Beyond Boston – Reflections and Intentions

picture of Fiona MacNeill outside MIT

The prototype that I brought to the Prototype Camp was a Change Maker development programme called ‘Blue Wave of Change’. The programme was designed around generative conversations and hung on a theoretical framework including Theory U, Appreciative Inquiry, Design Thinking and Systems Thinking.

The prototype was underway in a medium-sized public health organisation (7,500 people) by the time I got to Boston, and we had some early success indicators, including:

1. 66 nurses from all levels had completed the programme. These individuals had connected to a further 1,500 nurses by hosting generative conversations about:

  • the deeper purpose of their role as a nurse
  • the mindset they had and any impact on their practice, patients and relationships
  • their vision of the future they want to be part of

2. Significant themes around personal behaviour were identified as a result of deeper purpose conversations and these formed a behaviour framework
3. From the above, a series of powerful questions were designed for use in generative clinical supervision conversations
4. The framework and powerful questions were tested from June to September 2015
5. Conversations with the 1,000 nurses about the vision for the future resulted in 8 vision artefacts: 2 films, 2 performances, 2 visual artefacts and 2 songs
6. The above culminated in a 20-minute film that was shared with individuals on International Nurses Day

blue wave drawing and a prototype

What’s the current state of the prototype?
The prototype programme evaluated well.
There were lessons learned about the responsibilities of the organisation in taking the thinking forward and whilst we reiterated this at the front end, it wasn’t until returning from Boston that the full extent of what happened when we let go was evident. This provided great learning for the next iteration of the programme, which was commissioned by the same organisation for 50 Allied Health Professionals.


Irrespective of these challenges the prototype impacts included:

  • Large Design Thinking Event looking at prototyping Electronic Patient Records and the Personal Development and Review Process. We know ideas from this 2-day event were taken forward to the next stage of the thinking process.
  • Output from the prototype programme fed input for the organisations’ Quality Strategy, which is at the centre of its delivery commitment.

The second iteration of the prototype programme was slightly different and we set it up differently with the senior team and didn’t dive in to save them when they didn’t keep a commitment!

The result has been something that we believe has greater chance of sustainability. Part of this was to do with how we developed the group to prototype small changes using 2, 3 and 4D prototyping.


This has resulted in a number of changes within service lines which have a direct input on service users, including:

  • Goal setting for service users as a 2D activity
  • Service user assessment as an empathy journey
  • Personal Development and Review process redesigned as a generative conversation whilst still meeting governance requirements
  • New appointment cards completed by service users
  • Care home drop in conversations as an empathy journey
  • Marketing strategy for Occupational Therapists
  • New referral forms co-created for mental health liaison conversations



The third iteration of the prototype is currently underway in another slightly different format. With more of a guided mastery approach where we are spending time with the team undertaking the programme, giving them iterative feedback on their prototypes. It’s too early to say if this will have greater sustainability, but we believe it will.

Both the second and third iterations of the programme are being intensively evaluated and we expect to have significant evidence in June next year about real measurable impacts.

Finally, a 4th iteration is at a 2D stage and we hope it will be of interest to our colleagues involved in Health and Social Care Integration, especially around the area of co-production.

health and social care 2d model in drawn form


What else was sparked?

As well as the above, the prototypes from the Boston learning experience has influenced the following:

  • Design, development and prototyping of a Design Thinking Programme incorporating Theory U thinking into the Stanford Design Thinking Model
  • Design of activities using levels of listening and inquiry for an Appreciative Leadership Programme
  • Design of activities around VoJ, VoC and VoF linked to Eric Berne’s Transactional Analysis for an Appreciative Leadership Programme
  • Letting go and letting come as check-in and check-out in conversations and thinking sessions
  • Early days development of a creative 2D practical game that will help with stakeholder engagement, empathy journeys and better inform 4D activities
  • For Arawana, Dieter and Gene especially – a realisation that you can teach people to do 4D and it really works! Thank you for the lesson. It will remain with me always




Real impact?

  • We have shared the learning with over 200 other people, all of whom have learned in one way or another how to practically prototype. In a culture where you ‘do’ improvement using the Plan, Do, Study, Act method, this has had a huge impact on helping people in the room with us – and subsequently in the room with others, about the importance of creating the conditions where change can happen and be sustained.
  • The formative impacts described above, and the plan is to write a paper about the results



  • The age-old challenge that the ‘consultant’ isn’t there to fix things, challenging that parent child dynamic
  • Ensuring that the ideas that emerged had some chance of survival in the tick box world of command and control public sector organisations
  • Holding and noticing our own frustration!


bottlenecks and challenges in the organisation


What surprises me most about where I / we (my team) are now?

  • The Theory U thinking has permeated all of our work in some way and we have made it accessible to many others, and there is more to do!
  • Prototyping is fun and we even had a go with 100 primary school children who prototyped in 3D what ‘Growth Mindset’ meant to them – great to put something back
  • Prototyping has really reconnected me in a different way to my creativity
  • Meta modelling – playing with this thinking and mapping it up with other stuff that we love
  • The experience of Boston was critical – your generosity of spirit and open source high quality materials is astonishing and very humbling, and……. You can’t beat being in the room with people from all over the world and feeling that discomfort, that connection and that desire to do well by yourself and others you meet. This is different than a hub or a circle
  • 3 out of 5 of my original circle from January 2015 met up in NYC 2 weeks ago – we remain committed to each other: this is now about us, and not about you, as it should be!
  • And I met with Beth, which was a joy and more to come
  • I remain grateful……..x





What advice would I give?

  • Read beyond the Theory U thinking, map it to other concepts and ideas you already understand – there are some real universal themes out there. There are some great video clips about Design Thinking and prototyping within that process. These are really helpful if you have no idea what a prototype is
  • Give yourself time, don’t look for mastery, treat your learning journey as a prototype, and just keep iterating
  • Feel the fear and do it. Don’t get bogged down in the theory, try it out in practice – with others
  • Be aware of yourself, your listening, and your voices – keep a journal of how you’re feeling in different situations
  • Enjoy it – be patient with yourself. My journey with Theory U started in July 2014, and I am only now feeling that I’m happy with how I have internalised the learning and embedded it in my practice, my way!




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