The future of health system leadership

Systems leadership: how chief executives manage tension between organisation and system pressures

Aim

System leadership is the requirement for a leader of a single organisation to operate on behalf of a wider system, rather than their individual organisation. The current policy landscape does not incentivise system leadership, as many national structures emphasise a focus on individual organisations. This study aims to understand how chief executives in the National Health Service (NHS) in England implement system leadership in practice when faced with decisions that benefit the system to the detriment of their own trust.

Methodology

Semistructured interviews were conducted with ten chief executives from various NHS trust types to understand their perceptions and decision-making process in practice. Semantic thematic analysis was used to draw out themes in relation to how chief executives approach decisions which weigh up the system and organisation.

Results

Interviewees expressed advantages (such as support in managing demand) and disadvantages (such as increased bureaucracy) of system leadership and practical considerations in operationalisation (such as the importance of interpersonal relationships). Interviewees endorsed system leadership in principle, but did not feel that current organisational incentives support the implementation of system leadership in practice. However, this was not seen as a major challenge or impediment to effective leadership.

Conclusion

As a specific policy area, a direct focus on systems leadership is not necessarily helpful. Chief executives should be supported to make decisions in a complex environment, without a specific focus on healthcare systems as a unit of operation.

System wide collaboration? Health and social care leaders’ perspectives on working across boundaries

Purpose

Structural integration is increasingly explored as a means of achieving efficiency gains alongside improved health outcomes. In 2015, three boroughs in London, England began working together to develop an Accountable Care Organisation for the 750,000 population they serve. The purpose of this paper is to understand the experiences of working across organisational and sectoral boundaries for the benefit of the population, including enablers and barriers encountered, the role of financial incentives and perspectives on Accountable Care Organisations.

Design/methodology/approach

A single site instrumental case study involving 35 semi-structured interviews using a topic guide, with key leaders and decision makers from the site and nationally, between April 2016 and August 2016.

Findings

There are differences in levels of autonomy and operational priorities between councils and the NHS. Existing financial mechanisms can be used to overcome sectoral boundaries, but require strong leadership to implement. There are challenges associated with primary care participating in integration, including reluctance for small organisations to adopt the risk associated with large scale programmes. Interviewees were aligned on espoused ambitions for the Accountable Care Organisation but not on whether one organisation was needed to deliver these in practice.

Research limitations/implications

Progressing the integration agenda requires consideration of the context of primary care and the core differences between health and government. Further, research into ACOs is required as they may not be required to deliver the anticipated integration and system outcomes. Understanding if there are specific population groups for whom cross-organisation and cross-sector working could have particular benefits would help to target efforts.

Originality/value

This paper highlights some of the challenges associated with cross-sector collaboration.

Leadership mindset in mental health

OBJECTIVES

The objective of this study was to explore the concept of mindset for psychiatrists who are considering stepping into the leadership arena.

METHODS

Qualitative themes were extracted from dialogue on leadership development at a Royal Australian and New Zealand College of Psychiatrists forum for early career psychiatrists.

RESULTS

Three key themes were identified: adapting to a professional identity as psychiatrists; developing a mindset for leadership; and acting intentionally to seek opportunities for leadership.

CONCLUSIONS

Shifts in professional identity occur in the transition from trainee to specialist as early career psychiatrists become increasingly aware of broad systemic factors in clinical care. The concept of a mindset, distinct from a skillset of knowledge and expertise, may be an emergent quality for psychiatrists who are seeking to develop their leadership potential.

Supporting and driving trainee-led leadership

Medical leadership saves lives. Hospitals with high levels of medical engagement, where all doctors are actively involved in management, leadership and service improvement, have better outcomes. Leadership competencies are not only required by senior clinicians and trainees who aspire to positional leadership roles. From the moment they step onto the wards, all trainee doctors require a range of leadership and management competencies; however, trainee leadership capability remains an undervalued resource in the NHS. The rotation of trainees provides them with unique insights into healthcare systems, and with many challenges facing the NHS and trainees responsible for so much front-line clinical activity, all trainees must be engaged in leadership. The health system must engage and support trainees in leadership development, so trainees take responsibility for driving the quality and safety agenda and demonstrate leadership in transforming services. There is a need to professionalise medical leadership and attract trainees to leadership as an investment in the future of the NHS.