Strategy Meets Reality Podcast

Rethinking Value: Andy Wilkins on the Future of Health and Strategy That Learns

• Mike Jones • Season 1 • Episode 32

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What if the future of health isn’t just about fixing sickness—but creating value in how we live?

In this episode of Strategy Meets Reality, Mike Jones is joined by Andy Wilkins—founder of Future of Health, futures strategist, and author—to rethink what strategy means in health and care systems.

They explore why efficiency often works against long-term health outcomes, how integrated care and lived experience must shape policy, and why the next generation of strategy must learn faster than the systems it’s trying to change. This is a forward-looking, systems-based conversation on rethinking health, leadership, and public value.

🔍 In this episode:

  • Why healthcare strategy must move beyond efficiency
  • From treating sickness to building resilience
  • Using lived experience and Three Horizons thinking
  • Rethinking leadership and the role of AI
  • Designing health systems that adapt and learn

🎧 Keywords: Healthcare Strategy, Value in Health, Futures Thinking, Systems Change, Integrated Care, Three Horizons, Public Sector Leadership, AI in Health, Resilience, Andy Wilkins

📘 Learn more about Andy’s work: https://www.vision4health.co.uk/

 📬 Connect with Andy: https://www.linkedin.com/in/andywilkins/

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🔗 Full episodes, show notes, and resources: https://www.lbiconsulting.com/strategymeetsreality-podcast

📺 Watch on YouTube → https://www.youtube.com/@StrategyMeetsReality

Connect with host Mike Jones → https://www.linkedin.com/in/mike-h-jones/

Andy Wilkins (00:00)
what do we mean by value? How do we think about innovation, not just as what can we do to maximize the bottom line, but what can we do that creates real value for the people that we serve?

Mike Jones (00:02)
Mm-hmm.

Andy Wilkins (00:10)
no amount of bootstrapping a broken model is going to address this challenge that we face here. we have to recognize that our current paradigm is not capable of addressing the scale and nature of ill health in the population.

lean into reality, lean into that depth of what is value. And by excavating that understanding, a new opportunity for orienting the business and its learning journey will be revealed. And I think that's where strategy needs to focus its lens.

Mike Jones (00:47)
Welcome back to Strategy meets Reality podcast. I'm delighted today to be joined by Andy Wilkins. And luckily, it's probably one of the few podcast guests I've actually got to meet in person first, which is always a pleasure. So it was great to have met you and it's great to have you on the episode. Thank you for joining me.

Andy Wilkins (01:04)
Thank you, Mike. It's great to be here and have this opportunity to have this conversation. I've been really looking forward to it.

Mike Jones (01:10)
cool, me too. just for our listeners, do mind giving a bit of background about yourself and a bit of context what you've been up to lately?

Andy Wilkins (01:18)
Yeah, sure. So ⁓ I run what could be called a think and do tank called Future of Health. And it does what it says on the tin, really looking at long-term futures in health and helping health systems to reimagine themselves. But my journey to get here has been a long and interesting winding road. I did start my career at British Telecom BT in...

in their messaging business, I worked my way up and managed to lead near the end of my career there. Did a spot up in Arthur D. Little doing strategy consulting, so it was good to get out of running a messaging business and thinking about innovation and development there up into the boardroom and thinking about strategy and innovation in that biggest sense. And then I've done a lot of independent consulting since then across different sectors, industries.

Really looking at this question that's really sort of like the golden thread through my work, think really is what do we mean by value? How do we think about innovation, not just as what can we do to maximize the bottom line, but what can we do that creates real value for the people that we serve?

Mike Jones (02:13)
Mm-hmm.

Andy Wilkins (02:20)
And really sort of looking from the sort of outside back into the organization to go and spend time sat there with customers, citizens, residents, users to say, what does value mean for them?

Do we truly understand what they're trying to do in the context in which it happens? And use that as a source of insight to enrich the possibilities of what we could be doing, especially in a world that's changing fast with new technologies, et cetera. So that's led me to sort of product innovation, service innovation, customer experience, and I still, as a side gig, chair a bunch of customer experience conferences to keep my hand in really looking at what organizations are doing to try and connect to their reality.

And then that last 10 years really come home to health, which I did study as I studied physiology and psychology originally. And so that's brought me back home to health and boy is there an opportunity to think about what does value mean in health. You it's not, you're not buying shoes or groceries here. You're dealing with sort of human suffering, existential questions of life and death and illness and disease.

Mike Jones (03:14)
Ha ha ha.

Andy Wilkins (03:24)
which are some of the most fundamental things about reality that humans can experience. And really seeing how fractured and siloed health systems are, not just within organisations, but across organisations. So that's really helped me to think about what does value mean in a way that could be a call to action for multiple actors to come together and orchestrate what they do around the whole person needs of health.

both at the individual and community level. So I'm doing a lot of work at sort of what does the future of a 21st century health system look like and should look like and how do we mobilize collective action with new technologies and new medicines to kind of build that kind of future. So it's a different way of thinking about strategies rather than how do we squeeze more juice out of today. It's really thinking about what is the possibility of tomorrow and how can we inspire collective action to get there.

Mike Jones (04:14)
Yeah.

I suppose this is my challenge with strategy because it's sort of become this, I call it either the fast moving goods thing where it's all about just the product and how do we get that out or you see most strategies, it's about how do we do what we did last year plus or minus 10 % and it's quite profit growth focus where I think we're similar in the sense that I look at strategy as the pursuit of viability. So how does the thing, how do we stay viable in this changing?

environment. And that's where you've really got to, I'm glad you mentioned it, where you really got to look at and understand what value is. Because value isn't just what's normally perceived. If you look at some of the traditional, also the orthodoxy of strategy frameworks out there, it was very much about value is profit based, where actually value is that what's that relationship, what you add into the external environment that are helping people, your customers, by doing that, then you'll stay viable.

Andy Wilkins (04:52)
Mm.

Mike Jones (05:15)
But I don't know, how do you find that conversation with people when you look at strategy in a slightly different way?

Andy Wilkins (05:23)
Well, health has been a really interesting sector to finally land in because this question has more relevance, more depth, more meaning than potentially any other sector. And it's been an area that I've been really fascinated to get deeper into. What does value mean for someone if they've got a mental health issue or they're struggling with a chronic disease? And there I've...

Mike Jones (05:30)
Mm-hmm.

Andy Wilkins (05:47)
come to the position having thought about this, read about this, spoken to philosophers and all sorts of people about what we mean by value in healthcare, that we need to go beyond the traditional medicalised model of value which is are you sick or not?

Mike Jones (06:03)
Yeah, yeah.

Andy Wilkins (06:04)
what is the disease that we can fix through pill or surgery or something to think about health in a much more expansive way. And that's where almost Eastern traditions have really shone a little bit more of a light on that, that health isn't at its base is the absence of sickness. That's a glass half empty view of it. A glass half full of view is that health is more about vitality and flourishing and fulfilling one's potential.

Mike Jones (06:27)
and

Andy Wilkins (06:30)
And to do that, one needs to be in harmony and balance with oneself, with others and the world. And if you can find yourself in that state, you're more likely to be living through and enacting a life that's more fulfilling for yourself, for those you care about, the community you're in, the work that you do, and you're more likely to be undertaking the health behaviors and be in a state of mind that brings forth good health. health in that context is...

really thinking about value in that context, it's much more about facilitating the possibility for flourishing. And I've been using that in a very provocative way to health systems to say, it's not just about treating sickness, it's about supporting people in ways that maximize the potential for their own lived experience. And that's now starting to resonate a lot more.

Mike Jones (07:07)
Yeah.

Yeah.

Yeah.

And I think you're right. And it gives a different perspective. And I think that's really important when you're trying to reimagine what's possible. But then you see, you know, in the media with West Streeting and all that talking about, you know, pretty much targets on beds and, you just see a wrath of targets and you think, you know, are they getting confused with targets and strategy in the future? And all these targets, they,

limiting their perspective to just fighting today's problem and you know find it very difficult for them to step back and think actually how could we do this differently.

Andy Wilkins (08:01)
Well, this is where the strategy work I'm doing at the moment is starting to hit home and I'm quite hopeful for it, although there are some strong headwinds. As you point out, you can look through health, look through the health sort of system through this sort of metrics model, which has traditionally been the case. It's very much borrowed, as you're probably aware, from industrial thinking.

Hospitals are almost factories of care. You stuff patients in the front and process them through and spit them out as fast as possible. And 15 minutes appointments become 10 minute appointments, come six minute appointments and everyone claps their hands and awards themselves stars for improving efficiency and productivity. But the net result of treating people as sort of rats in a maze, like to be sort of shoveled through quickly is that...

Mike Jones (08:46)
the air.

Andy Wilkins (08:48)
People don't, you know, I've done quite a bit of research as well with patients passing through systems, et cetera, to sort of get their perspective on, what does value look like for them? And what they find is, you you didn't get a chance to say what you wanted to say, didn't really have a chance to explore and understand exactly what the doctor was saying. Most people in a...

a position of stress and anxiety so that they're not really receiving that information very well. Many of them can't understand the medicalized language. So many people walk out of there not having said what they wanted to say, completely confused about what was just said in terms of the diagnosis, the disease, the treatment, can't speak to their significant other who wants to help them about practical things that could be done, don't really know where to go if they've got any follow on questions. So this drive to efficiency and productivity

Mike Jones (09:22)
Hmm.

Andy Wilkins (09:38)
productivity denudes the quality of the engagement with the person. Of course in health, the person is involved in co-creating their own health. If they don't understand what they're meant to be doing, they don't understand the treatment, they don't understand where to go, then they end up deteriorating more rapidly and re-presenting as more demand. So we get this paradox that the more that you try to double down on productivity and efficiency, the worse outcomes you end up providing which generates more demand for the system.

And what we're seeing through a sort of mechanized model of doing that on an industrial scale is more and more money being poured into a system that's operating in this mechanistic way, but a population that's getting sicker and sicker. And if you take a step back, and this is where I've been making some cut through really, is that if we keep doing what we're doing, we'll keep getting what we're getting. And...

we've got a sicker and sicker population. So no amount of bootstrapping a broken model is going to address this challenge that we face here. So we have to recognize that our current paradigm is not capable of addressing the scale and nature of ill health in the population.

So let's down tools. Let's accept this model isn't capable of addressing the tsunami of demand that's about to hit it.

Mike Jones (10:53)
Yeah.

Andy Wilkins (11:00)
which by the way, the economists are saying in 10 to 15 years will double the cost of the NHS, which already is 200 billion and 40 % of all governments spend. And if you double that, you basically bankrupt the government, bankrupt the country. So in some ways we're on a burning platform, just continuing the old paradigm. So the work I've been doing is really starting to introduce this three horizons model in much more anger here, more existential level saying,

Mike Jones (11:07)
Jesus.

Yeah, huge.

Andy Wilkins (11:29)
Now, if what we're doing today is Horizon One, Horizon One isn't capable of dealing with the scope of the challenge. So let's down tools on Horizon One. What would a health system need to be that could speak to the nature and manifestation of ill health? And it can't just be treating disease when people sort of rock up at the hospital. It's got to be.

Mike Jones (11:50)
Yeah, yeah, yeah.

Andy Wilkins (11:52)
addressing some of the reasons and causes that disease appears. So we've got to become more holistic. We've got to bring more actors together. We've got to act in a more systemic way to look at what is driving health and illness in the population and mobilize coordinated action around that. And when you lay that out and invite actors to come together and think about that, most of them would agree, yes, we do need to do that. So the question then becomes,

what could we do, what could we be to be able to address that challenge? And it's been fascinating running workshops as I have of bringing council leaders, hospital leaders, primary care leaders, social care leaders, mental health community leaders into the room saying, look, if we stare into the future, we can continue what we're doing at the moment, which is effectively polishing our existing silos, adorning it with a bit more technology or.

Mike Jones (12:23)
Hmm.

Yeah, yeah, yeah.

Andy Wilkins (12:46)
We could look at it through another frame that we all hold a piece of the jigsaw here. But what is the picture we could build where we could collectively come together in a new configuration that could address that? And then what's the transformation journey to bridge us out of all this siloed short-term thinking to whole system working that can really get an optimal grip on this?

Mike Jones (13:04)
Yeah,

definitely really good ones. I'll speak to some of four and they were like, know, the NHS is broken. We just need to burn it down and start again. I said, but that's interesting. But the people you will invite to build it again are the ones that had the same worldview that created the previous system. it's how do we ensure that when we don't rebuild something that we're

building it on the old models that have proven, like you said, time and time again not to work. this is where you, I often get frustrated because when an organization is in trouble or is losing that value, straight away the predominant thought process is just, we need to be more efficient. We need to cut more heads. need to do this. And when you think about the NHS, it's not a...

It's not factory. Humans aren't a ⁓ thing that are predictable and everyone will be the same case. And I often look at the NHS and think you're built on as if you're trying to do individualized healthcare, but with a structure and system that is purely for sheep dip healthcare. Yeah. So that must be an interesting challenge trying to get people to reimagine what it could be.

Andy Wilkins (14:27)
It is, and one of the lenses I've been using to sort of look through this is really thinking about what is health. Now, when you ask doctors what is health, they sort of scratch their head and think, well, why are you asking me such a stupid question? It's obvious, no, no, no, no, what is health? And eventually you'll get out of them the absence of sickness, which is the very traditional medicalized lens. But depending on which specialty they're working in.

Mike Jones (14:35)
Mmm.

Yeah. ⁓

Andy Wilkins (14:54)
They will have a fractional piece of that understanding, if it is be a healthy liver or a healthy heart. And if you flip that round, when you look into a hospital, what you see is that you have an ologist for every organ of your body, but no one who sees the person. And health is something we experience. Systems biology is showing us we are one complex adaptive system.

Mike Jones (15:03)
Yeah.

point yeah

Andy Wilkins (15:21)
embedded in another one called life. But if we're not seen as a complex adaptor system, we're seen as a series of parts to be fixed rather than a whole that has its own integrity and interrelationality, then what we see is more and more people as they get older and sicker, which is unfortunately the case, going to see more and more of these experts who deal with piece of them and more and more people end up feeling like a pinball bouncing around in a system that only sees parts of them.

doesn't see the whole. And when you speak to people, they need to go home and live a life. They need to live a life as a whole, but they're getting partial, fractal information from multiple sources that often conflicts, has them pinging around or doubling up on tests, etc. Which leaves them disempowered, confused, at the moment they're getting older and sicker. So the whole model of dealing with parts of people and not whole people is part of the...

Mike Jones (15:59)
Yeah, yeah.

Andy Wilkins (16:17)
reframing that we need to do. And I think there's a general awareness that we need to move in that direction, but the whole system, as we've probably talked about with other speakers about other organizations, is so heavily siloed into specialisms and around pieces that it can't see the whole. And this is one of the reframing needs, if you think of a new paradigm of how do we see people as whole people, not as body parts on legs? And how do we use the...

Mike Jones (16:42)
Yeah.

Andy Wilkins (16:45)
empowering and enabling technologies that can start to bring all the information together across these different disciplines to reveal patterning, to reveal the whole person and therefore invite all of us to participate in a transcendent story that we're supporting a whole person, not just a part of a person.

Mike Jones (17:04)
Yeah, I think that's challenge that organizations face when you speak to them. They look at parts of the business rather than the whole business. They say they do, but they don't because they do everything in isolation. So they'll look at, you know, they'll say stuff like, you know, culture, they'll look at all in isolation to the detriment of everything else. That's really interesting about, you know, enabling a space where we can see the whole picture.

Is there a part also about, because you said about empowering the actors within that, is there there stuff about empowering the individual as the patient to give them more agency on their health?

Andy Wilkins (17:42)
Yes.

Yes, and this is very interesting when you start to think about where the boundaries of a system is, because at the moment most health systems would treat the patient or the person, if they're not yet a patient, and of course we want people to not be a patient, as sort of outside the system. So it's almost like the system is thinking about what it can do to this person. But when you think about health, health is something going on

Mike Jones (17:59)
Yeah.

Andy Wilkins (18:10)
inside and through that person and they are the owners of their own body and their own agency and any health intervention, unless it's sort of direct surgery, is going to involve them needing to undertake and participate in a treatment, probably change something of their lifestyle to account for whatever's going on and to be able to sort of live with the burden of that and live hopefully a value-creating flourishing life.

They are very much actors in the story of health generation. So there's a real challenge about how do we go from doing to working with people so that the relationship between people and those supporting them has to shift towards enabling and empowering.

Mike Jones (18:50)
Yeah, yeah.

Andy Wilkins (18:58)
And so that people can play a greater role in their own health. And this transactional model that we have at the moment can be very disempowering because I'm doing to you and telling you what to do and walking off without making sure I understand you, I see you, your context, what's important to you, what you're capable of doing or not doing. People have different capacities to understand and do things. So how do we empower and enable the agency of people has to be part of

how we think about generating better health. And that's an important part of this story.

Mike Jones (19:29)
Yeah.

Yeah, and I liked your previous point earlier about the, obviously, healthcare as the person, as system, but also that person's coupled to the external environment, because then you then start to look at different fractal levels and you think, well, yeah, healthcare's really important, but it's so linked to our welfare and benefit system and linked to all our ageing care of pension.

So all of it is very tightly linked.

Andy Wilkins (20:02)
It is, and one of the models that I've developed, which I find people find quite helpful, is sort of called it cells to cities, but it's essentially seeing that health is this nested series of regulatory systems. You've got genes that express into proteins, proteins into the molecular biology, into cells, cells into tissues, tissues into organs, organs into you.

Mike Jones (20:16)
Yeah.

Andy Wilkins (20:26)
You are a cognitive agent, so there's an ability to have agency and make decisions. So you are one complex adaptive system now located in a context. You're obviously in a family with a history, you're embedded in a social environment, hopefully a work environment that's furnishing you with purpose and meaning and a source of income. So you're in a social environment which is embedded in a physical environment that forwards you the capacities and opportunities to live well.

know, housing, transport, all the rest of it. So we know that up to 80 % of all the reasons that lead to poor sickness in terms of the chronic diseases are what people call the social determinants. So the environment that you find yourself in, the degree of loneliness, the mental health, the stress, have I got work or not? Am I living in shitty accommodation with mold on the walls? Have I got access to a healthy food environment somewhere?

Mike Jones (21:12)
Mm.

Andy Wilkins (21:24)
These are the things that generate either wellness or sickness that then feed back in and affect the genes, affect the molecular biology in the cells that then lead to the pathological cascades that lead to the organ-based diseases. So you can really see there's a circular series of causal pathways between how people live and the context we put people in and then what turns up as disease. So.

Understanding that is part of this new systems awareness because there are so many actors dealing with the pieces of that model who don't talk to each other, don't see that it's an interconnected model. So there's a real opportunity to lay this out saying that we all, many of the organizations responsible for health, but also councils, wellbeing, many, many industries are intersecting with this story.

So bringing them in to say, look, you hold a piece of a jigsaw of the health of individuals and populations, and there's some causal patterns and pathways that we're discovering. So can we orchestrate more collective action in service of greater health of individuals and populations? And this is the kind of meta-systemic work that I'm doing at the moment to try and bring those conversations and those actors together around a shared understanding. It's not just about.

maximising your bottom line in your silo, you're participating in a transcendent story of the health of the population.

Mike Jones (22:49)
Yeah,

That makes sense. even within organizations, when people look at employees, I think we're too quick to either blame the individual or try to take the individual away from the system they're in to try and fix them, but put them back. And they're not realizing that actually there's a lot of those determinants in the environment, in the work environment we created, the process, the policies, they're either...

supporting them to emerge what they need to do or not. And I think they don't tend to look more systemically, they just look at individual parts in the individual, which I think they're often missing the trick and they think that by throwing individualized things at people, that that will help.

Andy Wilkins (23:38)
So the area of work I've been doing that's bring this to life, that may be interesting to listeners, that many people may be aware that in the UK health system a couple of years ago, there's a decision to kind of split the country into local regions and create integrated care systems, for recognizing some areas of the country may have more rural or coastal or inner city areas with different types of health challenges.

Mike Jones (23:53)
Yeah.

Andy Wilkins (24:01)
with money distributed for the statutory services down into these local groups. And the idea was, can we get these local integrated care systems to convene, bring together hospitals and primary care and the different parts of the traditional healthcare service and then create partnerships that bring in councils, bring in social care, bring in the local community and voluntary sector to try and build something more of a joined up system.

So I've been very closely working with Suffolk and North East Essex over the last year and a half to take a lot of the things we've been talking about and bring that alive in their own system. So convening conversations between council leaders and hospital leaders in Suffolk and North East Essex to build this kind of future. And one of the ways they've been thinking about how we support the people and how do we bring this into a language that makes sense is to start to talk about how do we help people start well, live well, age well.

die well, this notion of living well sort of flourishing and think about what are the combinations and orchestrations of services that could be brought together to really make a difference on those different life stages because there's different types of challenges faced at different life stages and we decided we'd do a bit of a deep dive on aging well because if we are going to bring things together in new configurations we can take all the legacy stuff and glue them together.

Mike Jones (25:16)
Mm.

Andy Wilkins (25:28)
But there's a risk you create a Frankenstein monster that doesn't do anything for anyone. How do we root this in a deeper understanding of what really matters to the population? So we chose frailty and I led a piece of work there where we went out into the community, ⁓ 20 different houses from coastal to inland to rich to poor to male to female, different ethnic minorities and physical frailty and mental frailty.

Mike Jones (25:32)
Yeah, yeah, yeah.

Andy Wilkins (25:55)
to go and sit in people's houses to get a deeper understand of lived experience. So sit there for a couple of hours, have a cup of tea and tell me the story of your life. Where did you meet your husband? I met Bob in such and such and we had a family together. Then we moved here and then talk to him about how has frailty shown up in your lives? What sorts of things have become more difficult since you've had a bad hip or you had a leg problem or whatever it might be.

And then what people would do would reveal how frailty has shaped the different aspects of their lives, what became more difficult. How did it change your sense of self? How did it change your relationship with self, significant other, family, friends, and what changed as a result of that? What matters to you moving forward? What is most valuable for you if you look forward, looking at further deterioration, but what does quality of life mean for you? And where would you like...

Mike Jones (26:29)
Mm.

Andy Wilkins (26:49)
and how would that help me to show up? And through 600 pages of transcripts, what we were able to distill from that is a deeper, more gestalt understanding of how frailty shapes lives. And then through that understanding, we'll be able to take that back to the system and say, let's get geriatricians and primary care and social services and voluntary groups all in the room, because you all hold a piece of this story.

but we've never built something together. So having a more gestalt understanding of how our, for our population, how does frailty shape and change lives gives us a new canvas to think about. How can we bring these services together in ways that harmonize and resonate with the lived experience of the people that go through this journey. So we're not just reacting to problems and crisis, which is the kind of default mode.

We can help people plan ahead and anticipate and prepare and deal through and plan forward how they would like to be supported to enable them to empower themselves to live the best quality of life for as long as possible. And if we do that well, there's less demand on services. So it's a win-win for everyone, but it requires this different way of thinking about.

Mike Jones (27:49)
Mm-hmm.

Yes, yeah, yeah, yeah.

Andy Wilkins (28:06)
who we support and what lived experience have to say is the value story that can galvanize collective action.

Mike Jones (28:13)
Yeah, I think it's really useful. You were talking about using the free horizons model. So getting to look ahead and thinking about, you know, what could the future be of health? And I to find the challenge when people do futures is they, futures done bad, as I say, is that they talk about the future as an abstract sense. And it almost becomes this vision of the future.

but they don't then translate it to, okay, now we sort of understand that, what actions are we going to take today? And it almost seems it comes disconnected. There's this abstract view, but then nothing changes, no decision change, no resources change or funding changes to even start to think how do you do that transformation from present to the imagined future?

Andy Wilkins (29:05)
Yeah, so this is where a sort of deeper rendering of the Three Horizons can be quite valuable. So, you know, I've been doing Three Horizons work at whole health system. How would you imagine 21st century health care? And I've written papers on that and Imperial College have asked me to design a program which is now running called Leading Systemic Innovation in Health Care. How would you bring this whole systems approach to the design of whole health systems? And I run a...

Mike Jones (29:17)
and

Andy Wilkins (29:32)
program there, five day program on there. Obviously pulling that down into an integrated care system domain is giving, making that more tangible and real for a particular set of actions in a particular population. And one of the ways of thinking about this three horizons approach, it's slightly different from the traditional way of strategy where a company may have a vision, they may attempt to think about what a future might look like.

Mike Jones (29:57)
You

my opinion on visions, but yeah.

Andy Wilkins (30:01)
Yes, but

if I'm being slightly harsh, would say a lot of these visions are nice sounding word salad that sort of hang in the ether while we busy keep doing the stuff that we were doing, feeling comforted that we've got this kind of vision hanging up here in the abstract land and no one can ever get to it we don't really know what it means. So in the Three Horizons work is thinking about what would be a desirable future. Now, when it comes to health, you can see lots of

Mike Jones (30:09)
Yes.

Yes.

Andy Wilkins (30:29)
parts-based work ways of working a transactional model are not a way that's going to help people to live more complex lives with more complex health issues. There is a almost unavoidable conclusion that we need to be delivering more holistic help to people in their sickness. We need to be doing something more preventative. We need to sort of orchestrate care more holistically around people so we can work with them in their individuals and communities. And I don't think many people would disagree that

the siloed fragmented model at the moment would be enhanced greatly if we could coordinate and collaborate to orchestrate care around people. So something of that third horizon is quite easy to get to it in the abstract, but the piece that adds, I think, some bulk to that and helps with the challenge you laid out there is what would need to be true if we were to be able to deliver that? What would we need to look like as a system and be able to do?

Mike Jones (31:19)
Mm-hmm.

Andy Wilkins (31:25)
we need to be collaborating more, we need to share information across organisational boundaries, we need to be pooling budgets, we need to have a longer term view, we need to be adaptive and responsive, we need to distribute decision making, we need to give people more power, so there's something about that future that you can unpack as the sort of qualities of that future that then give you something tangible to aim towards. We're gonna need...

a leadership and governance transformation to take us to that place. We're going to need an information and IT environment that can share information in ways that allow us to do that. We're going to need to take our people on a journey from just following bureaucratic rules to be empowered to make more decisions within in guiding frameworks that can help them to release their creativity and their vocation, because lots of people in health do actually care but trapped in bureaucratic silos.

Mike Jones (32:16)
Yeah,

yeah.

Andy Wilkins (32:16)
to release so you can start to put some of the foundations in place that build towards what that third horizon is calling for. And this is very much manifested in a piece of work I've been doing very recently with a hospital trust where I've been invited to lead their 10 year strategy work using this three horizons approach. So rather than how do we squeeze more juice out of the current operations, it's

Mike Jones (32:40)
Yeah.

Andy Wilkins (32:42)
How do we reimagine what a hospital trust of the future could look like with neighbourhood teams, with multiple relationships, with multiple actors embedded in the community working with a more holistic acute function? What would that system look like? What would need to be true? And what are what we're calling the signature moves that begin that transformation towards that future? And what are the enabling capabilities that we're going to need to...

build to facilitate that transformational journey. So we're putting something together in a much more structured way to help that journey, the Horizon 2 journey, if you like, to vault towards that future. So a real different way of thinking about strategy. How do we get there rather than how do we squeeze more out of what we've got?

Mike Jones (33:21)
Yeah, yeah.

Yes, yeah, that's really important, especially when you think about strategy is it ends to be in this, the orthodoxy tends to be in this abstract state and it becomes almost paralysing for leaders because they're looking and going, Jesus, how do we get to that point? Even if, you know, we pretty argue most vision statements are just nonsense, but it can be paralysing because they don't, they're looking at that end state, but they're not looking at today's

affordances, the adjacent possibles that they could do, what are the actions that could start to change the gradient towards something that's more achievable. And I think that's where we need to get leaders into this idea of maneuvers, that there are things that you can start to do. You do those maneuvers, you act, then you can observe and orientate to see what has now opened up, what has unlocked, did it?

did it meet the external environment in the way that we thought it would do? And then it's that learning process to keep moving through. Because often I feel that people tend to look at the future as the future is what the future is, rather than that we do have some agency to shape what that future is.

Andy Wilkins (34:36)
Yeah.

Exactly. And that's not to ignore the pressures of today. mean, one pushback from people could be, well, hold on a minute. What about, you know, we've got quarterly numbers and yearly end targets. If we don't hit that, we lose our job. So part of that sort of marriage of the three horizons journey with Horizon One is still there. It's still the bulk of what people are having to face. But it's...

Mike Jones (34:43)
Yes.

Hmm.

Andy Wilkins (35:01)
Thinking then, you know, the clever bit comes, what are the Horizon 1 challenges that we're facing that in the absence of Horizon 3 and Horizon 2, we might bootstrap or do things to sort of patch up or squeeze more juice out of, but they could be very tactical moves that end up reinforcing the Horizon 1 paradigm and making it even more difficult to change. So given what we've just been thinking about from Horizon 3 and Horizon 2, can we start to deal with the Horizon 1 issues in a way that

is both tactical and strategic at the same time. Can we start to make changes in the Horizon One landscape that are simultaneously laying the foundations for Horizon Two and Horizon Three? So we can cleverly address some of the issues of today by using pathways and bridges that take us to the future rather than locking us in ever deeper to a Horizon One paradigm that's eventually gonna fail.

Mike Jones (35:56)
Yeah, and that's the thing, it helps with all sorts around the funding because they can look at it go, well, you we know we need to do these things now, but we know that in the near future, we're less reliant on them. So it's sort of sort of managed decline as you move on. Yeah, rather than putting money and investment into things that aren't necessarily going to be that useful for us in the future.

Andy Wilkins (36:21)
One of the interesting things that I've also been exploring around strategy is really this kind of experience I've had of sort of dealing with systems and now systems of systems, the sort of nested systems paradigm that we find ourselves in. So if we look bigger than health systems, we look to planetary health, and I've been doing a bit of a look at that. What you see is that the collective action of all of our organizations taking a...

Mike Jones (36:31)
Mm-hmm.

Andy Wilkins (36:48)
20th century approach to strategy in a 21st century world is leading, well, there are exhaust fumes, if you like, associated with that way of doing business that are now mounting up in society, mounting up in the environment, that are now creating blowbacks that risk destabilizing the very ground on which business and organizations are run. So, and I've been quite interested in the existential risk

conversation that's going on that if we keep doing what we're doing as a civilization in the way that we do business, the damage to the environment, the instability that it's causing and more generally is going to create more unstable conditions in the future that are going to make business and institutional life more complex. And there is a kind of wake up moment that's required now to look at some of those bigger.

bigger sort of instabilities that the way that we do business and strategy at the moment are collectively causing that we need to internalize into the way that we're doing strategy and business today. And I've been fortunate enough to be invited to participate in some workshops with some executive teams, one of which was a FTSE 100, to sort of lay out the polycrisis, the meta crisis, to say, look at these factors that are

Result from the way that we do business the way that we run our institutions there are externalities that are causing these instabilities that are going to loop back and create much more in stable environments not just for yourselves, but for for all of us and You're a big actor in this story and given what we've just laid out. What is yours to do discuss? And

Mike Jones (38:31)
Yeah, yeah.

Andy Wilkins (38:35)
What was really fascinating, listen to the discussion, was that never as an executive team had they had to think about this as an executive team. And there was this, wow, we're doing ESG, Andy, but that's not gonna be enough. No, no, that's not gonna. And it created a lively conversation because what the framing was is that, yes, you have a responsible bottom line, but you have a wider responsibility to the people that you serve.

Mike Jones (38:46)
Yeah.

Andy Wilkins (39:01)
employees that you have to the wider world and to future generations. You are stewarding some resources that are causing harm to the wider environment. Do you have a broader responsibility to address that through the way that you do strategy? So it's not just about maximizing profit for shareholders, but you have a wider civilizational responsibility at this moment in history.

to take account and take ownership and responsibility for some of these wider challenges. And what was interesting is that there was a very vibrant debate and the feedback was that we've never had the opportunity as an executive team to have this conversation. We all go home, we all switch on the news and go, hell, what's happening? We've all got kids saying, mommy, daddy, what the hell are you doing to make sure you don't screw the world up for us in the future? But when we sit as a board, we don't have that conversation. We're looking at rags, status and...

Mike Jones (39:32)
Yeah.

Yeah.

Andy Wilkins (39:56)
and sort of spreadsheets. But there was an excitement, if you like, to have that conversation. It needs to be had. I think there's an opportunity for some real radical reframing, not just in the traditional way we do strategy, but strategy that has a responsibility to the health of our civilization.

Mike Jones (40:05)
Yeah.

Yeah, there is. And I suppose all you talk about there is what I was mentioning earlier about that pursuit of viability. And it's thinking about that viability and how we're connected to the external environment and what does that viability mean as we progress through future. But then you raise a good point about boards not having this opportunity to have this conversation because they don't. like when we think about ambiguity,

uncertainty and all those sort of things. It requires sense making, but sense making requires capacity for the Exec Board, the leaders of the organisation. But we don't create that capacity because all the executives are so burdened by balanced scorecards and all these different KPIs that are great to tell me what

Andy Wilkins (40:50)
Yes.

Mike Jones (41:09)
happened six weeks ago or longer, but they rarely spend time to actively challenge the different perspectives around what the future is. So anything that's external or future, they don't make it, I don't think they value that time really. I think they're so used to just focusing on either today or yesterday.

Andy Wilkins (41:39)
Yeah, think there's that contraction of time which leads to a decision making that optimizes within that time frame rather than looking at the longer term consequences. But also what I've seen and certainly from my work where I've been working right up to sort systems of systems thinking of policy work, but I do go out in the field with elderly people and find out, you know, what's their lived experience. This sort of zoom into reality and zoom out to the macro picture. think

as leaders work their way up their career, there's a risk that they're abstractions of abstractions of abstractions and they're getting further away from the reality that their organization, their people are embedded in and that closing the loop between senior leadership and what's really going on, I think is super important.

implore any leaders to get out to the front line, go and see customers, patients, residents, just to see what the real world is like out there. And you'll be utterly amazed at the insight that you'll get.

Mike Jones (42:26)
Yeah. ⁓ this book.

Yeah,

it's a lot of challenge for people about their orientation, their worldview and what's it based on. know, when leaders go well, it almost becomes when they go down to visit the edges of the organization, I don't think they realize that they do that to ensure that their worldview of what's actually happening internally in reality.

is congruent with what they think. They do it as a sort of engagement show. look at me, I'm the leader and I'm going down to grace the people on the front line with my presence. And then everything smells of, you know, fresh paint and they hide all the problem children away. Everything looks rosy. But that's the sort of turmoil organizations got themselves in where

what we need to do is show people the reality because these people are going to go back to the boardroom and they're going to make decisions. They're going to make decisions based on a false reality.

Andy Wilkins (43:35)
Yeah,

often when I talk about it, I have a kind of chart which has like almost like a solar system with shareholders and senior management at the center. And then the senior managers orbit around that, the middle managers orbit around that, the junior staff further out, and then the customers out in outer space. But they're the ones that bring the revenue. They're the purpose that we're here for. So if you invert that and put the customers, the citizens at the center.

Mike Jones (43:53)
Yeah.

Andy Wilkins (44:00)
and the frontline staff orbiting around that with their relationality, delivering the value, creating the income, whatever. And then the middle management, the senior management, and the senior management and the stakeholders around that, they're incubating and supporting the delivery of the best possible relationality between the organization and the people that it serves. So this...

inverting that and saying this is where the real insight, this is where our organization touches reality. And we need to really lean deeply into understanding how that works, how it's shifting, how it's changing. How can we marshal and steward the environment to make our organization as successful as possible in delivering the purpose it's here for? It requires that different orientation.

Mike Jones (44:30)
Yeah, yeah.

Yeah.

And that's why I read like the viable systems model because it starts in the other way than traditional from the top. It starts from the bottom. What is the value? Why is this organization here for? And then builds on there to ensure that it's providing that value. And there's that constant learning loop to ensure that it maintains its coupling.

Andy Wilkins (44:59)
Mmm.

Mike Jones (45:10)
with the external environment.

Andy Wilkins (45:12)
Yes, that relationality with reality, which generates the learning, which needs to be absorbed into the organization, institution, so we can better what it's doing. When you layer in the new technologies that arriving, and AI being obviously a big one at the moment, I see a real fork in the road here for AI being leapt upon to optimize all the legacy shit that we do and squeeze more juice out of it.

Mike Jones (45:37)
Yeah,

yeah.

Andy Wilkins (45:38)
or AI being harnessed to accelerate our learning circles so that we can move and adapt and connect ever more deeply and in a more value creating way with reality. Which path are organizations going on? Many won't even know the difference between the two, but the work that I'm doing, especially with the conferences that I'm chairing, show that people are so excited about the technology as an optimization tool for Horizon One that...

Mike Jones (45:54)
No.

Andy Wilkins (46:06)
They're not thinking about how do we use this new superpower to reimagine what we do to create more value and become more relevant and speed up our learning cycles. This is a completely different way of thinking about it that I think is so important at this moment in history as we shift into this AI paradigm.

Mike Jones (46:25)
Yeah,

and it should do. Hopefully it will be there to help speed up the learning, but also hopefully create capacity so that the leaders can have that time to sense make. Because it's going to get more and more, I know it sounds a bit trite, but it's going to get more and more, you know, uncertain and more darkness is going to appear that we need to get humans together so that we can

Andy Wilkins (46:53)
Yeah.

Mike Jones (46:54)
we can understand perspective, see what they're seeing that I'm not seeing. Hopefully we can make that darkness a little bit less dark and have some collective action.

Andy Wilkins (47:00)
Well,

exactly. And this is where I think the Three Horizons as a more general tool can be quite useful. What I've seen when different silos are trying to talk to each other or different organizations are trying to talk to each other.

they can see there's probably some relevance in working together, but often they find it difficult to work together, largely because they speak a different language, they have a different clock speed, they have a different set of incentives. And therefore it feels like mixing oil and water, like they just can't get a grip. But if we do a little bit of three horizons work and think about...

what would a better future look like for what we're trying to do? How would we create more value for the people we're here to serve, given what we know now and with the technology? It would look probably something more like this, wouldn't it? We can have a discussion about what that would look like. But once you've got a common agreement on that, then you've got a shared transcendent story that invites different silos to come together and make that possible. So you've got a different conversation that can take place that the Horizon 1 one just can't

get a grip. It's a shared becoming as opposed to... So I think it's a very powerful sort of value creating narrative tool to get people out of their silos and working collaboratively and collectively on what we could be doing better to deliver more value.

Mike Jones (48:04)
Yes. Yeah, yeah, yeah.

Yes, I agree. And that's why we need to ensure we don't live in the abstract and how do we actually get that into reality. This has been fascinating. I really appreciate the conversation. But before we leave though, what would you like to leave our listeners to think about from this episode?

Andy Wilkins (48:35)
I think from all my work, strategy has often been harnessed to in the service of optimizing something and that's been the traditional 20th century model. I think now in a world that's asking deeper questions of business and institutions like why are you there and why should we trust you, strategy needs to be much more deep-leam.

Mike Jones (48:41)
Yeah.

Andy Wilkins (48:56)
embedded in an understanding of that reality and the degree to which we care about the value that we're creating. And the more that we lean into that, the more we see what really, really matters, what value really is. And through that, we can care more deeply and build greater trusted relationships with the people we serve and organizations that can lock themselves into that learning journey to discover and enact and

and be able to respond in that way, I think are the ones that are going to be successful in the future. So lean into that reality, lean into that depth of what is value. And by excavating that understanding, a new opportunity for orienting the business and its learning journey will be revealed. And I think that's where strategy needs to focus its lens.

Mike Jones (49:43)
Yeah, I completely agree. If people have got strategies, pretty much, what did we do last year? Plus or minus 10%. Yeah, exactly. And that point, the podcast strategy meets reality. think it's that make sure that we are in touch with reality. And that takes a lot to understand and be willing to listen to different perspectives.

Andy Wilkins (49:51)
That's not going to cut it in a fast changing world.

Exactly.

Mike Jones (50:09)
be it internally, externally, to really understand and reimagine what value is. And I think this has been a fantastic episode. And thank you so much for joining me.

Andy Wilkins (50:19)
Thanks for the invitation, really enjoyed the conversation. I hope this is useful for people.

Mike Jones (50:23)
Yeah, yeah, definitely, definitely. I'll put your contact details in the show notes so people want to reach out and learn some more. Please connect with Andy. And for the listeners, please, if you enjoyed this episode, please share to your network so they can get the value from this episode like I have. So thank you once again, Andy. Thank you for joining me. Cheers.

Andy Wilkins (50:46)
Thank you very much, Mike.