Strategy across a health and care system: five things I learned

This week I had the pleasure of joining a juicy discussion on the sometimes dry topic of strategy in health and care systems. The words “hour-long, Teams talk about strategy in healthcare systems” do not fill me with joyful expectation. But this was joyful. My Kaleidoscope colleagues Rich Taunt and George Dellal focussed on the central components of good strategy: participation, connection and relationships.

Collaboration across systems is widely seen as the best way to make populations healthier without bankrupting taxpayers. But systems are complex, and behave in very different ways to single organisations. So what’s the role of a ‘system strategy’ to help people work together? And how can they be designed to deliver real change rather than empty promises?

The speakers, Adrian Hayter, Samira Ben Omar, and Rob Webster reminded us of the need to take time. Build relationships within teams, across system partners and with the communities that are often neglected when we talk about systems.

Here are the five things I think are key for all of us trying to enable system effectiveness:

1. Cynicism is not a helpful leadership mindset

The ICS model of developing systems is different to what has gone before. A stance that says ‘this is just the latest [insert historic three letter acronym of your choice here]’ and it will soon be replaced by another is part of the problem.

Leadership of systems requires a focus on helping people find ways to participate hopefully and with optimism, whatever organisation or identity they come with. “Informed optimism doesn’t mean you only look on the bright side. It means you don’t overlook the bright side”, as Adam Grant said.

That starts with finding (not assuming) common purpose and points of agreement, a step that is often missing. Developing strategy in a way that starts with listening, dialogue and a focus on possibility is essential to progress.

2. We are the ‘system’ (and people need help to take that stance)

We are all part of the system. In the session we heard that system strategy is about creating the conditions where people can see and feel their part and can be activated to participate.

Part of this is about recognising the importance of identity and the safety that home organisations provide and allowing people to work out what enables them to step beyond, see and connect to the whole.

We heard a lovely example of an acute Trust giving over budget to address a workforce challenge in care homes, recognising the impact a loss of staff there could have on the hospital challenges. This is where a opportunity lies.

Informed optimism doesn’t mean you only look on the bright side. It means you don’t overlook the bright side

3. Communities as system partners (and leaders!)

So often in health and care strategy processes, communities are broken down into a set of needs, done to or for rather than with. What if we see them as a set of assets to be activated, maybe even, as Samira said, being seen as an extended workforce.

Good system strategy pays attention to both and finds ways to bring communities into dialogue about the development process and considers the part communities can play in enabling the change that the strategy calls for. And not entirely unrelated…

4. Building relationships is real work

In order to realise the potential in systems we need to take the time to create the relationship that allow for bravery, questioning of deep beliefs and the kind of critical thinking that moves us from tweaking what is, to more radical redesign towards what could be. That takes time and space and will often be met with the ‘but what are you doing” challenge. The answer, as Rob Webster told us, is the real work that makes change possible.

5. We may need to focus a little more on the ‘how’ than the ‘what’

All of this makes me think of something that comes up a lot in Kaleidoscope’s work on strategy development. It is often easier, when working on strategy, for a small group of very smart people to lock themselves away and develop a compelling sounding set of aspirational goals than to do the messy work of building the direction, alignment, commitment and participation of the people that will make things happen (or not).

I am still feeling the warm glow of possibility. We love helping people, organisations and systems with this stuff and we are here to help, if you want to have a chat please do get in touch.

If you want to catch up with the event, here is the playlist with the full event and video highlights.