If you’re involved in health and social care, and particularly if you’re concerned about patient and citizen voice, and improving person-centred care, you’ll be aware of the unprecedented strain that public services are coming under. Hospitals in England are collectively billions of pounds in the red, and adult social care has borne the brunt of cuts in many local authorities. The outcomes are increasingly visible: reduced quality of care; less time for care workers to spend with people in their own homes; more delayed transfers of care; and what amounts to rationing of elective surgery.
Another outcome is that it becomes harder and harder for people who feel ‘on the outside’ to begin with to get their voice heard, or to feel included in change initiatives from the start, rather than being on the receiving end of a consultation. And this isn’t because people don’t want to involve others. When you’re under pressure, or you feel you’re operating in a ‘blame’ culture with little room for manoeuvre, it can feel easier – and familiar - to retreat behind organisational or departmental boundaries; to blame others for what’s happening; or to stop acting altogether and wait for the next instruction from above.
This is exactly the wrong thing to do. We need to do the opposite. We need to come together to find new solutions and change the way we deliver services. This isn’t just a question of money. It’s what patients, service users and carers want – more joined-up services that they can access easily and that fit around their lives.
In other words, we need to find new ways of working – and leading - together.
And we can. This is where Systems Leadership comes in.
Systems Leadership is about how you lead across boundaries – departmental, organisational or sector. It’s how you lead when you’re not in charge, and you need to influence others rather than pull a management lever.
It describes the way you need to work when you face large, complex, difficult and seemingly intractable problems; where you need to juggle multiple uncertainties; where no one person or organisation can find or organise the solution on their own; where everyone is grappling with how to make resources meet demand which is outstripping them; and where the way forward therefore lies in involving as many people’s energies, ideas, talents and expertise as possible.
It recognises that leadership isn’t vested in people simply because of their title or position; that it is possible – indeed, necessary – for leadership to be shared and ceded – and that you can come together on the basis of a shared ambition, and accept partial or clumsy solutions on the way to getting there. Working with uncertainty, and ambiguity, is a given, and it’s expected that people will experiment with different methods and processes as a result.
Systems Leadership is therefore a really useful tool to have in your armoury when you’re working in difficult situations, and when you’re seeking to have your voice heard and get a place at the table.
And we know it works. There’s a body of evidence that shows that these approaches can shift the way people think; how they behave; and what happens on the ground as a result.
This is based on a national Systems Leadership programme, backed by the NHS, public health, local and national government, and social care, that’s been running for the past three years. One of the key aspects of the programme has been on-the-ground Systems Leadership support for people grappling with complex issues around service transformation. This support is now in some 60 places around the country, including in the Health and Social Care Integration pioneers, and many of the projects have seen innovative ways of involving citizens, patients and service users from the start. You can read more about this work in the report The Revolution will be Improvised II, and in the independent evaluation, The Difference that Makes the Difference. There’s also more information at http://www.systemsleadership.org.
Key things to note include:
- service users/citizens must be the centre of the work
- it's about relationships and trust, not structures and hierarchies
- you can start small, and from where you are
- use narratives and framing to change the way people perceive issues
- work with coalitions of the willing
- make connections, form networks and use offline conversations to build support
- look to make progress rather than solving an issue in one fell swoop
And above all, see yourselves as systems leaders, not as passive recipients. There will always be setbacks, and you’ll more often than not have to take the scenic route. But it really is possible to get significant change, and to see people make profound shifts in the way they view citizen involvement and patient voice.