and problem resolution

Gaining acceptance and implementation

In order to explore a best fit approach to the problem situation within the posture
and mobility service consideration was given to several creative thinking and soft
system techniques to support the case study. For the purpose of this paper
creative thinking approaches are loosely grouped as those that promote the
communication between knowledge and experience and the problem at hand
through the promotion of innovative and creative thoughts. It includes
brainstorming, the six thinking hats technique and synectics.
System techniques are identified as those that tend to be an approach to a
problem that takes the broad view and concentrates on the interactions between
different parts of the problem. It identifies real world problems and then
conceptualises the solution. Techniques such as critical system heuristics and soft
system methodology sit under this group.
Consideration of systems approaches
Flood and Jacksons (2002) grouping of the most important system methods and
methodologies into a system of systems methodologies allows a useful starting
point for the consideration of using a systems approaches. This approach groups
problem contexts into two dimensions; systems, where the relative complexity in
terms of the system(s) that make up the problem situation are considered, and
participants which refers to the relationship between the individuals involved. This
ideal type grouping of problem contexts is shown in table 1 with the systems
methodologies mapped accordingly.
Table 1

SIMPLE

COMPLE
X

UNITARY
Operational
research
Systems
analysis

Viable
systems
diagnosis
General
systems
theory

PLURALIST
Social
systems
design
Social
technical
systems
thinking
Soft systems
methodology

COERCIVE
Critical
systems
heuristics

No
known
best
fit
methodology

Flood and Jackson (2002)

Comparison of the case study problem situation with this approach is set out in
table 2 and table 3.

Table 2 Systems dimension

Characteristic
Number of elements

Posture and mobility service

A large number of stakeholders,

Quantity of interactions

Multiple interactions

Attributes predetermined

Some aspects are predetermined but

many are capable of being influenced
by the environment
Interactions organised
Very loosely within a framework of the
process.
System evolution
Reactive to a stimulus, change is
constant.
System is unaffected by behavioural No, highly affected by social and
influences
political
dimensions
of
human
behaviour
System is closed to the environment
Stakeholders are aware and reactive
of
the
political
and
financial
environment within the public sector.
Wider relationships with other health
provision.
Table 3 Participants dimension

Characteristic
Compatibility of interest
Compatibility of values and interest

Agree on ends and means

Participation in decision making
Act in accordance with objectives

Posture and mobility service

Underlying understanding of the
purpose of the service
Differ
on
some
issues
e.g.
Commissioners/providers
tend
to
consider the user cohort whilst
users/referrers the individual. Some
conflict over the service specification.
Mainly compromise rather than agree
All participate but not necessarily at
the same time, at the same point of
the system.
Generally yes although there are
occasional coercive elements, for
example
where
there
is
no
compromise between the resourced
ability of the service to meet non
essential mobility and postural needs

demanded by some users.

Checkland (1981) defined problem owners as those who have a feeling of unease
about a situation or a vague feeling that things could be done better and who
wish something were done about it. It is possible therefore to identify multiple
stakeholders in the problem situation under consideration.
The significant number of interactions between these stakeholders within the
posture and mobility environment and the non-deterministic nature of these
interactions suggest the classification sits nearer the complex end of the systems
continuum than the simple end. Participant relationships are largely pluralistic in
nature with a fundamental compatibility of interest in what the service is there to
provide for, that is mobility, but with some visibly different perspectives about how
it should meet its objectives. There are some areas of conflict, most notably
between WHSCC and HUHB over resource allocation and between users and
WHSSC/HUHB in regards to the restriction of the service specification to
essential health and posture needs only.
Given the categorisation of the problem situation as complexpluralist in nature the
matrix is suggestive of the soft system methodology (SSM) as a preferred
technique for the case study.
The relative strengths of the SSM technique have been highlighted as structuring
previously unstructured problems with unclear objectives, using people as active
participants in the situation and being able to deal with the existence of several
perceptions to a problem. (Platt & Warwick, 1995; Mingers & Taylor, 1992).
A number of potential drawbacks to this approach however are noted. The use of
soft system methodology takes more time than some other alternatives. In
particular the initial stages, the gathering of hard and soft data required for the
production of the rich picture, takes the bulk of the time involved in the overall
process. In addition using systems concepts requires the facilitator to hold some
experience in the technique.
Furthermore Flood and Jackson (2002) highlight some criticisms of the theory of
SSM. Firstly they state that it is debatable if this approach can deal with situations
involving conflict and coercion highlighting a concern that SSM holds little to deal
with the reality that organisations are arenas of political infighting and conflict over
status and resources.
Secondly they indicate that participation within SSM isnt necessarily cognisant or
free from the influence of the power relationship. Thirdly the idealism perspective
that SSM is based upon suggests that the foremost way to change a system is
through the changing of peoples weltanschauung. The extent to which SSM can
achieve this is challenged by Brown (1996) who identified that although SSM aims
to deal with cultural or attitudinal problem situations there is a question of how
deep a participant through debate can understand another participants
worldview.

Fourthly whilst SSM embraces all perspectives as equally valid it effectively allows
the dominate power culture to ultimately decide the practical solutions at the end of
the process. Lastly as the level of participation isnt specified within the process it
means the required neutrality within the process can again be dominated. This has
led to suggestions that SSM is likely to ... reorient the status quo in a manner
beneficial to those in power (Flood & Jackson, 2002).
On balance and reflecting on the description of the problem situation and the
evidence base I concluded that a systems technique would be a relevant approach
for my case study and there is sufficient evidence to suggest that SSM is the
preferred technique to the particular problem scenario under consideration.
Consideration of creative thinking techniques
Creative solving approaches such as brainstorming and synectics have been
found to improve communication skills and teamwork (Hicks, 2004). They offer a
number of potential benefits as a chosen methodology towards the case study in
question. In particular the opportunity to ensure good involvement of problem
owners and the relative speed at which it can be undertaken in relation to some of
the system methodologies were seen as advantages. It can be used where there
is a degree of conflict and approaches such as the six thinking hats enable the
direct opportunity to bring that emotion into the problem solving arena.
However purely creative approaches can tend to focus too much on the innovation
generation of ideas and less on the development and implementation of those
ideas (Proctor, 2010). In a similar way to the use of soft system methodologies
some previous experience in the use of these techniques is also important.
Hierarchies within the chosen group are also a problem with these techniques as
they can dominate the creative process.
Three particular techniques were considered:
Brainstorming
This is a key technique used to aid creative thinking. Its focus on eliminating
criticism from within the idea generating process is utilised within other creative
thinking techniques. As a group exercise it is broadly accepted that it produces a
quantity of ideas leading to larger numbers of innovative ideas than individuals
would devise (Hicks, 2004) although there is some evidence (Mullen, Johnson &
Salas, 1991 and Diehl & Stroebe, 1991) that it may not be as productive as
claimed.
Six thinking hats
This technique devised by de Bono (1985) attempts to assist people into moving
outside of their thinking style to get a more rounded view of a situation. It is
effective at exploiting different perspectives. Along with brainstorming it benefits
from being a relatively quick and uncomplicated process.
Synectics

This is a more sophisticated technique than brainstorming and is far better in

taking the development of ideas generated through a process to judgement of
possible solutions. This is a good technique for multiple problem owner situations
although this may require the problem area to be broken down into smaller groups.
There are significant practical and time issues of running several parallel sub
groups and combining the results at a later date.
However the technique allows for excellent commitment to change, more so than
the soft systems methodology where problem owners may have little involvement.
It offers open communications and can aid positive cultural change within the
problem area.
Consideration of a mixed approach
Hicks (2004) identified some confusion over the classification of problem solving
techniques and stated that approaches should not be thought of as discrete
alternatives, never to be used in conjunction with one another.
I therefore also considered using a hybrid approach to the choice of chosen
techniques by amalgamating elements of the creative thinking techniques within
the overall framework of soft systems methodology. I saw merit in this option as
the strengths derived from creative thinking techniques of greater inclusion of
problem owners and a greater likelihood of being able to influence cultural change
could mitigate for some of the weaker aspects of the system methodologies.
However I concluded to fully test only a single option on the basis of my limited
experience in all these techniques and a desire to gain greater understanding and
learning from one approach uncomplicated by any other.
Consideration of other factors
Having a defined period of time in which to undertake the application of a chosen
technique was originally a major consideration within this choice process. Despite
the identification of SSM as the preferred systems methodology the need to allow
several weeks in the initial stages of that approach was considered a constraint.
However the period available to undertake the work, 8-10 weeks, became less of
an issue than the consideration of the logistics surrounding any attempt to get
several problem owners together for one or more sessions to support a creative
thinking technique. This was particularly challenging as the groups involved
included several not within a direct employee status of HUHB, namely patients,
commissioners, contractors and general practitioners.
Finally in regards to my previous experience in one or more of the possible
techniques available I identified that no one approach held an advantage over any
other.
Summary of choice of approach

Both approaches are applicable to the problem scenario as it is identified as a

wicked problem. However in choosing the SSM technique a number of key
considerations were identified as decisive factors:
1. Its focus on participatory methodology and its ability to address several
stakeholders views.
Systems techniques deal well with the issue multiple ownerships. It is
recognised that synectics can also address this although it might require a
restructuring of the problem into a number of parts. The potential need to
have several sub groups then working on it and the inherent danger of
missing the problem by doing this tends to suggest the more holistic
approach of a systems technique would be the better alternative.
2. The lack of a clear definition of the problem situation
Which SSM as a technique is considered strong at addressing.
3. The holistic approach of systems techniques over creative thinking.
Significant human relationships and activity systems form part of the
perceived problem which together with the consideration of political and
social dimensions to the problem situation leans towards using the
perceived benefits of SSM.
4. The guidance of the evidence base.
This is supportive of SSM.
5. The timeframe available.
6. The desire to test and learn about only one approach.
Application of Soft Systems Methodology
Ho and Sculli (1994) stated that the SSM approach is based broadly on the
following characteristics of managerial problems:

There are many equally legitimate perceptions of the reality of the problem.

Each viewpoint of reality is restrictive or incomplete and can be challenged

by alternative viewpoints.

Debate and discussion among the interested parties will lead to a more
comprehensive understanding of the problem situation.

The discussion and debate will also tend to move the parties towards
some agreed feasible solution that should alleviate the problem situation.

The soft systems approach involves a seven-stage process of analysis as outlined

in figure 2 which uses the concept of human activity as a means of getting from
finding out about the problem to taking action to improve the problem (Wilson,
1984).

Figure 2

Checkland, 1981.

The first two stages of the methodology are concerned with finding out and the
building of a rich picture of the problem situation. Stage three builds upon this to
identify the differing views of the purposeful activity systems and the creation of a
root definition which is the idealized view of what a relevant system should be
(Flood & Jackson, 2002) leading to stage four which is an account of the activities
which an ideal system must do to meet the root definition.
Stage five allows for the comparison of the differences between the outputs of
stages four and the rich picture of stage two and naturally leads to stage six which
is concerned with defining what, if any changes are to be undertaken. The seventh
and final stage is around the implementation of such agreed changes.
Stages 1 and 2 - Information gathering and the creation of a rich picture

Nidumolua, de Biea, van Keulenb, Skidmore and Harmsen (2006) stated that at
this point in the process the intention should be to capture all relevant information
about a problem: quantitative and qualitative, objective, subjective and official.
Bell and Harper (as cited in Nidumolua, de Biea, van Keulenb, Skidmore and
Harmsen 2006) usefully provide a list of techniques that might be used during
these stages of the methodology and information was gathered about the posture
and mobility service through the following methods.

Observation within the service environment.

Reviewing sources of information such as the Welsh Assembly Government
Health and Social Care committee inquiry report of 2010 and minutes of the
All Wales Wheelchair service Partnership Board.
Complaint analysis.
Performance data analysis including access times.
Approved repairer contract monitoring data.
User feedback via telephone interview (see appendix 1).
Staff feedback via face to face interview (see appendix 1).
Commissioner feedback via telephone interview (see appendix 1).
Referrer feedback via telephone feedback and postal questionnaire (see
appendix 1).
Service management team discussion via face to face meeting (see
appendix 1).

The rich picture developed for the case study with this information is shown in
appendix 2. The picture allows for the emergence of a number of relevant
systems (Flood & Jackson, 2002) which are divergent viewpoints from the
stakeholders on the purpose of the activity systems. Five of these listed below
were considered for further investigation within this case study.
1. A system to provide wheelchairs to people with a clinically defined health
need.
2. A system to help immobile people become mobile
3. A system to plan and resource wheelchair service in Wales
4. A system to generate income for manufacturers of wheelchairs
5. A system to generate income for repairers of wheelchair
Stage 3 Formulating root definitions
The root definition is an attempt to define the essential nature of the relevant
system and what it does. Using Checklands (1996) guidance on how to mould a
root definition statements were created for each of the systems highlighted in
stage 2 using the elements of the CATWOE mnemonic. These are shown in
appendix 3.
For the purposes of this case study one system was chosen for further analysis by
the SSM approach, that of the system to provide wheelchairs to people with a
clinically defined health need. This was chosen on the basis that it may incorporate
some of the issues within the other perspectives and because timely access to the

main participants in this system, the staff, would mitigate for the constraints of
time.
Stage 4 Building a conceptual model
Conceptual models are purposeful activity systems that are built according to the
world view of the CATWOE. Underwood (1996) stated that they are designed to
be the ideal systems to do the desired job.
A conceptual model for the root definition a system owned by HUHB, who
together with its staff and the Approved Repairer, seeks to turn referrals for the
provision of wheelchairs into the assessment for, and provision of, a wheelchair to
help with providing effective health care for the patient within the constraints of the
service specification and available resources is shown in appendix 4.
This model was created in conjunction with some of the clinical staff, rehabilitation
engineering staff and administrative staff within the service. It shows two inner sub
systems based around receipt and assessment of referrals into the service and
around the identification, gain and delivery of the wheelchair. Surrounding these
activities is the need to monitor and control activity in relation to the following:

Efficacy The provision of wheelchairs is being successfully accomplished

within the restrictions of the service specification and funding.

Efficiency The total number of wheelchairs provided to users against the

cost of the resources used to provide them in a given period.

Effectiveness The aspirations of the commissioners and users are being

met.

Stage 5 Comparison of the ideal model to the real world and stage 6
recommendations for change
A comparison of the rich picture and the conceptual models created in stages 2
and 4 respectively was undertaken with some of the clinical staff, rehabilitation
engineering staff and administrative staff within the service and for each activity in
the model key questions was asked, namely:

Is this activity done at present?

If yes, how could it be improved?
If no, how could it be done?

The results are shown in appendix 5. They highlight the main points of debate
about the possible changes that could be made to bring about improvement.
Some of differences evident between the two are listed below.

In the rich picture there are far more handoffs of process or decision making
which create delays.

The conceptual model suggests greater coordination of the sub processes.

The rich picture shows fewer areas of control and monitoring activity.
The rich picture shows delays in processes.
The rich picture shows complaints by service users.
The rich picture shows fragmentation of the locations of staff and
management for the service over three sites.

The output of this process was an agreed list of recommendations for the posture
and mobility management team to consider. These are detailed in the next section.
Stage 7 Plan of action
The following list of recommendations was presented to a joint meeting of the staff
and management team of the posture and mobility service on the 14 th August
2012. These were considered to be the key actions that would improve on the
existing problem situation.
Recommendation
Move to accepting e-referrals as the norm using the
Welsh Clinical Communication Portal. This will allow
for the option of completion of the essential aspects
of the form required for a non complex referral whilst
ensuring some fields are mandatory for the complex
cases.
Acknowledge all referrals received by the service to
both referrer and users
Consider centralised ownership of staff diaries and
move toward a timetabled programme of clinical
availability
Consider methods to develop greater trust in the
decision making ability of all staff involved in the
system to allow for delegation of responsibility.
Change from a weekly, multidisciplinary assessment
of referrals to a daily process with rotating
assessors.
Consideration of a single location for all component
parts of the service including the Approved Repairer
and warehouse function
Within the constraints of HUHBs standing financial
instructions consideration should be given to
allowing both clinical staff and Approved Repairer
staff the opportunity to order equipment from
manufacturers in order to speed up lead in times.
Move towards a single software system for both the
service and the Approved Repairer.
Develop a communication strategy for service users
to explain delays in the system because of resource
constraints with the aim of reducing complaints

Type of change
Procedural

Procedural
Structural
Attitudinal
Procedural
Structural
Structural

Procedural
Procedural

Conclusion
The case study has provided an opportunity to choose and test a problem solving
technique within my organisation. The perceived problem in the posture and
mobility service was one of a service in which multiple stakeholders were
dissatisfied with the status quo.
The presentation to the posture and mobilitys management team elicited a
number of views as to the benefits of the recommendations with regard to
resolving the service issues. The management team accepted all of the
recommendations presented to them, with the exception of the potential for staff to
gain greater authority to order equipment, and acknowledged these actions would
improve the situation. However they also noted that without some of the other
aspects of the problem situation being tackled, that the problem hadnt been
solved.
In many ways this outcome is to be expected as by its definition a wicked problem
often has no solution and improvement is the realistic outcome. However SSM can
also be seen as not aiming to solve the problem in one fell swoop but to make
incremental improvements (Platt & Warwick, 1995). The issue also highlights the
difficulty in SSM as problem owners are not always involved in the process, in this
case the management team, to the extent that might be desired.
One recommendation did raise significant interest namely the consideration of
centralised ownership of staff diaries. This recommendation had previously met
with resistance from clinical staff following a proposal from the management team.
It can be suggested that the benefits of active participation (Ho & Sculli, 1994) and
the exposure to different perspectives inherent in the SSM process could be the
reason why they themselves now identified this as a positive change.
Despite the sense that the proposed recommendations were only a part solution
SSM did establish a platform for the consideration of multiple perspectives to a
complex problem. To that end the case study demonstrated how it could act
effectively within a pluralistic environment as suggested by Jackson and Keys
(1984) who argued, SSM is better able to cope with problems of the systemicpluralistic type than other systems-based problem-solving methodologies. This is
because it provides better guidelines (through debates and employment of
systems modeling) for the handling of multiple interpretations of the complex and
interrelated issues that exist in organizations.
On reflection I can understand that it would have been better to build conceptual
models for all of the relevant systems and achieved participation for all

stakeholders in the development of further recommendations, which may have

allowed for a holistic set of recommendations to have been presented. However as
SSM allows for an open and fluid process, with stages being visited in any order
and on more than one occasion, the option remains available for future
consideration.
The choice of SSM for this case study was guided in part by the system of
systems methodologies matrix (Flood & Jackson, 2002) which highlighted SSM as
best suited to complex situations where there are a number of stakeholders with
broadly similar interests in which there is little conflict. Despite the limitations within
the case study in modelling the entire problem situation the choice of SSM as a
technique for the case study still appears valid as:
1. The developments of improvements were as a direct result of the
participation.
2. There are indications of cultural positions being moved, for example an
acceptance of a previously considered proposal for change.
3. There is a wider understanding of the perspectives of all the stakeholders in
the system
4. There is a sense that the problem situation can be improved.
In relation to the relevant activity system modelled no one of the three groups of
staff involved hold a significant power base over the other and the only area of
conflict, around their understanding of their respective roles was dealt within the
process of SSM. Despite the perceived limitations of SSM to deal with conflict this
did not prove an issue in this scenario. This may have been because the conflict
was more perceived than real. Alternatively it maybe a demonstration of how SSM
helps participants gain greater understanding of other perspectives.
Flood and Jackson (1992) highlight that it is unlikely that SSM would be able to
resolve the fundamental disagreements that exist between some service users
and the service itself such as with regard to the restrictions of equipment to meet
only essential health needs. Again, modelling other activity systems to complete
the process would have given greater insight to this.
Despite Checklands (1981) claim that participation in SSM is neutral in practice I
perceive that Flood and Jacksons (2002) criticism is correct when it identified that
ultimately the priorities of those with power can dominate the outcomes of the
process. For example the recommendation to consider greater authority for staff to
order equipment without management team approval was rejected.
Hicks (2004) and Jackson (1982) both identify that SSM requires an appropriate
amount of time to undertake well. Time was considered a factor in the choice of
methodology and the gathering of hard and soft data required for the production of
the rich picture took the bulk of the time involved in the process. SSM is designed
to allow stages to be revisited or undertaken out of turn and this flexibility is useful
as it allows additional understanding or insight to continue to shape the process.
For example the final rich picture created was revisited several times from its
original drawing based upon the clarity and insight that each stage helps build.

Therefore time to effectively employ SSM is a key consideration in its use and
whilst experience in using systems concepts can undoubtedly mitigate some of
this I can see that some organisations may struggle to deal with the perceived lack
of a quick solution to their problem.
A final reflection on the case study is the extent to which I could have used more
than one technique jointly to address the problem scenario.
Hicks (2004) states that the success of applying a predominately soft system
approach to a problem relies greatly on the amount of creative thinking that has
gone on along the way. This suggests that the blending of more than one
approach to a problem situation may not only be possible but desirable, dependant
upon the situation. Other evidence (Checkland & Scholes, 1990) also suggests the
potential of this combination of techniques as a valid approach.
Given the reflections above on the involvement of the problem owner and the
potential constraints of time there is validity in the consideration of joint
approaches. For example whilst SSM emphasises the need for the proximity to the
problem owner they can remain distant throughout the process leading to a lack of
commitment to any proposed changes. Hicks (2004) indicated the potential to
synthesise synectics with SSM with the aim of getting more problem-owner
participation. Synectics may also offer an opportunity to speed up the front-end
process of SSM, which is the data gathering process, through the goal wishing
process.
In summary, SSM proved to be an interesting and valuable technique in its
application to the given problem scenario and has provided some actions which it
is perceived by some stakeholders, namely staff and the management team, could
improve the current situation. However it is recognised that the process was
unable to consider the whole of the complexity of the situation as set out in the rich
picture and further work should be undertaken to address this. To that end perhaps
the chosen problem scenario proved to be too large for the purpose of the case
study.
I would consider SSM a valid technique to the identification of options for
improvement of wicked problems such as the posture and mobility service. It
would appear that increasing participation of stakeholders and allowing for a wider
understanding of other peoples perspective on a situation does create a platform
for debate and consideration of new ways of working.

Recommendations
1. Consider modelling the other relevant activity systems to ensure the whole
of the problem situation is addressed and to test whether the perceived
conflict between certain stakeholders is real and whether SSM can be
utilised to find improvements.

2. Given that the interface of a complex systems with a pluralistic environment

of participants will be a common finding with an organisation such as a
Health Board I propose the greater use of SSM as a technique of choice
within my work environment but with a high consideration for the flexibility of
blending with a creative thinking technique to aid ownership and overcome
time issues.

References
Brown, M. (1996). A framework for assessing participation. In R.Flood and N.
Romm (Ed.), Critical Systems Thinking. Current Research and practice
(pp195213). NY: Plenum Press.
Checkland, P.B. (1981). Systems thinking, systems practice. Chichester; United
Kingdom: Wiley.

Checkland, P.B. (1999). Soft systems methodology: A 30- year retrospective.

Chichester, United Kingdom: Wiley.
Checkland, P.B & Scholes, J. (1990). Techniques in soft systems practice part 4.
Conceptual model building revisited. Journal of Applied Systems Analysis,
17, 57-72.
De Bono, E. (2000). Six Thinking Hats: An Essential Approach to Business
Management. (3rd ed.). London, United Kingdom: Penguin.
Dieh, l M., & Stroebe, W. (1991). Productivity loss in idea-generating groups:
Tracking down the blocking effect. Journal of Personality and Social
Psychology, 61, 392403.

Flood, R.L., & Jackson M.C. (2002). Creative Problem Solving: Total Systems
Intervention. (9th ed.). Chichester; United Kingdom: Wiley.

Hicks, M.J. (2004). Problem solving and decision making. (2nd ed.).London, United
Kingdom: Cengage Learning EMEA.

Ho, K.K.J., & Sculli, D. (1994). Organizational Theory and Soft Systems
Methodologies. Journal of Management Development, 13 (7), 47 58.
Jackson, M.C. (1982).The nature of soft system thinking: The work of Churchman,
Ackoff and Checkland. Journal of Applied Systems Analysis. 9, 17-28.
Jackson, M.C., & Keys, P. (1984). Towards a system of systems methodologies.
Journal of Operations Research Society, 35(6), 473-86.
Mingers, J., & Taylor, S. (1992). The use of soft systems methodology in practice.
Journal of Operations Research Society, 43(4), 321-32.
Mullen, B., Johnson, C., & Salas, E. (1991). Productivity loss in brainstorming
groups: Basic and Applied Social Psychology, 12, 323.
Nidumolu, U.D., de Bie, C.A.J.M., van Keulen, H., Skidmore, A.K., & Harmsen, K.
(2006). Review of a land use-planning programme through the soft systems
approach. Land Use Policy, 23, 187-203.
Platt, A., & Warwick, S. (1995). Review of soft systems methodology. Industrial
Management and Data Systems, 95(4), 19-21.
Proctor, T. (2010). Creative problem solving for managers. (3rd ed.).Abingdon,

United Kingdom: Routledge.

Underwood, J. (1996). Models for change: Soft systems methodology. Business
Process Transformation. Spring 1996.
Wilson, B. (1984). Systems concepts, methodologies and applications. Chichester;
United Kingdom: Wiley.

Appendix 1 SSM stage 1 Stakeholder feedback and information

Staff

Sense and receive service user frustration

Feel that referral information is often inadequate or incomplete
Users are not always available.
Sense that different staff groups do not value each others role.
Bottlenecks in processes

Referrers
Complicated, time consuming referral form 8 pages long
Reactive rather than planned
Inaccessible and remote, faceless
Calls not returned
Find it difficult to plan to be present to aid in a multi disciplinary assessment
Feel they lack influence over the choice of equipment to suit their particular
treatment goals.
Users
Difficult to get through to speak to someone
Lack of information
Waiting times can be too long and/or unknown
Service doesnt provide for all my needs
Management team
Number of complaints relating to this issue
Inefficiency related to wasted time and duplication
Reliance on contactor services for repair and maintenance and worldwide
manufacturing base.
Waiting times too long
Resource constraints

Commissioner
High political interest
Performance information not readily available

Appendix 2 Rich picture

Appendix 3 Root Definitions

A system to help immobile people become mobile
CATWOE
Customer
Actor

Description
Patient
Referrers, Clinical staff, Approved Repairers

Transformation
Weltanschauung

Immobile to mobile patient

A belief that the provision of a wheelchair is
essential for mobility needs
Owner
WHSSC
Environmental constraints Funding, clinical appropriateness, referral criteria,
service specification, range of wheelchairs
available.
Root Definition
A system owned by WHSCC, who together with referrers, clinical staff and the
Approved Repairer, help make immobile patients mobile through the provision
of wheelchairs within the constraints of the service specification and available
resources.

A system to assess and provide wheelchairs to people with a clinically defined

health need.
CATWOE
Customer
Actor

Description
Patient
HUHB employees, Approved Repairer

Transformation

Referral for a wheelchair to assessment and

provision of a wheelchair
A belief that the provision of a wheelchair for the
person referred is important in providing effective
care

Weltanschauung

Owner
HUHB
Environmental constraints Funding, referral criteria, service specification,
range of wheelchairs available.
Root Definition
A system owned by HUHB, who together with its staff and the Approved
Repairer, seeks to turn referrals for the provision of wheelchairs into the
assessment for, and provision of, a wheelchair to help with providing effective
health care for the patient within the constraints of the service specification
and available resources.

A system to plan and resource wheelchair service in Wales

CATWOE
Customer
Actor

Description
Patients
WHSSC

Transformation
Weltanschauung

No service provision to an available service

A belief that the provision of wheelchair services
in Wales is important in providing effective
healthcare
Owner
WHSSC
Environmental constraints Funding.
Root Definition
A system owned by WHSSC, who together with its staff, seeks to ensure the
planning and commissioning of a wheelchair service in Wales help with
providing effective health care for patients within the constraints of the service
available resources.

A system to generate income for repairers of wheelchair

CATWOE
Customer
Actor

Description

Transformation
Weltanschauung

Broken wheelchair to working wheelchair

A belief that the repair and maintenance of
wheelchairs for HUHB will be good for their
business profitability

HUHB
Employees of the Approved Repairer

Owner
HUHB
Environmental constraints Contract specification, income, range of products,
and availability of raw resources.
Root Definition
A system owned by HUHB, operated by the Approved Repairer, which seeks
to ensure that broken wheelchairs are maintained and repaired in order to
generate income for the business within the constraints of the service contract
specification and available resources.

A system to generate income for manufacturers of wheelchairs

CATWOE
Customer
Actor

Description

Transformation
Weltanschauung

Selling wheelchairs to HUHB

A belief that the sale of a wheelchair for HUHB
will be good for their business profitability

HUHB
Employees of the wheelchair manufacturers

Owner
HUHB
Environmental constraints Sales income, range of products, availability of
raw resources.
Root Definition
A system owned by HUHB and delivered by the manufacturers of
wheelchairs which seeks to ensure that requested wheelchairs are
manufactured and delivered to HUHB in order to generate income for the
business within the constraints of the sales income and the availability of raw
materials.

Appendix 4 Conceptual model

Appendix 5 Output of the comparison of

the rich picture and the conceptual model

Activity

Clinical assessment

Is
this If yes, how could it be improved?
activity done
at present?
Yes
Reduce the need to complete the whole document for non
complex cases, move from paper to electronic system, train
referrers, and acknowledge receipt of referrals.
Yes
Stop weekly process, reduce the number of people involved in the
decision making process, base the whole team in one location
Yes
Match skills of staff to the complexity of the assessment.

Create appointment
Obtain staff

Yes
Yes

Obtain location
Obtain user

Yes
Yes

Identify equipment

Yes

Obtain equipment

Yes

Send order to Approved

Repairer
Check stock
Obtain approval
Order stock
Deliver chair

Yes

Follow national guidance on best practice for this process

Clinical staff to stop managing their own diaries, fixed multi
disciplinary sessions.
Generally not an issue
Validate user contact information before the appointment stage;
communicate progress in waiting time situation.
Generally okay, ensure all staff has equipment training on new
products.
Optimal stock levels, larger warehouse, Approved Repairer to
create orders
Using the same software system

Yes
Yes
Yes
Yes

Using the same software system

Allowing clinical staff to authorise orders
Allowing clinical staff to authorise orders
Generally not an issue, contractual specification.

Obtain referral
Assess referral

If no, how
could it be
done?