Visionary pragmatism, and the other creative muscles that NHS infrastructure needs to flex

Previously, I talked about why creativity matters in infrastructure, and why it’s not just a ‘nice to have’ for NHS strategy.

Now I want to explore a few of the creative muscles we actually need to flex if we’re serious about building the next generation of health infrastructure. 

1.   Visionary pragmatism

I’m pretty sure I made this term up. Yes, I use it a lot. No, I won’t apologise.

For me, it perfectly captures the skill that’s needed to allow creativity to flourish, especially in the complex world of the NHS and public services.

To create the right future for our health infrastructure we need people who are both visionary and practical. People who can dream big AND be willing to take the first step. People who can ask ‘what if?’ and follow up with ‘here’s how’.

People who happily challenge the status quo, but at the same time are unafraid to say ‘there is no way that can work within our existing infrastructure’.

Because creativity without grounding is just fantasy.

But without imagination, we’ll never create anything new.

It's a delicate, almost paradoxical, balance.   

The real magic is in knowing how to navigate that tension. Understanding when to hold back, when to lean in, and when to pivot. It’s about building flexible foundations that invite future creativity and change. Foundations that others can build upon, adapt, and carry forward.

It’s adaptability and resilience in action.

And that matters. Because the spaces we shape today will either limit or unlock the transformation we’re aiming for tomorrow.

2.   Systemic curiosity

Creativity doesn’t start with answers.

It begins with asking better questions.

We need people who are curious about how things fit together. People who can zoom out (Shard style) and see the patterns, quiet relationships, and hidden gaps that don’t show at ground level.

Curiosity pushes us to look deeper, revealing the hidden and ever-changing links between infrastructure and the very essence of health; from service delivery and changing workforce models to climate resilience, community identity, the possibilities of artificial intelligence, and the underlying socio-economic factors that influence our wellbeing.

It’s this kind of questioning that challenges us to not just see infrastructure as a passive enabler, or the backdrop to the conversation.

Rather, it allows us to see infrastructure as a vital, dynamic force actively shaping health and care - embedded deeply within the complex ecosystem of physical, digital and social environments that influence every aspect of our lives.

When we lean into curiosity this way, we start to rethink the conversation itself.

Who needs to be involved?

Wat questions should be asked?

Where these conversations must happen to truly unlock change?

Without curiosity, we’re stuck with the status quo.

But with systemic curiosity, we open the door to imagining all sorts of new possibilities.

3.   Imperfect action (the most underrated creative skill)

But having curiosity and asking the right questions is only part of the story.

Once we’ve imagined something better, we have to be brave enough to start - even when we know the first version likely won’t match the vision in our heads.

Because here’s the truth - Reality will rarely live up to the idea we’ve created.

Not at first.

Maybe not ever.

But that’s not a reason to hold back. It’s a reason to begin.

Small. Messy. Imperfect. Just start something.

Rome wasn’t built in a day. The Sistine Chapel wasn’t painted in a weekend. Every breakthrough we admire, every game-changing invention, every bold innovation was once an early draft. A prototype, or rough sketch, of what it would eventually become.

One of the biggest blockers to creativity? Ego.

I’ve lost count of how many times someone’s looked at a pilot project and said ‘Oh yeah, I thought of that’. Or worse – ‘Is that it?’

And to some extent, I get it. The finished product rarely matches the original imagined vision. But the people who dared to try and implement something that by our standards is imperfect? They’re 10 steps ahead of the ones still waiting for perfection.

We need to stop treating imperfection like failure. And start recognising it for what it is - progress in motion.

Pride won’t build the future.
Neither will fear of falling short.

Starting will.

Even if it’s a bit scrappy.

Even if it doesn’t quite land the first time.

Even if it feels smaller than the vision you had in mind.

Because building something better is never about getting it right the first time. It’s about being bold enough to begin at all.

4.   Empowered doing

This might just be the most important one.

Let’s park the previous skills for a second. The reality is that there are loads of brilliant ideas that never make it out of our shiny strategy documents. Not because they’re unrealistic or unworkable, but because no one gave them the space or permission to actually start.

Creativity needs room to breathe.

It needs permission to test, to learn, to get things wrong safely, and to keep going anyway.

We say we want innovation.

We put it in the vision statements.

It is in our organisational strategies.

But are we really building the conditions to actually DO it?

It's an especially pertinent question in the public sector - where the stakes are high, scrutiny is real, and risk is so often intertwined with life and health.

The challenge isn’t ambition. It’s creating the environments where experimentation is possible and protected. Where we learn to navigate some risks, not avoid them altogether. (And yes, especially in infrastructure.)

Because if we don’t make room to try something new, then we’re not designing the future - we’re just trying to create a more polished version of the past.

Bringing it all together

Creative infrastructure isn’t about quirky designs, architecture or endless blue-sky-thinking workshops. Nor is it some distant ideal.

It’s about using creativity strategically to look at what we have, what’s possible, and what people really need.

At the same time.

In the same conversation.

With the same people.

Imagination + pragmatism + curiosity + action. That’s the blend.

And sometimes, it just starts with asking:

What if we thought differently?

Because the way things are now? It’s never the only way.

But building something better? That’s going to take a good dose of creativity.

So, what conversations are we missing?
Who else should be at the table?