1. Quality of life

2. Changing complex systems Complex systems seek stability People living in complex systems take comfort from stability and fear change Attempts to change them often result in unanticipated consequences Those trying for change get the blame whatever the outcome We tend, therefore to tinker round the edges rather than trying for transformational change

3. Complex adaptive systems Not machines so no traditional forms of control Leadership is distributed. The boss can’t control everything Small changes in one area might have large impacts elsewhere and vice versa Outcomes are unpredictable so continual monitoring and learning and chage is part of the process of change

4. Changing complex systems Challenge the stability of existing behaviours and structure Set simple, order generating rules Expect new insights and ideas to emerge Have an open, learning attitude, using plan, do, study act cycles Keep calm and carry on!

6. Albert Einstein Insanity “is doing the same thing over and over again and expecting different results”

7. Improvement science W Edwards Deming (1900-1993) – “In God we trust, all others must bring data” – “By what method? Only the method counts.” Don Berwick – “Some is not a number. Soon is not a time.” Scottish Patient Safety Programme – “By how much and by what method?”

8. Hospital SMR – 9.3% reduction

9. General ward C.Difficile rate (per thousand patient days) 1.15 0.12 90% reduction

10. Central line infection rate (per thousand line days) 2.8 0.84 70% reduction

11. Life expectancy trends Portugal Scotland

12. Life expectancy trends

13. Walsh, D. et al. Eur J Public Health 2010 20:58-64; doi:10.1093/eurpub/ckp063 Male life expectancy at birth West Central Scotland and 10 post-industrial regions Post industrial regions of Europe

14. Male mortality 15-75 Scotland and 15 other European countries

15. Female mortality 15-75 Scotland and 15 European countries

16. Attention to detail

17. Suggestions for collaborative working Early years and children Young persons offending Physical activity across the population Planning and design of communities Entrepreneurship

18. Adverse childhood events risk of alcoholism Hillis et al 2011

19. Adverse childhood events risk of perpetrating violence Boys experiencing physical abuse Duke et al 2010

20. Risk of heart disease and early adversity

21. Social connectedness 148 studies comprising 308,849 participants, high levels of social integration conferred a 50% increased likelihood of survival. Complex patterns of social integration conferred a 90% increase in survival. Simple connections such as living with others versus living alone conferred a survival benefit of 19%.

22. SG LAs NHS 3 rd Sector Enhancing social connectedness 1. Light the fire 2. Build communities Help to connect people Coproduction

23. Risk Factors- mortality Blair et al BJSM 2009

24. Risk reduction associated with physical activity Chronic conditionRisk reduction All cause mortality30% risk reduction CVD, stroke20-35% reduction Diabetes30-40% reduction Hip fractures36-68% reduction Colon cancer30% reduction Breast cancer20% reduction Loss of function30% reduction Depression/dementia20-30% reduction