Belinda Weir

By Belinda Weir, Director of Leadership, Health Services Management Centre

How many ties, spanners and babel fish does it take to change a system? No. it’s not a joke but a real question, about how we develop system leadership. The concept of systems leadership is not new, but has gained rapid momentum in recent years, in response to the unprecedented challenges facing the public sector.

Systems leadership is often seen as an answer – if not, the answer - to the need to lead across organisational boundaries whilst balancing the competing priorities of financial austerity, and rising demand for care.

Systems leadership -  the product of multiple interactions within a health and social care system - is not confined to a formal managerial role but emerges. As situations change, different people or agencies may come to the fore to lead by virtue of their specific skills and experience. Systems therefore require leaders who are adept at handling complex and ‘wicked’ problems, able to influence change, and to support the emergence of people with influence at different places in the system.

At HSMC we have been working to develop system leadership capability in the NHS for several years. We have also evaluated different approaches to this way of working, distilling what it is that defines ‘good systems leadership’ and exploring the development support required.

The key message is that there is no single recipe or template. Our experience has taught us that effective systems leadership is fundamentally contextual and has to be grounded in a deep understanding of the local environment.
There are however common threads that we and others have identified as essential elements and that we include in our leadership programmes:

  • Systems thinking and the ability to understand – even enjoy! – complexity and ambiguity;
  • Valuing diversity and making the most of the differences that disparate voices bring to the table;
  • The constructive management of conflict;
  • The ability to tell stories which engage and compel change; and
  • The capacity to make rapid and wide connections across the health and care system

Nevertheless, research also suggests a need to pay particular attention to weak ties - the loose connections formed across and between organisations and teams. When leaders intentionally build connections using weak ties, they are exposed to new ideas, different ways of thinking and can develop creative approaches to complex problems.  Both strong and weak ties are important in the development of effective systems leadership but arguably we have focused heavily on the importance of strong and formal ties – such as inter-professional team-based working and complex new governance structures – and lost sight of the value to be gained through developing weak ties.

Despite best efforts, health and care services too often continue to be provided by leaders working in professional or organisational silos, meaning that the synergies of integrated working fail to materialise. The reasons for these failures of systems leadership are complex and not confined to the lack of weak ties. For a start, not everyone can (or wants to) work flexibly across boundaries and it can be lonely to try and lead in the interstitial spaces between organisations and groups.

At HSMC we have been supporting  systems leaders to operate comfortably at the margins of organisations, professions and teams. We have observed that the leaders most comfortable operating outside group boundaries and identities are often people who have worked in different parts of the health and care system and may not have strong allegiances to specific professional or team identities, acting instead as boundary spanners and translators – the babel fish of leadership perhaps.

Lord Victor Adebowale, in his conversations with system leaders on our masterclass programme, talked about “… individuals, of no specific organisation or level, who are able to talk the language of both sides.”  These babel fish leaders can communicate across barriers – language, structural and social - enabling systems to develop shared narratives of change. Working with babel fish leaders can be challenging, for by definition they are not motivated by belonging to a particular group or profession, and their existence can threaten the strong ties that high-performing teams develop through having a shared purpose and team identity. However if we acknowledge translation and communication across barriers – language, professional and organisational – as an essential component of systems leadership, the role of babel fish leaders is undeniably critical. In our systems leadership development programmes we therefore focus on helping teams understand and build weak ties, seeking to develop leaders who can be both spanners and babel fish. How many weak ties, spanners and babel fish does it take to build a system? It depends on the system, but all are essential.