The practice of system leadership

Being comfortable with chaos
Comments: 5
System leaders often do not see themselves as such, believing that any successes they achieve are due to working behind the scenes rather than leading from the front. But given the unprecedented challenges facing the NHS, the system needs leaders who can motivate staff and managers to work differently, across service and organisational boundaries. That is the only way to meet the needs of the growing number of people with complex and long-term conditions, many of whom rely on care and support from different services.

This report draws on the experiences of 10 senior leaders to look in depth at the skills needed to be a system leader. The 10 individuals are from different backgrounds and work in different contexts, and give some very candid reflections on their successes and failures. But they share a track record of having tried to bring about change (not always successfully) through using ‘soft’ power, enabling others to see and deliver the changes that are needed.

Key findings

Interviewees gave similar views on how to go about achieving system change and the barriers that need to be overcome. They emphasised the following strategies.

  • Start with a coalition of the willing, build an evidence base, and build outwards; it is vital to engage clinicians in understanding the need for change and to lead efforts to achieve that change.
  • Involve patients, service users and carers because they have an invaluable role to play in helping to identify which services need to be redesigned.
  • Strike the right balance between constancy of purpose and flexibility by facilitating conversations about what needs to change and how; being flexible about how that might be achieved; and ensuring the momentum is there to deliver change despite the inevitable opposition.
  • Pursue stability of leadership, something that has proved difficult in a context of frequent reorganisation of the provider and commissioning landscape.

Policy implications

There was consensus among those interviewed that much more needs to be done to develop system leaders. This could include ‘buddying’ younger, less experienced managers and clinical leaders with more experienced counterparts, and doing more to protect whistle-blowers. But there was some debate as to whether system leadership can be taught, or needs to be learnt the hard (and long) way.

There is now a strong and clear vision for system-wide change that is developing momentum, with the NHS five year forward view bringing together the multi-headed hydra that might be described as ‘the top of the NHS’ – NHS England, Monitor, the NHS Trust Development Authority, the Care Quality Commission, Public Health England and Health Education England.

The practice of system leadership - Being comfortable with chaos | by Nicholas Timmins

Print copy: £10.00 | Buy

No. of pages: 78

ISBN: 978 1 909029 50 7

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#543833 Prof. Minesh Khashu
Consultant & Prof. of Perinatal Health
Poole Hospital NHS FT

Thanks Nick. Useful insights.

"I think collaboration is the most important innovation for the NHS today". It is not the fancy technology that is holding us back but largely:

1. Poorly set up and functioning structures. The system is set up to work in a 'them and us' way. Evaluation is based on organisation not system performance e.g. CQC

2. Lack of right skill set for the job at hand. Too much EGO and organisation centric agenda. Behaviours need to demonstrate efficient working beyond boundaries.

3. How do you expect laprosccopic surgery to flourish if the leader has been practising open surgery for 35 years and is too 'rigid' to accept that he/she needs to pick up a new skill or focus on a different set of behaviours. Quite a few 'senior leaders' happy in their old ways which brought them success in the past but are outdated for what the NHS requires today.

4. Their is urgency mentioned umpteen times in the 'talking' but very little urgency shown in action.

#543839 Terry
Member of the public

Oh how I wish I could be reading something new here. So many of the same old words and wish lists while even the most basic of services to the patient continue to suffer. Integration of heath and social care seems as far away as ever.
Does it really mean that the service is no longer properly selecting, training and developing present and future leaders?....I think so. Individuals seem to be simply looking for their next promotion rather than the giving of a service. How dare whistle blowers tell the public the true facts!!... Lets have more meetings more reports and maybe the problems will simply disappear!
There are centres of real excellence but they are being overshadowed by a growing number of inflexible, incompetent managers and leaders who still find ways of staying in post and unfortunately promoting those in their own image.

#543840 george coxon
various inc system leader I believe!
care homes and various other groups and bodies

I've devoted a good amount of time this morning to reading this report with an open mind and receptive heart before I meet the Regional Skills for Health Director in the southwest and the Skills for Care lead too later this morning and have printed extracts for onward use and application so thanks to all for this - written by great people I recognise
I feel 80 page investment of time reading is as critical as time compiling so the value of the impact and contribution it will make is dependent on the likes of me - a modest front line leader dealing with enabling, empowering, reflecting, shaping culture, instilling pride, humour and reputation for our services in my 50 odd staff. The bit that I would want to add re leadership citing Derek Sivers and his irresistible 3 minute youtube clip on leadership is to say it is about credibility - ie leading by example - if you are no longer doing the thing you are leading about be very careful how you pronounce and expect others to follow - see the dancing guy in the Sivers clip - He started dancing and is still dancing when all the crowds joined him !!

#543841 Pearl Baker
Carer/Independent Mental Health Advocate and ADvisor

It goes without saying you cannot be a systems leader unless you know the system, which is changing all the time. Lets take 'integration' LTC
such as Mental Health, first question are you subject to section 117, Guardianship or COP, second what are their problems? assess, including 'safeguarding', identify needs, then implement. What agencies could be involved in this exercise. DWP,COP, Appointees, Housing, Guardianship, CCG, LA, Carers, Banks, Building Societies, Personal Budget, Support Workers.

To be a Systems Leader you must have knowledge, and that takes time.

There needs to be various System Leaders specializing in different subject matters, with some 'crossover' between agencies, i.e Housing Benefit regulations is the same for all groups.

It comes down to one question, you cannot be a System Leader if you don't know the system.

#545217 Peter A Barnard
Writer / reseracher / reader / annoyer

1. There is no shortage of leaderhip
2. There is no leadership training
3. But I believe systems leadership can be taught and I am happy to share how although health is not my field...

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