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

Standard
Authentic Leadership, culture of compassion, Leadership, Motivation, NHS Leadership, Organisational development, Resilience, wellbeing

2017 – My year of Focus

I was asked at the beginning of the year what my word for 2017 is and I decided it is ‘Focus’.

Just before Christmas I found myself in a complete state of overwhelm and was working inefficiently, flitting from task to task; meeting to meeting and trying to juggle too many variables at the same time.

Over the break I took time out to reflect and think about what I wanted to do differently in 2017 and came to the conclusion that less is more and I needed to re-prioritise.

I realised that in order to stay resilient I need to be more discerning and disciplined with my time, to not give it away too easily and spend more time on the things that energise me and make me happy in life including my spiritual and physical wellbeing. Most importantly I need to prioritise my time with my friends and family and ensure that I’m not taking them for granted.

I have decided to prioritise to five key things to focus on, which are:

1. The creation of a diary management system to prioritise both my work and social to have a much better use of time. This includes saying no more often and builds in protected time to think; write and research to ensure we stay ahead of the curve in leadership; OD and new models of care. This will ensure I can dedicate the right amount of time to the three major programmes that I am currently leading. I’ve designed a colour coding system so I know what is a must-do and what I can delegate or drop if necessary.

2. Limiting my social activities to only having one to two nights a week when I’m going on to an event after work. Prioritising things that I’m really passionate about. I became a Fellow of the Royal Society of Arts in November last year and am keen to connect with their Reinventing Work network as is connects with my passion of creating more love in the workplace – the theme of my 2016 blogging year.

3. Leaving work on time to go to the gym and making time to get enough exercise. Particularly reconnecting with the activities I love such as yoga; climbing and recently I’ve gone back to High-Intensity Interval Training (HIIT) . Even after a few short weeks it’s making a real difference to how I’m feeling.

4. Improving my sleep as before Christmas I was only getting 5 hours a night and I was finding it was affecting my decision-making and judgement. I’m experimenting with making sure that I’m winding down and in bed for between 10pm and 11pm to make sure I’m getting enough sleep aiming for between 7 and 8 hours a night to try and maintain my ability to stay focussed

5. Writing To Do lists is something that I have to really discipline myself to do. I’ve been lucky enough to have been able to rely on my memory for keeping me on top of my workload for my working career. However I noticed that as I became more overwhelmed, coupled with getting less sleep I found that I was starting to forget to do things until the last minute, which is very out of character. I find writing a To Do list quite cathartic and am using magic white board paper on the wall to write things down as well as using a To Do List book and a daily ‘plan of attack’ to make sure I prioritise every day. I find the discipline hard but rewarding when I do it.

I’m hoping that by putting in place these simple changes I’ll stay resilient; passionate; achieve more in my working day and have a greater sense of wellbeing. I’m starting to see the shoots of improvement and I’m encouraged to stick with it for now.

I hope you’ll stay focussed with me in 2017!

 

About the author

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

Sarah’s blog was nominated in 2016 for a UK Blog Award – healthcare

Sarah is passionate about getting more love into the workplace which was the theme of her 2016 blog series and nominated for the UK Blog Award

Standard
%d bloggers like this: