The mental demands of leadership in complex adaptive systems

The impact of cognitive biases, mental models, and mindsets on leadership and change in the health system

Understanding how cognitive biases, mental models, and mindsets impact leadership in health systems is essential. This article supports the notion of cognitive biases as flawed thinking or cognitive traps which negatively influence leadership. Mental models that do not fit with current evidence limit our ability to comprehend and respond to system issues. Resulting mindsets affect cognition, behaviour, and decision-making. Metacognition is critical. The wicked problems in today's complex health system require leaders and everyone involved to elevate their personal, organizational, and disciplinary perspectives to a systems level. Three examples of mental models/mindsets are reviewed. They do not change simply because we wish or will them to. The first step is being aware of what they are and how they impact our thinking and decision-making. Some tips for managing these traps are offered as examples of how to challenge our leadership approach in the health system.

The Improving Global Health Programme - leadership development in the NHS through overseas placement

The Improving Global Health (IGH) programme develops leadership capacity within the National Health Service (NHS) in a novel way. NHS employees collaboratively run quality improvement projects within organisations in low-income and middle-income countries with whom long-standing healthcare partnerships have been built. Leadership behaviours are developed through theoretical and experiential learning, alongside induction and mentorship. The health systems of overseas partners are strengthened through projects that align with local priorities. This article develops solutions to two main problems: how reciprocal global health programmes can be designed and how global health programmes based in leadership can attract women and black and minority ethnic groups into leadership. The outcomes of both sides of the IGH programme are described here. The overseas perspective is described using the reflections of two current partners, highlighting improvements in the local healthcare system and demonstrating growth in local team members. The UK perspective is evaluated using two surveys sent to different groups of returned IGH participants. Leadership, global health and quality improvement skills improve, having a significant and long-lasting impact on career trajectory. The IGH programme is attracting women and black and minority ethnic groups into leadership. Through collaboration and reciprocity, the IGH programme is developing a new cadre of NHS leader that is diverse and inclusive. The use of long-standing healthcare partnerships ensures that learning is shared and growth is mutual, creating development within the overseas and UK partner alike.

A qualitative analysis of vertical leadership development amongst NHS health-care workers in low to middle income country settings

PURPOSE

The improving global health (IGH) programme is a leadership development programme that aims to develop leadership skills and behaviours alongside quality improvement methodology in National Health Service (NHS) employees in a global health setting. Through collaboration, experiential learning and mentorship, the programme aims to produce both vertical and horizontal leadership development in its participants. This paper aims to describe the programme and its impact, in terms of leadership development, in a sample of participants.

DESIGN/METHODOLOGY/APPROACH

Open coding and thematic analysis of leadership development summaries (LDS) completed by 39 returned IGH participants were conducted. LDS are written on completion of the overseas placement; participants reflect on their personal leadership development against the nine dimensions of the NHS Healthcare Leadership Model (2013).

FINDINGS

These IGH programme participants have reported a change in the way they think, behave and see the world. A development in sense of self and experience in developing team members are the two most commonly reported themes. Adaptability, communication, overcoming boundaries, collaborative working, "big picture" thinking and strategic thinking were also identified.

RESEARCH LIMITATIONS/IMPLICATIONS

The study is limited by the relatively low number of completed LDS. More work is needed to understand the long-term effect of this type of leadership development on the NHS. Other leadership development programmes should consider focussing on vertical and horizontal leadership development.

ORIGINALITY/VALUE

This more granular understanding of the leadership skills and behaviours developed and how it is the programme's design that creates it, has not previously been described.

Organizational change and everyday health system resilience: Lessons from Cape Town, South Africa

This paper reports a study from Cape Town, South Africa, that tested an existing framework of everyday health system resilience (EHSR) in examining how a local health system responded to the chronic stress of large-scale organizational change. Over two years (2017–18), through cycles of action-learning involving local managers and researchers, the authorial team tracked the stress experienced, the response strategies implemented and their consequences. The paper considers how a set of micro-governance interventions and mid-level leadership practices supported responses to stress whilst nurturing organizational resilience capacities. Data collection involved observation, in-depth interviews and analysis of meeting minutes and secondary data. Data analysis included iterative synthesis and validation processes. The paper offers five sets of insights that add to the limited empirical health system resilience literature: 1) resilience is a process not an end-state; 2) resilience strategies are deployed in combination rather than linearly, after each other; 3) three sets of organizational resilience capacities work together to support collective problem-solving and action entailed in EHSR; 4) these capacities can be nurtured by mid-level managers’ leadership practices and simple adaptations of routine organizational processes, such as meetings; 5) central level actions must nurture EHSR by enabling the leadership practices and micro-governance processes entailed in everyday decision-making.

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Resilience to chronic stress will prepare health systems to face acute shocks.

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Collective problem-solving and sensemaking enable everyday resilience.

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Distributed leadership, feeling safe and reflective practice are key processes.

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New forms of health system strengthening are needed to nurture resilience.