Leadership and the Integrated Care System.
Integrated care systems (ICS) are fragile and still developing. The five year forward view (FYFV) gave system leaders a broad direction of travel but did not deliver the detail required for implementation.
The key to successful implementation and development of Integrated Care systems is robust system leadership.
Leaders of the system need to give their followership a vison and reason for being participants in the development of new models of care and this can only be achieved by developing trust, but progress only occurs at the speed of trust and when bringing together mighty systems, trust is most often the missing ingredient.
There has to be a joint vision and purpose as we develop this new way of delivering care for our populations with the starting point being an agreed purpose.
The most successful companies sell their products to us from the inside out, that is the “WHY”. If you consider “Apple” as an example, they tell us about why they are here not what their products do. They have a sustainable purpose, to give us, the consumer, products that make our lives easier. They are here to make lives better through quality products that meet our needs in a demanding and high-pressured world. You will rarely hear or see companies like Apple selling the latest speed of the technology, or the size of the memory, no, it’s all about the purpose of the company and the impact they want to have on our lives.
Simon Senik talks about the “Golden Circle” the “Why” first, the “How” second and the “What” last. Most organisations work from the outside of the circle to its centre. That is the “What’s it all about” first, what can this product do for you, rather than telling us why they are here, forgetting about the very thing that we all buy into, the Purpose. Have a look at Simon Senik here: https://www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action
Leaders in the NHS need to create the same purpose and vision for both system users, patients and employees.
The starting point for each of the ICS’s, is very different as is their size and complexity but ultimately, they all have to work on their governance structures as well as how they are going to change the service model. Most importantly, they have to sell the purpose and the vision.
Leadership remains the key to the success of this process.
In a recent paper published by the Kings Fund, it suggests that in “order to achieve success, organisational leaders will need to surrender some of their autonomy in pursuit of the greater good of the populations they collectively serve, and national leaders to act urgently to enable systems of care to evolve rapidly”. (C.Ham. H. Alderwick. Place based systems of care, A way forward for NHS England. November 2015). https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/Place-based-systems-of-care-Kings-Fund-Nov-2015_0.pdf
At the Kings Fund summit just this week, Chris Ham Said “Integrated Care Systems” are writing the manuscript. To sum it up, there is no user manual or instructions as to how these new integrated systems are going to work, they are having to make it up and they will all be different, as the essence of this new way of working is population and place-based health care.
There seems to be agreement on five key principles to developing robust system leadership:
- Develop a shared purpose and vision. (The Why)
- Frequent personal contact- walk the floor, go to gemba. As a philosophy, Gemba is a reminder to managers of all levels that sitting in an office isolates them from ‘real’ processes and work. In Gemba there is a drive for management & leaders to stay connected with the shop floor (the place where the real action occurs. (Taken from the philosophy of Lean 6 sigma)
- Surface and resolve conflict.
- Behave altruistically towards each other.
- Commit to working together for the long term.
As we move forward with the development of ICS, the leaders of the NHS and we as followers, will need to embrace change and new ways of working. We will have to find “New Cheese” and in order to do that, the organisational leadership will have to embrace innovation and work to integrate systems, people and resources for the longer term.
This will undoubtedly leave some feeling betrayed.
Ronald Heifetz talks about “One person’s innovation can cause another person to feel incompetent, betrayed or irrelevant, not many people like to be “rearranged”. Leadership, therefore requires the diagnostic ability to recognise those losses and the predicable defensive patterns of response that operate at the individual and systemic level. (Heifetz, R (1992). The practice of Adaptive leadership. (1st edition ed.). United States of America: Harvard Business Review Press).
None of this is easy but the NHS has Ordinary People that Achieve Extraordinary Results Always, therefore lets makes this an OPERA moment and not a BOHICA moment!