What does it mean to lead across a system?
In December, we welcomed NHS leaders from across the North West to the Barnes Wallis Building, Manchester for our latest masterclass, in collaboration with AQuA, MIAA and ADASS. The event provided a safe, reflective space for three recognised leadership experts to share their different stories about what they have learned as they have led across systems.
Opening the day, Elizabeth Bradbury, Director, AQuA welcomed speakers to share their personal perspective in order to share some of the highs and lows associated with the challenges of creating place based models of care - exposed to common themes, behaviours and skill sets which maximise effective system leadership.
What kind of leader is required to embed quality improvement?
Elaine Mead, Chief Executive, NHS Highland, a passionate NHS leader and innovation expert shared her unique story about integrated care in the Highlands and how the organisation has improved health and social care and created a quality improvement culture with The Highland Quality Approach (HQA).
NHS Highland is the largest health board in Scotland and faces the challenge of an aging population and fragile healthcare services. The HQA strategy focuses on people, quality and care, inspired by John Kotter’s Eight Steps to Successful Change. The HQA applies a Lean model, integrating management and providing value to patients and service users; “chasing after waste” to provide high quality care at a lower cost. Elaine described how they learned from the Virginia Mason Institute in Seattle, along with Boeing and Toyota, and explored how this could work in an NHS healthcare setting. Leaders were trained in rapid process improvement, to lead by example across projects and fostering links between small project groups and the organisational hierarchy.
Elaine emphasised the focus on the organisation knowing ‘why’ they were doing what they were doing; creating a clear connection between NHS Highland’s vision and where teams focus their efforts. “Leaders may think they are saying the right things but the message can be lost in translation”.
“Go see, ask why, show respect” Toyota Chairman Fujio Cho
Elaine encouraged attendees in the room to go out and learn from their teams; to “go to the gemba” and empower staff by engaging them in problem solving and creating a culture where it is ok to share issues. Leaders at NHS Highland are out in their teams and working with them to understand what needs to be done; ‘From the Board…to the floor’, creating a personal face to face relationship. Every Board meeting includes staff coming to present; sharing results, issues and receiving support.
Sharing her ingredients for success, Elaine highlighted the importance of creating a circle of safety which then rolls out further into the organisation, allowing people to innovate and be creative; and to seek out and learn from the best examples, celebrating and communicating successes in your organisation and system.
Closing, Elaine thanked her fantastic staff at NHS Highland for making the story possible.
What kind of leader is required to change people’s lives?
The second speaker was Fay Selvan, Chief Executive, The Big Life Group. Fay started work as a social entrepreneur in 1991 and established The Big Life Group in 2002. The purpose of the Big Life Group is to provide a range of initiatives that help people to help themselves. They describe themselves as in the business of changing lives for people who have the least.
As a member of trade union family living in Hulme, once coined the ‘worst housing estate in Europe’, they would talk about social justice around the tea table. Fay’s passion came from an upbringing in inner city poverty that was the strongest community she’d ever known, where people had to take action things for themselves after being let down by public services.
A single parent with a mortgage, Fay decided to give up her job to set up a community centre in a local church. After Fay encountered her first death, a tragic example of how they society had failed to support someone who wanted to change their life, she turned system failures and despair into passionate, pioneering work that made a difference to the way in which drug services were delivered.
This work resulted in a theory of change for the organisation.
- The Big Problem: disparate local services focused on single issues and not the whole person. Which creates challenges in how people receive disparate services, focusing on single issues not the whole person
- The Big Life Way: starting where people are at and helping them get to where they want to be. Using the Big Life Way people have the tools to help themselves and feel empowered
When exploring culture, Fay believes that hierarchy stops innovation happening and spends her time enhancing staff work life and in developing an inclusive workforce to improve culture. The results of this can be found in the staff survey where 95% of staff felt their role makes a difference.
Next Fay shared how staying true to your leadership values can change lives, even in the face of adversity. She told a story of Big Issue in the North, where a high number of sellers are Romanian and Bulgarian. The public didn’t buy from them because they were immigrants, income dropped and they were excluded from services. The Big Life group defended their right to sell the Big Issue and address issues of community cohesion. The Big Life Group trained up ‘guides’ in the Roma community so they could educate others how to access services, from putting bins out to what a health visitor is, and within 2 years community cohesion improved.
Lastly, Fay believes that you need to be prepared to take risk yourself and for your organisation. The Big Life Group ran a free school programme. They didn’t know about education but they knew about communities. They found a head teacher and she took a leap of faith and they built a school. To do this you have to love what you do.
Fay gave a truly inspirational presentation and had different lens on some of the system changes that we are trying to make across health and social care in working with local communities.
What kind of leader is required to achieve excellence across a system?
The final speaker was Jim Mackey, Chief Executive, Northumbria Healthcare NHS Foundation Trust and former Chief Executive at NHS Improvement.
Northumbria Healthcare covers a large area from Berwick down to Hexham, and employs over 10,000 staff. Jim explained the impact of services on employment in the area. “Population is our family”. The North East is high performing region with 3 provider trusts rated ‘outstanding’ and a long record of quality. Jim puts this down to North East passion and robustness!
Jim explored the many acronyms and definitions for what we mean by system e.g STP, ICS, Devolution and talked importantly about what a system should not be. System working should not mean added complexity or confusion of accountability, or planning in a dark room. System working should be about the patient/citizen. Systems should support; they cannot replace institutions.
Public do not perceive, understand or care about the complexity of our ‘system’ – “it’s all NHS”.
In Northumbria they have put a focus on patients/citizens, quality, relationships and behaviours. It is important to carve out time to talk and spend time with people. They have also invested in leadership development and OD, with 2018 seeing the 21st year of Northumbria Healthcare’s whole system leadership programme bringing together leaders in trusts, primary care, pharmacy, and more.
Jim reflected on his personal experience as a Chief Executive – there are some things that only he can do. He echoed the importance of humility, and described how he has developed his ways of working to be able to get out and engage with real people. He has learned how to manage himself and his preferences as an introvert; accessing the support of a coach. In system working he advises to look for points of agreement that can move you forward, not disagreement. You need to try hard and it takes time.
After a question and answers session with the panel of experts, Dianne Mardell, Associate Director of Portfolios, NHS NWLA, closed the session reflecting on the stories from different leaders in different systems, and how their lessons were common in terms of the focus on our citizens and the importance of relationships for effective leadership and how we take that back to our workplace and embed in our own system leadership journey.
The collaborative are currently working on a new masterclass series for 2019/20, watch this space.
Find out more about our collaborative masterclass series.
To explore development opportunities coming up in the North West, go to What's On.