Letting go of certainty: rethinking how we lead in health and care

Crisis is now the context for many health and care leaders. Learning to navigate crisis and uncertainty as the norm requires a new ‘leadership operating model’. The stories we’ve told about leadership too often bestow leaders with main character energy – decisive, certain, all-knowing. The world has changed, and our leadership story must change with it. No more heroics.  

Today, the performance and quality of health and care services demands leadership that is more considered, more attentive, and more relational. The job of leaders is not to ‘rescue the system’ – they can’t anyway – but to create the conditions that help the services and organisations we work in to evolve in the right direction, and to invite others to join them in that urgent task. It’s the only story of leadership that’s fit for the myriad challenges we currently face.  

Complexity is one of those ideas that’s both foundational and strangely intangible. At one level, it describes the basic condition of our lives and the organisations we inhabit. At another, it’s an abstraction: compelling, but difficult to translate into everyday leadership behaviours. 

But for those leading in health and care, complexity isn’t optional, it’s the water in which we swim. It’s influence without authority, the conundrum of rising service demand and a diminished budget, the process of a care pathway redesign, neighbourhood health inequalities, and the dynamic of a multi-disciplinary team. It’s all of this set against a backdrop of technological revolution, geopolitical uncertainty and workforce dynamics changing beyond recognition. In health and care, complexity isn’t a theory; it’s everyday operational reality.  

Last year, The King’s Fund and the London Interdisciplinary School (LIS) came together to co-design a new executive-level education course for health and care leaders. We sought to design a course that would give leaders more space – and depth – to explore the implications of complexity in their context. Drawing on LIS’s expertise in interdisciplinary learning and The King’s Fund’s long history of supporting system leadership in health and care, we co-designed Leading Through Complexity – a 10-week programme dedicated to reimagining what leadership looks and feels like when complexity and uncertainty are the norm, not the exception. 

We learned that for today’s leaders, complexity isn’t a problem to be solved, it’s an orientation to problem solving itself that then shapes how they lead. Grounded in the simple, humble recognition that there are many unknowns, ambiguities and competing perspectives in most of the important decisions that must be taken, a different mindset emerges. One that looks and listens for patterns, relationships and signals from across the system, and that can synthesise diverse sources of information into a coherent view. 

Complexity inspires a very human need for control, grip and certainty where in fact there is none. The most effective leaders can resist this psychological and cultural pull and instead take up their leadership in ways that leverage the diversity of thought and collective intelligence available to them. It’s an evolved form of leadership, one more tolerant of uncertainty and guided by clear moral purpose and intentional curiosity. It’s leadership as a sophisticated 21st century problem-solving strategy, and we need much more of it. 

A good place to begin is with something small and intentional. In complex environments, no one person can see the whole picture, so these actions matter because they widen the perspective on offer. Asking thoughtful questions changes what’s visible to other people, and brings more options into a room. Inviting in a voice that’s usually missing shifts boundaries and gently disrupts old power habits. Paying attention to how people are already adapting tells you where the system has energy and insight (and allows you to ‘jump on a running horse’ when making change happen). Trying small experiments makes learning possible without taking big risks. These everyday choices – listening more carefully, sharing influence, staying curious – are practical responses to complexity. 

A space to step back – and step up 

As well as understanding complexity and its implications better, leaders also need respite and an opportunity to pause, recover and reconnect with themselves and others. The challenges we face in health and care can feel relentless, and belonging to a community of peers can supply some much-needed perspective and solidarity – no longer ‘walking in the dark’ alone. As one previous participant put it, the course offered the chance ‘to climb out of the river and look at it from the bank’.  

Leading Through Complexity combines interdisciplinary teaching with space to pause, and real-world application with facilitated collective learning. Across a blend of in-person and online sessions, you will: 

• Explore the evolving landscape of health and care leadership. 

• Learn to influence beyond your formal authority and across system boundaries. 

• Build internal resilience to uncertainty and the ability to work skilfully with ambiguity. 

• Practise tools for collective intelligence, systems thinking and psychological insight. 

• Apply your learning to a live leadership challenge using a bespoke ‘course artefact framework’. 

The course is delivered by experienced faculty drawn from LIS and The King’s Fund including behavioural scientists, anthropologists, policy experts and practitioners with lived experience.