In light of recent revelations from the Francis Report on the Mid Staffordshire NHS Foundation Trust to the Ockenden Report about Shrewsbury and Telford Hospital NHS Trust, it’s clear that some areas of our healthcare system have consistently fallen short. These reports highlight the pivotal role of organisational culture as the foundation of high-quality care. Yet, despite recognising this, transitioning to new operational paradigms remains a challenge.

Our restructured organisations offer us a unique chance to reassess governance models. Drawing from past failures, we are now pivoting towards more flexible systems that value diverse perspectives. In a world dominated by logic and rules, we must also embrace a holistic approach to healthcare. This means integrating disciplines such as psychology, sociology, neuroscience, and philosophy with traditional evidence-based practices, considering the broader context of culture and history.

Traditional processes and metrics work well for predictable scenarios, but they falter in the face of human behaviour and complex, dynamic systems filled with uncertainties. We must, therefore, value experience, empathy, instinct, and collaborative decision-making more than ever.

Inspired by Michael Polanyi’s four types of knowing, we can apply these insights to our healthcare systems:

• Propositional (Facts): Often found in medical records and data, these are considered truths, although they can be skewed by assumptions and biases.
• Procedural: Consistent practices established through logical constructs, seen in legislation, regulation and evidence-based medicine.
• Perspectival: Gaining insights from multiple viewpoints is crucial but often overlooked in healthcare, where incorporating diverse ideas is not a practiced skill.
• Participatory: This involves active engagement in sense-making, moving beyond mere task execution to contribute meaningfully with one’s energy and intuition.

Healthcare has traditionally focused on rigid policies and procedures rather than embracing the wisdom gleaned from life experiences and reflective practice. As Albert Einstein famously said, “INSANITY is doing the same thing over and over and expecting different results.” This sentiment mirrors the quality improvement cycles which often repeat the same projects repeatedly.

Stress can narrow our focus and diminish our capabilities, leading to defensive or avoidant behaviours. Conversely, environments that foster psychological safety promote collaboration, creativity, and innovation, allowing us to utilise our experiences effectively.

For organisations, understanding patient safety and delivering high-quality services requires a shift from fixed to growth mindsets and from goal-oriented to values-based decision-making. Embracing feedback and moving away from a constant need for approval are essential steps in this process.

We’ve implemented several strategies to support this shift:

• Inclusion of lived experiences in all system aspects.
• Person-Centred Solutions that truly place individuals at the heart of decisions.
• Job Canvases that centre the person in their role.
• Decision-Making Groups to enhance quality assurance in various operational processes.
• Celebration of differing opinions and reflexivity in practice encouraging a diverse and dynamic environment.

Practical exercises such as attempting to understand differing viewpoints, summarising others’ opinions without interjecting one’s own, and routinely challenging the status quo can help normalise these practices.

With a new lens of understanding and values which include psychological safety, we are pioneering a model called Participation-Centred Care (the Wisdom of the Crowd), merging personalised medicine with participatory practices, organisational development, and distributed wisdom. This approach promises to reshape the foundations established by evidence-based medicine into a more inclusive and holistic framework.