Leadership, System Leadership

How do you lead when you’re not in charge?

The world of health and care has changed and is almost unrecognisable from a decade ago.  People are living much longer but with increasingly complex needs.  This means that they navigate across the health and social care boundaries and often into the voluntary sector as well, and more often than not the system does not act as such and makes it even more difficult for patients to get all the care they need.

Place-based care is looking to address these difficulties with the advent of Sustainability and Transformation Partnerships (STPs) and Accountable Care Systems to try and integrate the system for the benefit of patients.  This means that the traditional delivery of care within organisations and led from the top is no longer fit for purpose and the dawn of a new style of leadership is required; one that can lead across organisational boundaries and professions – one such as systems leadership.

So what does systems leadership actually mean? Traditional organisational leadership was very clear cut; the buck stopped at the top of the organisation and it was very clear who was in charge.  Now we are working in a complex, ambiguous environments that include many different agencies trying to work together to solve often intractable problems and therefore no single person is in charge, and moreover it’s a collective effort across a system.  The simplest definition I have seen of systems leadership is from the Leadership Centre who simply defines it as ‘how you lead when you are not in charge’.

This new way of working defies how we have understood leadership for decades, if not longer, and so requires a shift in mindset in order to move to this new way of leading. According to the research done by the Leadership Centre there are 6 key principles that can be applied to lead in this new world:

  1. Relationships, relationships, relationships – this is all about building trust with others so that you can collectively get things done.  Do not underestimate the time this takes and you really must invest the time with the right intention and level of commitment.  You do not have the same levers that positional power and hierarchy allow you to pull within an organisation and so you need a different approach. However, this is not about bending people to your way through manipulation of relationships, but working as a collective and building trust and commitment over longer periods of time.
  2. Start small – to build relationships you actually need to work on things together, but you will also need to see the fruits of that partnership very quickly so as to demonstrate that you can get things done more effectively together.  Start on something small and eminently achievable and start from where you currently are not where you aim to be in the future.  This way you will build relationships and demonstrate results quickly.
  3. Go where the energy is – if you want change to happen quickly, find the people who have great ideas and enthusiasm and champion them.  It is amazing how quickly people who are given support and encouragement can drive forward change.  The coalition of the willing is the best option to help you to start to reach a tipping point and then you can bring more sceptical and laggard people on board.
  4. It’s all about the conversation – when you think about your organisation and how things get done, often it’s about the informal organisation that nestles within the formal hierarchy and governance where the real work gets done.  It’s the relationships, networks and connections that people have that drives forward change.  This is the same at the system level.  It’s all about having the right conversations; building the right networks and developing trust and commitment right across the system.  So, go out for that coffee with your counterpart in another part of the system, it’ll be amazing what you might learn.
  5. Be brave and experiment – solving intractable, ‘wicked’ problems that are complex rather than complicated requires all parts of the system to have courage to try things out and seeing if progress can be made with a particular issue.  Cross organisational; cross boundary; cross profession challenges will not be fixed in one fell swoop and will require the learning to be iterative.
  6. Systems leadership is everywhere and anywhere within the system – there is a mistaken belief that you can only lead the system by those at the top of the organisations getting together.  This is the old-world thinking imposed onto the new problems.  Systems are everywhere and at all levels and are made up of thousands of connections and so people at all levels of the system should take these principles and lead from within the system to really make change happen.

 

I have been putting these principles into practice over the past two years as the joint lead for the development of the Foundation Healthcare Group; a collaboration between Guy’s and St Thomas’ NHS Foundation Trust (a teaching hospital and tertiary centre in London) and Dartford and Gravesham NHS Trust (a local hospital in Kent).  The core principle has been that we can develop a sustainable solution for the NHS provider sector through acute care collaboration to ensure we make best use of scarce healthcare resources to continue to deliver high quality healthcare for local populations.

The focus has been both on patient pathways and overarching governance for how to formalise our collaboration.  The principles of systems leadership described above, were echoed in a recent report we published which described our learning for how we brought the clinical teams from both hospitals together to design better clinical pathways and better outcomes for patients.  This work is starting to demonstrate really excellent results for patients after only a year of being up and running.

The conclusion for me is that systems leadership takes time, energy and commitment but the results are worthwhile.

It relies on patience and the core values of the individuals involved to be able to put ego aside and to concentrate on the greater good, as often the answer does not clearly emerge and cannot be forced no matter how enigmatic and strong the leaders may be.

Dealing with the volatile; uncertain; complex and ambiguous world that we now find ourselves in will take a brand new set of skills that will require personal and organisational investment so that we can collectively all lead when we’re not in charge.

 

Systems Leadership conference for GSTT senior leaders held on 20 July 2017 opened by Amanda Pritchard, Chief Executive

2017-07-20 13.09.35

About the author

Sarah Morgan is the Director of Organisational Development and Programme Director for the Foundation Healthcare Group (Acute Care Collaboration Vanguard) for Guy’s and St Thomas’ NHS Foundation Trust and passionate about leadership and organisational development and the development of innovative strategic solutions for the NHS

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culture of compassion, Leadership, wellbeing

Put your energy in the right place – how to get more love in the workplace – part 5

I had a revelation this week; one of those Aha! moments that come along very infrequently but when they do they make a significant difference. It was about energy and the need to put your energy in the right place to increase your work productivity and sense of well-being.

It emerged during a coaching session when I was thinking about how to more effectively lead the programme that I am currently directing. What became clear was that as the programme is in the start-up stage and does not have a full team in place, my energy has been spent in the mechanics of the programme, administrating and being ‘in the weeds’ of the day to day rather than strategising and thinking through the policy implications.

My preference is for global (strategic) thinking, which is right brain dominant and leads to a focus on the future state; the big picture and people with this preference thrive on experimenting and spend time ‘thinking’ rather than ‘doing.’ This means that when I put my energy into detail; reactive activities and short term tasks, it results in a drain in my energy.

I had convinced myself that I was getting to the end of the week exhausted and lacklustre due to the fact I had been spending all of my time on intellectually challenging activities; however when I really thought about it and closely examined how I spend my time during the week it became clear that the majority of my time is spent in meetings and working on the mechanics of setting up the programme leaving only a small amount of time left for thinking and working on strategy and policy development.

This has started me thinking about energy and how to use it more wisely to be more productive in the workplace by focusing it in the right places. A further look into some tools and techniques for how to do this best revealed a really informative Harvard Business Review article about ‘how to manage your energy not your time.’ The article identifies that energy is defined in physics as the capacity to work, and comes from four main wellsprings in human beings: the body, emotions, mind, and spirit. It suggests that it is possible to systematically expand and regularly renew energy through specific rituals, which are described as behaviours that are intentionally practiced and intentionally practices so as to become unconscious thinking.

This article summed it up for me: “To access the energy of the human spirit, people need to clarify priorities and establish accompanying rituals in three categories: doing what they do best and enjoy most at work; consciously allocating time and energy to the areas of their lives—work, family, health, service to others—they deem most important; and living their core values in their daily behaviors.” Take their test to see if you are heading for an energy crisis and for top tips on how to prevent it.

My revelation has made me think more widely about the fact that, despite having the highest staff engagement scores in the country, my organisation is in the worst 20% of Trusts scoring that staff are working long hours and we are noticing that for the first time stress due to workload is on the rise. Finding the approaches that are going to make the difference in busy, healthcare environments is very difficult. Working on helping staff to manage their energy may be the completely different approach we might need to consider.

Over the next few months I’m going to be trying out some of the new techniques coupled with applying the learning from Covey’s 7 Habits of Highly Effective People (more on this in a future blog) to see if I can change my energy balance; be more productive and fulfilled and hopefully make more quality time for my team and colleagues.

Resources used:

Identify the difference between strategic and global thinking http://www.selfgrowth.com/articles/are-you-a-linear-or-global-thinker

Test whether you have a strategic or a linear thinking preference http://www.harvardbusiness.org/blog/are-you-strategic-thinker-test-yourself

 Full article from Schwartz and McCarthy; 2007; Manage your energy not your time; Harvard Business Review https://hbr.org/2007/10/manage-your-energy-not-your-time

Covey; Stephen R; The 7 Habits of Highly Effective People; Rosetta; 1989 

About the author

Sarah Morgan is the Director of Organisational Development and the Vanguard Foundation Healthcare Group Programme Director for Guy’s and St Thomas’ NHS Foundation Trust

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