The challenges facing today’s leaders in health and care are complex. Now, more than ever, they need to be system leaders, capable of working across boundaries to find solutions to the increasing demands placed on services. They need to bring together expertise and use resources from primary care, secondary care, mental health services, public health, social care and the voluntary and community sector. The list is exhausting. They also need to engage with people who use health and care services, and their carers, on the one hand, and senior specialists and politicians on the other.
To help identify the skills that might be needed for leadership in this new order, the King’s Fund commissioned our fifth annual publication on leadership and management in the NHS and wider system, The practice of system leadership: being comfortable with chaos, which draws on the stories of 10 senior leaders.
Many of those interviewed resisted being labelled as system leaders. Their reluctance may be due to another belief: that to achieve change you need to give credit to others. They exemplify Chinese philosopher and poet Lao Tzu’s saying: “A leader is best when people barely know he exists, not so good when people obey and acclaim him, worse when they despise him ... But of a good leader who talks little when his work is done, his aim fulfilled, they will say, ‘We did it ourselves’.”
The ability to be resilient in the face of uncertainty and change but not to be consumed by them is something that will resonate with today’s health leaders as they read these testimonials. While the issues discussed by those interviewed varied, the stories show that being able to influence and persuade requires particular skills and behaviours, including having an eye on the long-term future of health. They also reflect the importance of investing in relationships and building trust in order to build alliances to produce change.
Interviewees accepted that behaviour that protects and promotes individual egos and ambitions – a tendency that looms large in “heroic” old-style leadership – has little place today. Collective leadership, which is what the system leaders profiled here demonstrate, becomes part of how we grow and nurture a culture in which staff at all levels can work with patients and service users to deliver high-quality and compassionate care.
Although there are barriers to achieving effective system leadership – the pressures of balancing the books, the need for a different approach to training and development of future leaders, the heavy-handedness of regulation – there is optimism in our report.
Many of those interviewed highlighted the fact that so many organisations – NHS England, Monitor, NHS Trust Development Authority, Care Quality Commission, Public Health England and Health Education England – had come together to present a vision of system change in the NHS Five Year Forward View, which reflects the values and commitment to collective leadership. The time for identifying, nurturing and using the strengths and talents within system leaders is now.
To follow the discussions at the King’s Fund’s fifth annual leadership summit today, please use hashtag #kflead
