In 44 areas in England, NHS organisations have come together with local authorities and other partners to develop sustainability and transformation plans (STPs) – ambitious, five-year plans for the future of health and care services in local areas. In this brave new world of delivering care across organisational boundaries, one challenge stands out among many: how can leaders collaborate to deliver the changes that are needed?
, Assistant Director of Leadership and Organisational Development at The King’s Fund, has been working with STP leaders from STPs including Frimley Health, and Bedford, Luton and Milton Keynes who are developing collective strategies to deliver greater impact for patients and service users in their areas. And it is not just STPs that are experimenting with new ways of working. Nicola and her colleagues have also supported local authority and CCG leadership teams developing new models of commissioning, as well as areas implementing new care models such as Salford, and North East Hampshire and Farnham. Nicola Walsh
‘We design our leadership and organisational development activities based on intelligence we collect from holding conversations with local leaders – so each programme is tailored to specific needs,’ explains Nicola. ‘Our intention is to work in partnership with leaders “in place”, providing an appropriate level of support and challenge to provoke new ways of working.’
Often the focus is on how organisations can collaborate more effectively. ‘Involving leaders in a process of enquiry, we design interventions that aim to build relationships and develop leadership practices as part of a place-based approach,’ says Nicola. ‘We also spend time working with NHS and local authority leaders to explore the shared purpose for collaborating with one another.’
In the past, partnership-working between the NHS and local authorities often meant one organisation leading and driving the change. Nicola challenges this way of working. ‘STPs and the implementation of new care models requires a range of different leadership models that distribute decision-making and authority across collaborating organisations,’ she explains. ‘We explore these issues in our work with leaders, recognising that distributed decision-making will maximise staff and community engagement and contribution.’
Time is also spent exploring how leaders talk and listen to each other. Nicola says: ‘Leaders who have the skill to understand how they may intervene to keep the dialogue going to explore new and different solutions to longstanding problems are vital.’ She has found that focusing on this is key to success: ‘People are often in transmit mode and may not be listening sufficiently to the different perspectives nor perhaps creating the space in meetings to explore and generate new solutions to the challenges they are facing.'
Understanding the context
Nicola describes a further layer of expertise that permeates all her work with leaders: ‘Our work is firmly rooted in our knowledge of health policy and health services research. When we design a programme for system leaders, we use this knowledge to work through real issues and apply an appropriate level of challenge.’ For example, leaders working with the challenges of introducing new models of care may find experiences from health and care systems outside the UK a useful way of examining their local issues.
For Nicola, the challenge can often be one of focus. ‘Leaders are, understandably, often focused on the technical issues such as new ways of contracting for services. But inter-organisational relationships, collective responsibility and commitment are critical to secure the changes needed to transform services. Our role in the leadership and OD team at the Fund is to support leaders to focus on these, enabling them to implement new models of care that place a greater emphasis on prevention, integration of services and enabling people to take more control of their own health.’