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complex systems Health In All Policies Prevention Public Health

Move More – a whole system approach to physical activity

 

 

Short blog setting out the structure and rationale behind our approach to physical activity.

Thanks to Anna Lowe for helpful comments

 

Strategy.

We set out to be the most active City by 2020. The mission and vision are clear, as are the main building blocks are clear. These are set out in our the strategy is here. All of the material is on our website. (It is worth noting that the website is a good website, we have invested in this, this has (surprisingly) been problematic as people often draw a conclusion that Move More is a comms and marketing, and the annual (June) move more month)

 

A whole system approach Whilst the mission is clear, all the steps are not known.

The strategy is a “whole system approach” (adopted at least 3 years before the term became all new and sexy). Ive written a bit on whole systems and the like before

 

Our approach is whole system sort of thing – adopted 5 year before it became popular.

 

We talk complex adaptive systems. All three words matter – complex, adaptive, system.

Vision and mission inspired.  Infiltrate heart, minds and systems.

 

There is no command and control. No single detailed plan, no single controller, or no single person knows all of the things that are going on to achieve the broad goal.

Command and control is (probably) impossible. If you must adopt command and control mindset, seek to command and shift the most important leverage points in your system (see below). See Donella Meadows and similar, also Team of Teams on this

 

The role of controller to continually nudge the system to refocus it’s efforts to improve the trajectory of the critical metrics.

 

The aim of the strategy is to 1) set mission and vision, 2) orchestrate the response across many actors, NOT to describe every step in detail. The leadership role should focus on setting the rules and conditions not specifying a plan. The lead role is that of orchestrator, but doesn’t know how to play all of the instruments (maybe even what all those instruments are)

 

We know we compete with other strategies  for bandwidth – so we bolt move more into other strategies and other bandwidth – economy, community, NHS. Use Move More as convening force around health, skills, employment, crime and many other social issues

 

Though we may have a basic set of principles setting our view of the way the system operates, We wont always hold true to those principles

 

Serendipity has been  important. But creating the right condition for serendipity to be more likely is arguably MORE important.

Trusting in communities is key.

 

Governance

Is though the National Centre for Sport and Exercise Medicine, this was established on the back of the Olympic legacy. The NCSEM Board is part of the city intrastructure.

Aim is – Translation, education, influence, evaluation.

There was capital investment from Olympic legacy where we built 3 new centres – not insignificant feat. The mission is REALLY about complex system co-ordination and mission.

 

We DO have some structure around the main workstreams of the strategy – Communities, NHS (ex/med), Workplaces, Environments, Schools, CYP/Families, Exec Group/Co-ordinating Group, YSF provide significant backbone of this

 

“Delivery”

There is a legit call for “activity”. People need to be able to see and count it etc etc…. activity is important.

Investment IS needed. Good things don’t happen out of thin air.

Of course there IS delivery of activity, across many different areas of service delivery, policy, or across many different institutions.

There are silos. This is arguably impossible to avoid

Main chunks are exercise as medicine / they don’t call it miracle cure for no reason, transport, environment, communities, workplaces.

In all of these spaces a lot going on.  You might not see it all.  We can always do better.  But it is there.

No one person knows it all. Don’t have a central team but range of people who share an aim.

That said many amazing things happen in the name of “move more” day in day out. I certainly have no idea what they all are.

Leverage points v delivery. We focus on micro stuff of delivery. This is important, but we ignore big system shifts at our peril. And this we shouldn’t be surprised when we don’t get big shift in the metrics we want to shift. For our system, what IS our story about how to shift the most important system levers. We try to focus and come back time and again to Donella Meadows on system leverage points and this 18 ways to change a system. Looking at the system, what ARE the most impactful and important leverage points and how to influence them.

 

Measurement, indicators and metrics

We set out to be the most active city in the country. We are well above mid table according to the Active Lives survey.

Overall monitoring is through the Move More Index here and the link to the metadata is here.

Indidividual initiatives are evaluated in a proportionate way.

We probably need to do some more on metrics that pertain to how the context or environment is changing to support the overall aim your are seeking to shift. Arguably as, or more, important than metrics that pertain to micro level interventions, or individual behaviours. So KM of segregated bike lane per 1000km of road vs % of people who regularly cycle. We also think we need to stop thinking about measuring interventions and services in isolation but overall measures that think people, lives and systems. We are doing some thinking on this – upstream measures of obesogenic environment

Often attribution is high on impossible. Yes, of course measure the impact of individual activities within the system. We may never be able to attribute activity x to outcomes y. A number of reasons – 1) The messy background, 2) Baseline trends and counterfactuals, 3) Other factors in the system beyond your sight or control

Move More Index

 

Where next – the future

Sheffield  have right strategy. Don’t loose nerve – locally or nationally.

We won’t be changing our core strategy but we will adapt and refresh it this year.  We will set a target “ More than now”

We will reflect on what we have learned. The acid test is wow well have we done in East Sheffield, or in those with a disability. Have to land this in an audience less receptive to the message.  Arguably the key challenge.

Coordination and connection alone is a really big job.

We would like to move towards having a more structured approach to implementing the MM plan. But doing so without killing the creative/collaborative/iterative approach that we currently have but we would like a bit more substance (so that it’s clearer to people what we actually do).

For this there will likely be a light touch implementation plans for each of the subgroups and regular coordination group meetings so that the core MM team are all aware what everyone else is doing

-so much opportunity to grow this agenda and the NCSEM agenda, feels a bit tough being stretched across both

We know we have some more work to do on upstream and infrastructure indicators. 

we havent formally mapped “the system” – all of the constituent parts, how they interact, who are the key actors and their role, whether they share the broad vision.

We will explore new hooks – carbon will likely drive the transport agenda, what implication does this have for active travel thus move more. .

Evaluationcomplex system evaluation is key. We should think in those ways

Get Harry Rutter to do complex system stuff for legislators and senior civil service??

We will be rethinking why it matters in different languages. 1) NHS and Social Care demand (Sitting is the new smoking – direct comparisons impossible – but similar order of magnitude. 5% deaths/ 7% illness). 2) Economy (sport economy directly and indirectly, skills and workforce development from sport and leisure, healthy people = productive economy), 3) social justice (use of sport around crime and criminal justice) – see this link how sport is being used as a long term drug prevention strategy, of course there will be caveats but it is very powerfully put)

We may relook at our expectation on national govt. There is SOME coverage of PA in some of the big national strategy documents. NHS – LTP is a given, but given what we know about exercise and frailty, I look forward to the investment. I am far interested in the coverage of ownership of PA in non NHS  documents.  DfT, DfE, Home Office, HMT.

 

 

 

 

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