System leadership

More than 100 guests joined GGI’s latest monthly breakfast webinar to take part in a discussion about system leadership.

The guest speaker at GGI’s breakfast webinar about system leadership was Richard Kirby, chief executive of Birmingham Community Health Care (BCHC), who has over 20 years’ experience of NHS leadership, including working on new models of care at Sandwell and West Birmingham, and at Walsall Healthcare NHS Trust, where he led the integration of hospital and community care health services.

The discussion included sharing insights and learnings on:

• how to assess how adaptable your board is
• how to build system relationships
• how to balance competing statutory obligations (e.g. NHS trust vs integrated care board).

How to assess how adaptable your board is

There's a saying that practice makes perfect, but if you practise the wrong things, then practice doesn't make perfect, it actually reinforces imperfect.

In the context of board and team and leadership development, it's really important to ensure what we're doing to improve ourselves is consistent with that chaotic and complex environment we're operating in. This means not only adapting leadership styles, but also adapting our means of improvement and our means of being relevant within that environment.

To assess how adaptable your board is, consider these questions:

1. In your board environments, how outward looking are you? How much time do you spend considering the world around you?
2. How adaptable is your board? How willing and able is it to adapt to change?
3. Are you practising the right kind of skills, the right kind of outlook in your board development activities? Are you looking towards analysis and anticipation of the environment and how it's going to affect your organisation? Are you using skills like influence, empathy, narrative, to create a different way of operating?

Beyond the board, how are you championing the principles of adaptive leadership across the system and organisations? Key levers include how leaders are recognised and rewarded – including, but not limited to, financially – how they are developed, and how they are recruited.

How to build system relationships

Lessons learned on building system relationships from BCHC and the discussion contributions from other organisations include:

• Be broad and inclusive: For example, the journey to building a primary and community care collaborative for the Birmingham and Solihull ICS, of which BCHC is a member, involved bringing together 36 primary care networks, 200-plus practices, adult social care providers, community health service providers, community mental health teams and local voluntary sector providers in Birmingham and Solihull.
• Move slow to go fast: When working with multi-organisation multi-disciplinary models, you need the right relationships between the partners and the right levels of confidence before setting out the plan for the future. It is important to take time to understand and appreciate that the way GP practices work is fundamentally different from the way NHS trusts work, which is fundamentally different from the way local authority social care partners work. And it's different again in the relationship with the voluntary and the community sector.
• Ensure equality in relationships: System leadership can be compared to a starling murmuration. The bird at the front isn't the bird at the front all the time. The birds weren't sat down and given a role or their plan for the day, but they have common goals, they have their instincts, they have the same sort of responses to threats and attractors. They know a few basic rules about not flying into each other and keeping a certain distance and responding to what goes on around them. This is analogous for quite a lot of the behaviours we need to show in systems: being really clear about what our goals are, a common narrative, creating sets of values, giving autonomy to the individual actors so they actually are able to sense and respond.
• Shape a shared purpose (which helps enable difficult conversations): “What will hold something like this collaborative together isn't, in the end, the structures we build, though it will be important to get those right. What will hold us together, what enables us to have difficult conversations at the moment when we're trying to work things out, is the sense that we are steadily building a sufficiently strong shared purpose to carry this through.”
• Evolve as you grow: The right structures and governance will evolve as organisations and systems develop and may well need to adapt and change.
• Have humility in citizen engagement and work with local authorities: Moving beyond service user groups and the models for hearing feedback. “We are only just at the beginning of what I hope will be a serious and productive conversation about how we bring citizens into the design of the services that we aim to provide through the collaborative. We're relying heavily on some really good work that Birmingham City Council in particular has done with its approach to working with community.”
• Demonstrate how you are making a difference: Can you show that through developing the kind of leadership we've been talking about, we can make a bigger difference for the citizens we’re here to serve? “In the end, if we can't do that, then it's all just so much hot air, isn't it?”
• Leave egos at the door: Effective systems don’t revolve around the assumed hierarchies that traditional organisations do. The interrelationships in effective systems are functional and designed to achieve objectives – just as in nature. The queen bee has a clear role and contribution to make to the hive and status is a mere by-product.

How to balance competing statutory obligations

Several examples were cited of NHS trusts and foundation trusts being asked to stretch services, e.g. in-patient beds, which were already under pressure and short-staffed. For many, this last winter was the first significant example of how teams had been asked to benefit the system in a way that didn’t directly benefit them. Key lessons for gaining support included:

• Facilitate frank conversations: clinicians need to feel able to express clearly how much pressure they are under and how much further additional requests would stretch them.
• Seek constructive challenge: searching and appropriate questions from the non-executives about whether the balance is right, helps to stress test options and build confidence.
• Address safety: be precise about the measures that would be put in place to make services as safe as possible.
• Limit the time periods: be clear about how quickly services could be stepped back down – colleagues were nervous that they would find themselves in a place where most of the things that were put in place for the winter then became permanent.
• Conduct robust impact assessments: learn which ‘leaps of faith’ were justified and learn how approaches could be adapted for following winters.

If you would like to find out more about any of these discussions, contact us now.