I have always believed that we are learning every day and taken the opportunity to make small changes to my own practice if I notice that we should be doing something differently and encourage my teams to do the same. This requires us to be open to the concept that the world is not black and white, or that there is a right or wrong way and have seen how we place a defensive wall around ourselves if we do not adopt a flexible mindset.

By being open to new opportunities for change, both from local improvement outputs or national strategy, these form the foundation stones for change. These ideas, let us practice implementing change so we can all be change agents, champions and influencers of new thinking. These also provide the possibility of healthcare entrepreneurialism.

A wicked problem is another area of entrepreneurial opportunity.

They are a problem that’s difficult to solve—normally because of its complex and interconnected nature. Wicked problems lack clarity in both their aims and solutions and are subject to real-world constraints which hinder risk-free attempts to find a solution.

What are wicked problems in healthcare?

• Environmental challenges with a need for regenerative design
• Radicalisation and extreme perspectives from our social communication
• Complicated technology and integration including artificial intelligence
• Consumer led health and social care solutions with limited resources
• Poverty and Health Inequity
• Knowledge management in a rapidly evolving world
• Personalised medicine
• Patient and human subjects’ privacy and protection
• How to build trust in our health and social care systems
• How to have a workforce that is competent, confident and happy

In the beginning of my career, expert opinion and consensus view led the evidence base. We now analyse our data, initially retrospectively to make changes and create evidence based medicine and solutions and now have moved to real time data to visualise todays immediate crisis or success. This gives us lots to think about but rarely builds creative thinking or generates new solutions.

In our complex worlds, multiple stakeholders have different opinions, have different values and priorities and work within different organisational structures. Although we all want to be more collaborative, we cannot implement easily a new system approach in which we will be required to transform.

This is where the entrepreneur can try something new and experiment. They can understand the wider perspectives of the stakeholders especially if they do not belong to one group and they can demonstrate delivery which could be adopted by the wider community.

My own unique talent is to be able to look at new service design recognising that skills can be taught and develop governance systems and shared values to ensure safety and effectiveness. This can lead to an improving service where resources can be used more effectively but that quality improves.

In the 90’s, I was part of the advanced practice movement sharing the burden of diagnosis and treatment with new models of service design.

In the 00’s, I continued to identify models in healthcare moving from doctors towards a wider multidisciplinary team with improvements in capacity in these services but ensuring that they were caring, trauma informed and met high quality standards.

In the teens, I founded my own company based on these principles in forensic healthcare which has grown to be one of the largest providers of forensic services in England.

What next? We need to turn our attention to the workforce shortages and their experiences of distress. Those who use our services have complexity of needs and we have greater understanding of the impact that the failure to address the social determinants of health, alongside our own biases has led to widespread inequality. Mental health and understanding our behaviour whilst we experience a crisis of meaning are all wicked problems which provide opportunity.

So which wicked problem?

I do believe you need to have to have passion and understanding of the issues so my focus will always be towards making a difference to people, empowering individuals and using all our lived experiences to build better systems.

My new opportunities are:

Being able to make a difference to those who experience disadvantage and create a new workforce of those with lived experience harnessing their power and ambition to pull together the existing infrastructure to meet their goals – so The Maslow Foundation was born.

Being able to make a difference to health and social care and their crisis of staffing, with a model of psychological safety, ensuring safe spaces to nurture our talent and build confidence and competence, providing a space of trust, authenticity and consistency to feel safe to practice without shame and self doubt – hence Nurture Health and Care Ltd was born.

In these organisations we can:

• Frame the problem without worrying about the systems
• Identify the purpose asking for diversity of thought, in a neutral space ensuring our lived experience informs design
• Design solutions
• Experiment
• Scale what worked or learn from those things that did not go well
• Share our knowledge and create an open learning system to showcase our design

I loved this video as feel it solved a wicked problem and hope you create your own health and care incubators to nurture your ideas and implement through action.