Inspiring System Innovation

Learn more about Fullscope’s role in change and how our  system response to mental health and wellbeing in today’s England demands a bold and radical change of direction.

At Fullscope we have been thinking about and testing out new ways of responding to the growing demand in the mental health system. Let’s start by looking at the story behind the revolutionary Agpar score and how it relates to system innovation.

How did the Agpar score inspire change?

In his book Better, Atul Gawande explored the secret behind a lifesaving discovery that we should all be inspired by.  In the mid-1930s, delivering a child had been the single most dangerous event in a woman's life: 1 in 150 pregnancies ended in the death of the mother.   

Scientific advantages such as the discovery of penicillin and other antibiotics significantly helped to reduce the risk of the death for mothers. But the situation wasn't so encouraging for newborns, 1 in 30 still died at birth.  

Then a doctor named Virginia Apgar had an idea. It was a ridiculously simple idea, but it transformed childbirth and the care of the newly born.  

Apgar was an unlikely revolutionary for obstetrics. She had a combination of fearlessness, warmth, and natural enthusiasm that drew people to her. She became the second woman in the USA to be board certified in anaesthesiology. Over the course of her career, she would go on to administer anaesthesia to more than twenty thousand patients, however, the work she loved most was providing anaesthesia for child deliveries. She loved the renewal of a child coming into the world.  

But she was appalled by the care that many newborns received. Babies who were born with visible physical disabilities, too small or struggling to breathe were listed as stillborn, placed out of sight, and left to die. They were believed to be too sick to live. Apgar believed otherwise, but she had no authority to challenge the conventions: she was not an obstetrician, and she was a female in a male world. So she took a less direct but ultimately more powerful approach: she devised a score. 

The Apgar score, as it became universally known, allowed nurses to rate the condition of babies at birth on a scale from zero to ten. Published in 1953 to revolutionary effect, the score turned an intangible and impressionistic clinical concept of the condition of new babies into numbers that people could collect and compare. 

Around the world, virtually every child born in a hospital came to have an Apgar score recorded at one minute and five minutes after birth. Ask most research physicians how a profession can advance, and they will tell you about the model of "evidence-based medicine" the idea that nothing ought to be introduced into practice unless it has been properly tested and proved effective by research centres, preferably through a double blind, randomized controlled trial. 

The Apgar score changed everything. It was practical and easy to calculate, and it gave clinicians at the bedside immediate feedback on how effective their care was.

“When you’re finished changing, you’re finished.”

– Benjamin Franklin 

How does the Agpar score relate to Fullscope’s mission to improve mental health?

The above example demonstrates that simple change can make a huge impact. It needs a bold and brave approach. It needs willing professionals, leaders and funders. It needs a collaborative approach and a system that is focused on wanting to do better for children, young people and their families.  

The next logical question is…

How can this be achieved and why do we need system innovation?

Our thinking is inspired and influenced by the brilliant Rockwool Foundation.  

System innovation is needed when society faces a systemic challenge which requires a systemic response, and when society has a systemic opportunity to create a new kind of system. Systemic challenges, growing demand for mental health support, push innovation forward; systemic opportunities, trying more collective ways of responding, pull it. While the first is about tackling a problem, the second is about realising a possibility. While linked they are quite different activities.

'Focusing on improvements of outcomes within a current system may provide clear results in the short term. But, ‘the trouble is that those may not be the results that you are most proud of because the constraints you are accepting as unchangeable, and the time horizon for how long those impacts last….Those impacts tend to plateau or erode over time, precisely because they get washed away by other forces in the prevailing system that you had not dealt with’ (Gates & Fils-Aime, 2021, p128). 

We must come together as a local system and realise our possibilities: the status quo is not an option. Like Apgar and the waves made through the simple introduction of the scoring system for newborn babies, our system response to mental health and wellbeing in today’s England demands a bold and radical change of direction.  

Collaboration is key to change and at the core of Fullscope’s mission as a third sector consortia to affect a more accessible, relevant and equitable system to support children and young people in Peterborough and Cambridgeshire with their mental wellbeing.  

Join the Rockwool Foundation's free online learning festival, Making the System Shift, and learn more from the innovators influencing our work Learning Festival 2022: Making the System Shift — The System Innovation Initiative 

Calling for changemakers! If you are interested in further thinking, discussing or joining this work please contact us via info@fullscopecollaboration.org.uk