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​Having recently returned home to England from a nine-year stint across the pond, I've spent the last few months reading articles, asking questions and drawing diagrams. 

There are lots of different styles of clinical leadership, for example transactional, transformational or situational. There are also lots of roles undertaken by clinical leaders, such as medical director, chief clinical information officer or chief nurse at a clinical commissioning group.​

The joy I had in my work in the 1980s caused me to create Buurtzorg in 2007. We now employ 14,000 people in Holland, and are expanding across the world – including in the UK. The government came to play an important part in our growth in Holland, but not by accident. 

Picture, if you will, a typical range of people using NHS services. Who do you see? Perhaps a frail older person, a new mother, an anxious adolescent, an overweight middle-aged man. We can all come up with our own range of stereotypes.

My grandfather was one of the first NHS surgeons, becoming a consultant ophthalmologist in North Wales in 1948; my father was a consultant physician from the early 1970s. And I'm a consultant of sorts at Kaleidoscope, which is not part of the NHS but functions, we hope, as a benign disruptor in its ecosystem. 

What drives successful (and sustainable) system change? This won't stop being a relevant and compelling question. We should perhaps acknowledge though that, at least in terms of healthcare, we have a prevailing orthodoxy - that top down, mandated and performance managed changed is the default method.

I haven’t always loved being a doctor. Too often during my training, I left work wondering how I could drum up the enthusiasm needed to return to work the next morning. Long hours on call, constantly rotating to new wards and clinics, and the sense of futility I felt was intense.

We at the Stroke Association are boldly pro-reconfiguration. As an organisation representing over a million stroke survivors and advocating for the best possible treatment and care, how could we be anything else? 

Stroke is not the same as cancer. Maternity services are not the same as psychological therapies. But is there learning to be gained from thinking about how system change happening in one clinical area could be transferred to others? 

Dr Angus Ramsay looks at the learnings from our recent webinars on the reconfiguration of stroke services, where we had wide-ranging discussions of key aspects of major system change.