Theory U in Practice

Before the NHS, many people had little or no access to healthcare. In 1887, the Queen’s Nursing Institute Scotland (QNIS) was set up to train pioneering nurses to care for the ‘sick poor’ in their homes. Today, we support community-based nurses to be the best they can be, enabling them to become catalysts for change in their communities.

The Queen’s Nurse title was the most prestigious qualification for district nurses until 1969 when it was replaced with a national certificate. In 2017, we awarded the title for the first time in almost 50 years, to 20 community nurses who had been on a U-shaped journey of discovery over nine months.

Every year, from now on, QNIS will enable 20 nurses from across Scotland – who work in our communities in a huge variety of ways – to sense their emerging future by undertaking the Queen’s Nurse Programme.

Read more about the first Queen’s nurses and their roles.

Theory U

The Queen’s Nurse Programme took a year to design and is heavily influenced by a number of things, including Theory U. The other pillars of the programme are the Queen’s Nurse excellence profile and the framework for person-centred practice Person-centred Practice in Nursing and Health Care (McCormack B, McCance T, 2016).

As facilitators we have different experiences of how this has shaped our thinking individually and collectively.


Brendan McCormack, Head of the Divisions of Nursing, Occupational Therapy & Arts Therapies at Queen Margaret University, Edinburgh:

I read the book Presence: Exploring Profound Change in People, Organizations, and Society (Senge, Scharmer & Jaworski, 2008) when it was first published, and the work completely connected with me.

I have a long background in humanistic practices in both nursing and facilitation more generally as well as a passion and commitment to creativity in learning, practice development and research for the purposes of personal and collective transformation.

Presencing captures the essences of respectful person-centred humanistic relationships that are built on self-discovery and growth. As an archetype of presencing and transformation, Theory U holds so many possibilities for development, growth and ultimately transformation. For me, the magic is in the engagement, reflexive knowing and the unfolding possibilities where the only limits are ‘ourselves’.

On the Queen’s Nurse programme we manage to stretch our own potential for transformation as facilitators and in those engagements enable participants to take that risk with us. ‘Trusting the process’ has always been a key principle underpinning my facilitation practice and nowhere is this more evident than in our programme. It is this essence of trust that enables all of us to travel the U together and experience moments of transformation.

Clare Cable, Chief Executive and Nurse Director of the Queen’s Nursing Institute Scotland:

After being introduced to Theory U by Brendan, I went to buy the book and was impressed by the theoretical underpinnings and the powerful tools. I did the MOOC, which I found fascinating. I was then fortunate enough to get a Florence Nightingale Foundation leadership scholarship which meant that I could attend a week’s Presencing Institute (PI) Foundation Programme and Social Presencing Theatre workshop in Oxford.

Oh wow – that was when it really connected! There’s something incredibly powerful about experiencing ‘pre-sencing’.

As an experienced facilitator myself, it was such a privilege to have the space held by experts from PI, not the usual suspects. Four extraordinary people from across the globe, including two women both in their 70s, Arawana and Marian, bringing their wisdom was a joy.

I learned so much about myself, the model and facilitation. I was truly inspired and have brought a great deal of that learning back to enhance this year’s Programme.

Jane Cantrell, Programme Director at NHS Education for Scotland:

As a community nurse and educationalist currently working in the NHS, I have been exposed to the current extreme pace of change. The prevailing approach to quality improvement in healthcare is based on improvement science with its emphasis on measurement, which I have struggled to connect meaningfully with.

Engaging with Theory U principles has given me a different focus and, in some ways, has completely changed the way I perceive things.

The important messages about looking after and changing self along with the key ideas of holding space for what wants to emerge has really ‘struck a chord’. I have been able to take this not only into the Programme but also into my daily life and work. In essence, the importance of intuition, which I have long supressed, is part of the real me has started to emerge again.

I feel that this is important in the context of the Programme – if nursing is about art and science then we appear to have lost the former and engaging with the principles of Theory U helps to readdress the balance.

How Theory U has shaped the Programme

The Queen’s Nursing Programme starts with a week’s residential which is very like a PI Foundation Programme. In the same way, the space is thoughtfully created and ‘held’ by the facilitators, and participants are invited to embark on a creative and contemplative journey.

Just as with any U Lab workshop, each day begins with a different form of mindfulness and moves into interactive sessions which explore aspects of person centred culture; starting with self, using outdoor spaces as much as possible and encouraging experimentation with art, sculpture, poetry and movement.

Participants are divided into action learning sets and each day includes time for personal reflection, walking and journaling, and ends with storytelling from a range of inspiring guest speakers at the fireside before dinner.

The photograph below is of a mandala, co-created in response to a workshop on flourishing.


Over the nine months, there are two further workshops which are designed to support each person as they work on an issue of importance to their community. Their journey is further enabled with monthly coaching, a Whatsapp group and a web forum. The poem that follows was written together at one of the workshops.

Blog Pic 4

The impact of the Programme and the benefits of Theory U in our practice has been remarkable.

Further information

If you’re interested in learning more, please visit the QNIS website

Read more about the first participants of the Programme here.

You can also download these articles:


Nursing Standard


Collective Leadership

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