Innovations in health and social care - Hidden Insights

Added on

Hidden Insights facilitate a group problem-solving method where facilitators act as “expert non-experts”.  They don’t analyse why things don’t work – they help people discover what does work now, and how, then share it.


  • Lack of resources to help vulnerable people
  • Growing demand for support
  • Tradition of short term intensive fixes
  • Learned helplessness in the community


  • Strengths based, facilitated approach to discover hidden solutions and skills already available in the community at no or minimal cost.
  • Works by enabling small changes in behaviour and practice that have a big impact on confidence and outcomes – without going too deep/ being therapy
  • Taps into networks and creates new friendships and groups
  • Simple and repeatable 3-step group process, with powerful working principles, that can be learned and facilitated by professionals and community members
  • Closely allied to design thinking and always sets up collaboration
  • Time-affordable – once learned, Hidden Insights can be applied in a morning or in several short sessions – or over a longer period for harder issues (e.g. FGM).
  • Changes the culture in organisations and communities, works from the inside out, bottom up.
  • Fits around and accelerates other programmes, provides useful skills for Local Area Co-ordination, Asset Based Community Development, Family Circles etc.

Evidence base

Evolved from the Sternin’s approach to positive deviance, which has been successfully used world-wide in public health, reduction of hospital acquired infections, domestic abuse, FGM. 

Cited in many books and articles as a positive approach to complex change.

Pascale, RT (2000) Surfing the Edge of Chaos

Pascale, RT, Sternin and Sternin (2010) Positive Deviance – how unlikely innovators solve the world’s toughest problems.

Grint, K – (2010) Clumsy Solutions to Wicked Problems

Heath, C and Heath D – How to Change when Change is Hard.

The work using this approach has always been done in the field and was not set up as academic research.  However, a social impact assessment has been done on one project in the UK – showing a return of £4 for every £1 invested.

In conversations with Dr Dee MacDonald and Dr David Watson, in the School of Social Work at the University of Brighton, they identified it as a neat way of underpinning key changes in social work such as restorative and evidence-based practice, collaborative design. Links to positive psychology (Seligmann, Frederickson, etc), social learning (Vygotski), appreciative enquiry (Cooperrider), motivation (Deci and Ryan, cited in Daniel Pink, Drive – autonomy, mastery, purpose), Mind-set (Dweck), neuroscience, Theory U, Otto Sharma. 

Expected impact

Trained facilitators immediately impact on communities by building networks and connections between individuals, and getting a shared understanding of the different aspects of a burning issue.

The community individuals bond and start to take responsibility – creating a working group, usually of about 8 – 10.  This working group gets people in the community together to discuss and work on finding hidden solutions to their issues, getting evidence that they do work, then spreading them.  This engagement and discover stage works quickly, in a matter of weeks.

In our recent Huntingdon Grub Hub example, 127 individuals participated.  The wider impact will be on tens of families immediately.  There will be benefits to the wider community in terms of reduced anti-social behaviour, and to services as there are at least five examples of where mental health support was not needed because of improved connections in the community.  This ultimately affects the whole estate.  This project cost about £30,000 in terms of trainer fees and staff time before it became self-sufficient.  The community raised the £120 a week needed to run the events.

We worked with a group of teenage parents in Gosport, who found better ways of coping with isolation and parenthood for themselves, then learned to facilitate sessions for at risk students in the local school.  They identified the risks of being a parent and the potential impact on their lives.  This ultimately potentially involved all 2000 student in the school.  In the year that the young parents worked there, it was reported that conceptions dropped from a rising total of 11 to 3.  This project cost £15,000 in terms of trainer time.

A project in Salford for fathers engaging with their families better, produced estimated returns on social capital of £4.00 for every £1.00 invested.  However, this project cost £126,000 and continued to rely on a professional leader.


Biggest projects using this approach exist in healthcare in the USA, Canada, Mexico and Brazil.

Used extensively in Africa, Asia for public health and cultural issues

In Europe, there have been projects to identify and spread what works in helping immigrant young people with mental health issues in the Netherlands, practices to improve outcomes for children in care in Denmark, and a UN funded project to reduce endemic domestic abuse in Moldova.  We have run projects in the UK around domestic abuse (x3), parenting, (x2), service improvement (x4).  We have trained staff in Cambridgeshire, Haringey and West Sussex, in order to maximise impact. They have gone on to develop services using this approach, gain funding and facilitate community development.

What would councils/health organisations/local areas need to do or have in place to enable it to happen?

To incorporate the Hidden Insights steps and principles values into training of professionals and community developers.  To get a licence to train others using the same approach, developing a set of underpinning competencies in facilitation, and a positive encouraging mind set.  Works well with LAC, ABCD, Buurtzorg-style organisations.  Also works well in management as is encouraging and evidence-based.  

What would kill it?

We have already been affected by:

  • Restructuring of the sponsoring organisation/s with changes in key roles, often several times over.
  • Competing performance measures and targets between partner organisations
  • Changes in policy from Government and partner organisations
  • Costs being loaded into the project from commissioning organisations
  • Top-down, input-based prescribing, commissioning and management.For further information:


Jane Lewis, Director –

TLAP are collecting stories that showcase innovative ways to offer care and support that focus on an asset-based approach to people’s well-being rather than a deficit approach.  This work is a continuation of six innovations in social care. Our ambition is to move from 6 to 66 innovations.