Where do we want to get to?
What is our vision for system-wide clinical and professional leadership?
Effective clinical and professional leadership is a key component of effective system change. Without system-wide leadership capacity and capability, the potential of an Integrated care system cannot be met.
Our vision for clinical and professional leadership is for a vibrant community of leaders working across boundaries all over south-east London, with clinical and professional expertise at the centre of how the Integrated care system makes decisions.
Why does system-wide clinical and professional leadership need support?
While there are many existing skills organisational leaders can draw on, successful clinical and professional leadership across a system will not happen by relying on past skills alone.
There are a range of ways in which successful system-wide leadership differs to organisational leadership; for example system-wide leadership involves a very different concept of ‘team’ compared to organisations, with individuals being asked to lead across multiple boundaries, professions, and cultures.
Across the system, we are currently spending lots of time on system-wide leadership functions (in the region of 100 days a week), yet have yet to put in place the support we need to make the most effective use of this time.
Appropriate support is needed to help leaders adapt to – and flourish in – system-wide leadership roles. This support comes at three levels across south-east London:
- Supporting clinical and professional leaders in their formal system-leadership roles – Time formally set aside and resourced for activity across south-east London, with the leader thinking primarily about the system rather than a specific organisation. For example, clinical and professional leaders within NHS South East London.
- Supporting clinical and professional leaders in their organisational roles contribute to system-wide work – Time when leaders are representing their specific organisation yet are contributing to system-wide work. For example, attending system-wide meetings.
- Supporting ‘leadership on leadership’ – Time formally set aside and resourced specifically to provide leadership on how the system performs functions (1) and (2).
All leaders who contribute at any of these levels can be thought about constituting a ‘community of clinical and professional leaders’ across south east London. Specific aims at this community level include:
- Culture of learning and improvement – Empowering leaders to develop a system which focuses on learning and quality improvement.
- Breadth and depth of relationships – Fostering and supporting leaders to connect, build relationships and share knowledge across the system.
What type of support is needed?
The mindset shift required for clinical and professional leadership, particularly those already involved in organisational leadership roles, will be different depending on where they come from in the system. GPs for example, particularly those involved in CCG leadership roles, are likely to be more used to focusing on a systems approach than secondary care clinical leaders. To be successful working across a system, clinical and professional leaders will need support to ensure they have:
- Clear purpose and motivation – to lead effectively, leaders need to be intrinsically motivated and connected to a high purpose. This means balancing governance processes with ways we can encourage energy and enthusiasm by giving leaders autonomy to make their own decisions.
- Information – leaders will need access to data, evidence and high-quality analytics so they can develop a deep understanding of the population needs, areas of unwarranted variation, challenges and issues being faced in their place. This will be essential in engaging colleagues within the system to identify the issues that they can work on together to create sustainable change.
- Leadership development – not least so they can identify the type of leadership, tools and techniques that will be required to build relationships across traditional organisational boundaries (and beyond the NHS) and create effective collaboration to address the issues that have been identified.
- Skills and training – beyond leadership development – do clinical leaders have the understanding, skills, and experience to make change happen across an area where management structures are likely to be in a constant state of evolution? This involves both formal quality improvement skills, and realpolitik know-how to get the change made.
- Protected time – particularly formal system-wide leadership roles require protected time and space. This is particularly important for developing a wider set of relationships than required with organisational leadership. We need to build spaces for listening, reflection and coaching, this needs to be protected time to think and formulate ideas away from the day job.
- Mentoring and sharing learning – there needs to be encouragement, resource and senior sponsorship with the permission to try and fail or fly. We need to ensure knowledge sharing across the system, this can be done in a variety of ways, including; the creation of local learning sets or communities of practice to provide peer support and learning, having access to coaching opportunities as individuals and ideally being part of a wider network of leaders so you can learn from the best of what is happening and can support and learn from one another.
- Insights from elsewhere – it is essential for leaders to learn from perspectives outside of their traditional bubble to inform where priorities for the system are, crucially hearing voices from citizens and people with lived experience. Additionally, exposure to learning and leadership outside the NHS can help to understand how challenges are tackled in other sectors.