Last year I was asked to be the Guest Editor for the journal Perspectives in Public Health. I choose the topic of innovation; but not in the sense of new technology, but instead how people work together in innovative ways; focusing on behaviours and attitudes in a culture of increased complexity and ambiguity.
I asked a friend of mine, Linda Holbeche, if she might like to contribute a paper on the subject of leadership. Linda is an expert on the subject and I felt that she would have something valuable to say. Linda indeed submitted a paper; it worked its way through the peer review process and finally appeared in the special edition in May 2011.
The paper focused on how GPs (ie family doctors) were to work together in consortia in light of the emerging ideas around the Health and Social Care Bill, particularly in commissioning services. A year later with the imminent accent of the Bill into law I went back to Linda’s paper to see how things had changed.
Linda identified that in an environment which is more ambiguous and fast changing the focus should be less on establishing rigid formal structures and more on building lasting relationships between people, ensuring that governance structures were an enabler to this as opposed to a constraint to action. Leadership will need to focus on how people make sense of the emerging reality as opposed to forming “grand plans” of the future which will never materialise; here Linda states:
The process of sense making is becoming a core competence [of leadership] since it provides an approach to dealing with unpredictability and the impetus to respond effectively to the environment. For … sense making is the ability to decide what information to heed, what to ignore, and how to organize and communicate that which we judge to be important. Therefore the skill of synthesis is particularly crucial for leaders and reflexivity is key to strategic action. (p135).
So how have things changed? The one thing that I am hearing from many people in health is this: people are now talking to each other; GPs are talking with hospital doctors and managers with doctors. Not only has the intensity of those conversations increased so have the networks. That can only be a good thing as long as those conversations are focused on delivering better health and social care.
In a recent talk by Mike Farrar, the CEO of the NHS Confederation; he stated that there needed to be a greater focus on:
- How people manage the wider context (or ecology of the health system) and not just what happens in their own organisations.
- Becoming emotionally understanding of what happens, and not just fighting battles with logic.
- Actually thinking things through, particularly with the demise of Strategic Health Authorities to tell them what to do.
- Recognise that many of the improvements are to be found at the ‘boundaries’ between and within organisations; requiring dialogue and joint working to realise those benefits.
- Boldness, and ‘speaking truth to power’.
If the benefits of the new Bill are to be realised, then the increasing intensity of conversations need to be shaped around a different idea of leadership. It is here that Linda’s article has something valuable to say in order to build on some encouraging first steps.
Ref: Holbeche, L (2011) , GP consortia: navigating ambiguity to produce greater public value?, Perspectives in Public Health, Vol 13, No 3, p131-136