Leading across Systems : More Facing-Out, Less Fitting-In

Over the past 18 months, our Impact4Health team has worked with several hundred leaders, practitioners and clinicians from health and social care communities to build shared understanding, skills and confidence to lead the sustainable transformation of care across organisational boundaries.

In some cases, these groups have been existing leadership teams, such as an STP executive/ senior leadership group across an STP footprint, a joint executive team leading several separate CCGs or the leadership team of a region’s Clinical Senate & Networks.

We have also done this work with networks of OD leads across geographical patches, to enhance their awareness and capability to support systems leadership development in their local areas.

In other places, we have brought together individuals and teams to jointly explore how to balance  the need for day-to-day ‘survival’ with the quest for fundamental shifts in the way we lead and co-create care.

In the coming weeks, I will be blogging about what we are learning from our Systems Leadership work in the health and social care setting.

I hope this might trigger new insights, prompt practical action and stimulate creative work.

Some of our observations are not easy to read (or write…..). They might be viewed as controversial, overly-critical or downright simplistic. Yet controversy gets people talking, criticality is not intended as criticism and there is arguably enough complexity already.

In highlighting our reflections, I am not sniping from the sidelines. Quite enough of that goes on already. I want to help, not hinder.

So I will state quite clearly now: I admire all of you who choose to work in service of the public. I take my hat off (a sunhat today – hip hip hip hooray!) to everyone who navigates institutional and organisational life on a daily basis. Whilst I choose not to do it, I immensely respect those of you who do.

As a partner in our system of public care for over 20 years, I am constantly humbled, inspired and left in awe by your dedication, commitment and tenacity.

I also find myself inwardly (not outwardly, I hope!) squirming with frustration, speechless with amazement and hopping around with impatience as I observe the way so much of the workforce  - at all levels - has become conditioned to think and behave according to norm rather than exception.

Part of me is not surprised by this. Organisational and social norms make conformity the 'safest' response, enabling us to 'fit in'. However, 'fitting in' to the existing system of care is what staff, patients and organisational leaders have had to do for too long. And there is still massive pressure to do so,  despite the 'let's transform care' narrative.

To transform and sustain our public services, I believe we need more exception and less norm; more facing-out and less fitting-in. Only by breaking patterns of habitual thinking, acting and leading in our work can we co-create a new exceptional norm, suited to the times we live in. 

In the blogs to follow, I look forward to sharing practical examples, and inquiring into how we can continue to create new 'exceptional norms' in our leadership across systems of care. In the meantime, please share any ideas, insights and responses which may help illuminate this conundrum!