Learning, networks, and sensemaking together: our first year at NHS Horizons
By Marc Harris and Victoria Treadway
We (Marc Harris and Victoria Treadway) joined NHS Horizons in October 2023 to be part of a rapidly expanding Insight and Impact team. As part of this team, we’ve been working across varied health and care challenges to better identify and understand breakthroughs in thinking and practice. The past year has been pivotal in shaping us personally and professionally, and here we reflect on what we’ve learned and what this means for the way that we support others in large scale change.
What creates change in complex systems, and what does this mean for how we measure and understand it? These are two questions which have stretched our thinking over the past year. In trying to find answers to these questions, we have been drawn to three key themes:
- Learning creates change
- Networks and communities are essential for change
- The need to do research and evaluation differently
1. Learning creates change
The Center for Accelerated Learning powerfully reminds us that “learning is change and change is learning” – they are two sides of the same coin. Our experience at NHS Horizons has deepened our appreciation of this truth. Organisations and teams are increasingly recognising that learning goes beyond simply acquiring new information; it’s fundamentally about transforming how we work, think, and collaborate.
“All learning is relational”
Anna Birney
Our Rapid Insight approach has repeatedly demonstrated that the most impactful learning emerges through social and collaborative processes. When teams create spaces for shared reflection and collective sense-making, they’re not just exchanging information, they’re actively reshaping their understanding and practice. These moments of collective insight often catalyse subtle but profound shifts in how teams operate.
We’re actively applying this approach within our own team, developing and testing a Learning and Impact Framework that emphasises experimentation and reflection. This goes far beyond just measuring what we do – it’s about creating a continuous cycling of learning which shapes how we work. We’re keen to connect with others on this journey, recognising that our own learning deepens through dialogue and exchange with the wider system.
“The past 12 months have been a transformative period of learning for me, coinciding with my 20th year of working in the NHS. Looking back, I’m reflecting that my career has been characterised by a common thread – enabling change through learning.
“Joining Horizons has taken my understanding to the next level, showing me the power of learning at scale and how it can be translated into meaningful, lasting change.”
– Victoria Treadway, Senior Associate, NHS Horizons
2. Networks and communities are essential
Through our work at NHS Horizons, we’ve come to understand that networks and communities are fundamental to how transformation happens in complex systems. These connected groups of people, sharing insights, challenges, and solutions, create the essential but often intangible, infrastructure through which change flows.
However, building these communities requires purposeful effort and careful attention to inclusion. We’ve seen this first-hand through several key programmes. The School for Change Agents has created a vibrant community of practice where change-makers can learn together and support each other’s growth. Similarly, our Proud2b network has demonstrated the power of a unified voice and the vital role of supportive communities where people can share, learn, and grow together. Our work integrating physical activity into health and care has shown how communities can mobilise around shared challenges and create more viable solutions that can only emerge through deliberate and sustained dialogue.
What makes these networks particularly powerful is their ability to transcend traditional boundaries. Healthcare doesn’t exist in isolation, and neither should our approaches to change. We’re increasingly seeing the value of building connections that extend beyond the health sector, bringing together partners from across the whole system. These cross-sector collaborations bring fresh perspectives and innovative solutions to long-standing challenges.
3. Doing research and evaluation differently
Our experience in the Insight and Impact team has nurtured a new way of thinking about how we approach research, evaluation and insight. While traditional tools (such as interviews, surveys and focus groups) remain valuable, there is a growing need to apply them in radically new ways. Understanding and creating genuine system change requires something more – it requires creating the spaces where meaning can emerge through collective exploration and sense-making.
Through our work across diverse health and care challenges we have developed approaches that prioritise co-creation and collective understanding. Rather than simply measuring predefined outcomes, we’re creating opportunities for people to come together to make sense of what’s emerging. This means paying attention to the quality of conversations happening, the connections being formed, and how impact ripples through networks over time.
The richest insights emerge when we create spaces for people to interact. When we bring these different perspectives together, we see opportunities for change to emerge, which are rooted in the lived experience of people working across the system. This diversity makes the opportunities for change much more sustainable. Critical to this approach is maintaining a balance between rigour and adaptability. While we need robust ways of collecting, analysing and interpreting data, we also need approaches that can flex and evolve as we learn and the landscape shifts.
“My biggest lesson over the past year has been the deeper realisation that insights aren’t created, they are co-created. The most powerful moments happen when people come together to collectively make sense of what’s emerging – sharing their experiences, connecting different perspectives, and discovering new paths forward together.
“In a world of increasing complexity, this is about creating spaces where shared insight can emerge from our collective understanding.”
– Marc Harris, Head of Insight and Impact, NHS Horizons
What will the next 12 months bring?
The future of healthcare transformation lies in our ability to nurture networks thoughtfully and inclusively. This means actively seeking out diverse viewpoints, creating spaces where different experiences and expertise can meaningfully contribute, and fostering connections that might not naturally occur. By building communities that span traditional boundaries we’re creating the collaborative infrastructure needed for sustainable system change.
Looking ahead, we’re particularly excited about the potential of Learning Health Systems to systematically embed learning cultures across the health and care landscape. While not a new concept, they’re gaining renewed relevance as a framework for structuring the kind of adaptive, collaborative learning we’re seeing emerge naturally in response to complex challenges. These systems offer a promising architecture for scaling the connection between learning and change, moving us beyond isolated pockets of innovation toward systematic transformation.
Personally, we are energised by the growing recognition that research and evaluation need to evolve and adapt to be fit for purpose in the increasingly complex world in which we live and work. What excites us is the emergence of more collaborative and adaptive approaches that embrace this complexity – methods that value different forms of knowledge, that recognise the power of collective sense-making, and that see evaluation as an opportunity for learning rather than just measurement and accountability. Looking ahead, we’re excited about developing even more collaborative approaches to research and evaluation.