Five ways system leaders think differently (and why this matters more than ever in health and care)

Systems leadership is needed now more than ever. But what are the key characteristics that define a systems leader?

The importance of the shift from focusing just on individual leadership performance to developing a systemic awareness, is one of the common realisations of senior health and care leaders who have engaged seriously with the concept of systems leadership. It points to something important; the skills that make someone an effective leader are not always the same skills that will enable them to lead across complex and changing systems. 

What is systems leadership?

Systems leadership is the capacity to lead across system boundaries in pursuit of outcomes no single organisation can achieve alone. It is less a set of techniques than a way of being; it involves the ability to look at the bigger picture, act with the whole system in mind and recognise that we are always a part of the system we are trying to change. 

As a senior consultant at The King’s Fund and director of the Fund’s Top Manager and Building Your Authority programmes, I see first-hand what system leadership actually involves and what it asks of today’s leaders. Here are five characteristics that mark out systems leaders.

1. They see the interrelationships and interdependencies across systems

Many of us have been trained to manage within our organisations, not lead. We develop expertise within a defined remit, build authority, manage performance and deliver results. That works well for bounded, more predictable problems. 

But the most significant challenges in health and care – the entrenched inequalities, fragmented care pathways and increasing workforce pressures – don’t sit neatly within any single organisation. They are properties of a whole system, generated by the relationships and interdependencies between its parts. 

Systems leaders develop the capacity to see those interrelationships. They look beyond their own boundaries, notice how different parts of the system connect and influence one another and ask deeper questions at the level of the whole system rather than just its parts. Leaders who develop this ability describe moving from a reactive, event-by-event stance to a more contextual one. They see hidden patterns, hold a longer-term view and intervene in a way that changes something at its core, rather than just managing the symptoms. 

2. They understand how structure drives behaviour

When something persistently goes wrong in a health and care system, the instinct is often to look for someone to blame; X team isn’t performing or X leader lacks grip. Sometimes there may be elements of truth to this. More often, there aren’t. 

Systems thinking asks us to consider much harder questions. What is it about the structure of this system that is really shaping behaviour? How do national or local incentives shape our work? How does information flow within this system, or not? Where do boundaries and accountabilities create the conditions we face?  

The structures shaping behaviour are not neutral. They reflect existing power dynamics and systems leaders need to be willing to see and work with those honestly. This requires leaders to turn the lens on themselves and ask: ‘How might my own choices, habits and assumptions be part of the problem?’ Leaders who have taken time to reflect on this describe a significant shift, from scanning the horizon for causes and solutions to becoming genuinely curious about their own contribution to the dynamics they face. As one leader put it: ‘I stopped asking “why won’t they change?” and started asking “what am I doing that makes it easier for things to stay the same?”’

3. They anticipate unintended consequences

Complex living systems don't respond to interventions in straight-forward ways. Actions have consequences that ripple outward, circle back and often produce effects that were never intended in a ‘feedback loop’.

In health and care, this pattern is painfully familiar. A target is introduced and clinical behaviour shifts to meet it in ways that create new pressures elsewhere. A workforce initiative improves retention in one area but inadvertently draws staff from another challenged part of the system. The solution becomes, in time, part of the problem. 

Leaders who think systemically develop the habit of asking ‘and then what?’, tracing how a system might respond to a change over time and staying alert to the unintended consequences that well-intentioned interventions can generate. Recognising feedback loops doesn’t necessarily prevent them from happening but it does make leaders more alert to them, more likely to ask better questions before acting, and more honest about the trade-offs involved. 

4. They move from individual to collective leadership

This is perhaps the most fundamental and culturally difficult shift that systems leadership requires. It involves moving from a model of leadership focused on individual expertise and authority to one of collective leadership and importantly, followership, where individuals actively engage with leadership, while maintaining their own judgement, values and agency.

This shift doesn’t mean abandoning accountability or expertise. It means recognising that the challenges we face cannot be solved by any single leader, however skilled. Senior leaders describe this as moving from leading through the authority of their position to leading through the relationships they hold. From feeling compelled to have answers to creating the conditions in which better answers can emerge. This requires leaders to have a different relationship with authority, with difference and with not-knowing. It also demands a different kind of thinking, an ability to build trust, and a willingness to work across system boundaries with generosity. 

5. They know that changing a system starts with changing themselves

The most counterintuitive but consistent finding from those who have done this work is that you cannot lead change in a complex system without also being open to changing yourself. The structures generating a problem often include our own mental models; the assumptions and perceptions that shape what we notice, what we ignore and how we respond. Developing the capacity to examine and challenge those models isn’t a soft add-on to leadership work – it is the work. 

What health and care systems need now

Health and care systems in England need a different quality of thinking and a different kind of leader. The problems they face are chronic, deeply entangled with human behaviour and relationships, and will not shift through top-down intervention alone. 

What is needed is a leader who can see the whole system, understand what is driving behaviour within it, anticipate the consequences of change, lead collectively rather than individually, and remain genuinely curious about their own part in what happens. 

That is what systems leadership really asks of us. And the evidence from those who have undertaken this work seriously, suggests it is a capacity that can be developed and that developing it can turn out to be one of the most significant things a leader can do.