Why Systemic Problems Need Systemic Innovation

Across the health and care sector, we are surrounded by good ideas. Smart people, effective pilots, promising technologies all working hard to solve persistent problems But the same issues keep showing up.

Why?

Because most of those ideas are designed to address symptoms, not systems. When we treat a bottleneck in isolation, we risk solving the wrong problem or pushing it elsewhere in the system.

What looks like innovation on the surface can end up reinforcing the very patterns we’re trying to break. To make lasting progress, we need a different approach. We need systemic innovation.

Surface Symptoms vs Systemic Structures

It’s often easy to spot what’s going wrong in a particular service or team:

• Delayed discharges (We have talked about this extensively HERE)
• Repeated unplanned admissions
• Workforce shortages
• Poor data sharing
• Service duplication

These aren’t standalone issues. They are the visible outcomes of deeper system dynamics such as fragmented incentives, unaligned governance, legacy funding models, institutional silos and a risk-averse culture.

Without addressing those root causes, even the most well-intentioned innovation will hit a ceiling. Worse, it may quietly fail because the context around it remains unchanged.

That’s why systemic innovation starts not with solutions, but with systems thinking.

What Is Systemic Innovation?

Systemic innovation looks beyond the immediate challenge to understand the wider web of relationships, behaviours, and structures in which that challenge sits.

We do a lot of this at Future Care Capital and it involves:

• Zooming out to map the system as a whole
• Spotting patterns and feedback loops that shape behaviour
• Understanding incentives and constraints, both formal and informal
• Engaging stakeholders across boundaries
• Testing interventions that shift the conditions, not just the outcomes

This approach is particularly important in complex, multi-agency environments like health and care where no single actor has full control, and every change triggers knock-on effects elsewhere.

Why Health and Care Need a Systemic Approach

The challenges facing health and care today are not isolated or accidental. They are the product of decades of decisions, trade-offs, and interactions. That means they can’t be fixed with a new app or another pilot alone.

Let’s take one example: delayed discharge.

At first glance, it may appear to be a capacity issue – no beds, no staff, no onward care options. But dig deeper and you’ll often find:

• Communication breakdowns between hospital,  community teams and the local authority
• Lack of real-time data on care availability
• Misaligned goals between sectors (e.g. NHS targets vs social care funding pressures)
• A culture of defensive practice, driven by fear of risk

An intervention that only addresses one of these (say, a digital discharge tracker) may help in the short term but if the underlying relationships, roles, or incentives don’t shift, the delays will persist in new forms.

Systemic innovation focuses on changing those underlying conditions.

What It Looks Like in Practice

Systemic innovation doesn’t necessarily mean big bang transformation. In fact, it’s often most effective when done incrementally through focused interventions that change the context for others.

At Future Care Capital, we’ve developed and deployed systemic innovation approaches across multiple projects.

While each context is different, certain design principles remain consistent:

1. Start with a system map

What happens where and why. This isn’t a static diagram – it’s a dynamic way of surfacing how things really work, who’s involved, where handoffs break down, and where hidden enablers might be.

Mapping isn’t just for analysis; it’s a tool for alignment.

2. Engage the right people early

Systemic change needs cross-boundary input. That includes frontline staff, decision-makers, patients, commissioners, and partners.

Often, bringing these voices together uncovers blind spots that would otherwise stay hidden.

3. Run structured innovation sprints

We use facilitated sessions—sometimes called Innovation Enablers—to help stakeholders generate options, test assumptions, and make informed decisions together.

The format can vary, but the goal is always the same: create movement without defaulting to consensus for the sake of consensus.

4. Design for feedback loops

Don’t build and hope. Build, test, observe, adjust. Interventions should create new feedback loops that reinforce positive behaviours and highlight when things aren’t working. This is especially important in complex adaptive systems like healthcare.

5. Measure what matters

Too often, impact is assessed by what’s easy to count, not what’s meaningful to track. Systemic innovation requires indicators that reflect learning, behaviour change, and system shifts not just short-term outputs.

The role of systems thinking in innovation leadership

For organisations and leaders tasked with driving innovation, embracing systems thinking requires a mindset shift. It’s not about giving up on action – it’s about taking action that reflects the true complexity of the problem space.

That means:

• Tolerating ambiguity in the early stages of work
• Being honest about internal misalignments or conflicts
• Creating space for experimentation, not just implementation
• Rewarding curiosity and cross-silo collaboration

In our work with health charities, NHS partners, and funders, we’ve seen how this mindset can accelerate progress. When people understand the system they’re operating in – and are empowered to change it – momentum builds.

From Innovation-as-Product to Innovation-as-Process

There’s a temptation to see innovation as a product: a new tool, platform, or programme. Something you can point to and say, “We did that.”

But systemic innovation is less visible and more enduring. It’s about creating the conditions for better decisions, healthier collaboration, and shared ownership over outcomes.

It’s less “what did we build?” and more “what has now become possible?”

That shift is harder to capture in a press release but far more powerful in the long run.

Change the Context, Not Just the Component

So, what’s the conclusion here? If you want real change, don’t just fix the broken part. Acknowledge and shift the system around it.

That’s the essence of systemic innovation.

For organisations in health and care, this means stepping back, challenging assumptions, and creating space to work across boundaries. It means moving from short-term fixes to long-term transformation.

At Future Care Capital, we help organisations do just that. Through our innovation enablers, strategic advisory, and diagnostic-led reviews, we support partners to understand and design through the complexity and embed an innovation well.

Because when the system changes, everything else can too.