System Leadership - Belinda Weir

Date: 19 May 2016

Author: Belinda Weir, AQuA Affiliate and Director of Leadership and Senior Fellow, Health Services Management
Centre, University of Birmingham/Leadership Associate: The King’s Fund

Definition: The concerted effort of many people working together at different places in the system and at different levels, rather than of single leaders acting unilaterally. Secondly, systems leadership crosses boundaries, both physical and virtual, existing simultaneously in multiple dimensions. It therefore extends individual leaders well beyond the usual limits of their formal responsibilities and authority.” (Virtual Staff College, 2013)

Systems leadership is a challenge to traditional paradigms of heroic organisational leadership. Given the growing complexities of the health and social care environment, traditional theories of leadership are becoming less and less useful. Checkland (1999) shows that systems leadership goes beyond partnering or cooperation: it requires considerably more of system leaders than retaining their individual power and authority whilst working with others. 

In thinking about systems leadership it is helpful to differentiate between leadership (as a product of relationships between people in a system) and leaders (people who influence this process). In this sense, systems leadership does not mean getting a wider range of followers to follow the leader’s commands; instead, leadership occurs when people interact within a health and social care system. A complexity view suggests a form of “distributed” leadership (Brown and Gioia, 2002; Gronn, 2002) that does not lie in an individual leader but instead in an interactive dynamic, within which any particular person might participate as leader or a follower at different times and for different purposes. Leadership is not confined to a formal managerial role, but emerges in the systemic interactions between individual connected agents (Marion and Uhl-Bien, 2001, 2003). Individuals act as leaders in this dynamic when they mobilize people to seize new opportunities and tackle tough problems. As the situation changes, different people may act as leaders by leveraging their differing skills and experience. This is important because agencies – and leaders - operating independently have neither the budget nor the human resources to respond to the current level of expectation and demand; nor do they have sufficient know-how for solving complex multi-dimensional problems unless they pool information and skills with others (Kings Fund 2011). Therefore existing communities of practice (Lave and Wenger 1991) need to come together to mesh and adapt their healthcare practices to fit with the political, economic, social, technological and environmental realities of the system. The system requires leaders who are adept at facilitating that meshing process and able to influence practice change (Weir & Fillingham, 2014). 

Working collectively and across the system becomes vital for leaders to challenge practices that are not fit for purpose and build on strengths in a way that will have an impact. But despite local and national commitment to achieving better system-level integration and distributed leadership, the reality is that many services are still provided in professional or organisational silos. The reasons for this are complex, including different approaches to decision making, working practices and on-going ‘tribal interests’ which mitigate against collaboration (Gask, 2010). Re-designing services to deliver integration is difficult, requiring leaders to work flexibly across boundaries and professional groups, and calling for confident, skilled and focused systems leadership.  Experience shows that this can be a significant barrier for leaders. Challenges to authority, power and knowledge can be hard to manage.

Confidence and resilience are needed to accommodate the lengthy and often unpredictable timelines over which improvements are delivered. Systems leaders need to be highly skilled in holding the tension between different perspectives in the wider system; they must develop new mind-sets and approaches to leading change, learn to share power, risk and information and build coalitions of purpose around the needs of communities rather than organisations.

 

References

Brown ME and Gioia DA (2002) Making things click: Distributive leadership in an online division of an offline corporation. Leadership Quarterly, ISSN 10489843, 13(4): 397–420.  

Checkland P (1999) Systems Thinking, Systems Practice. Chichester: Wiley

Fillingham D and Weir B (2014) System leadership: Lessons and learning from AQuA’s Integrated Care Discovery Communities. London: The Kings Fund

Gask L (2010) What work has to be done to implement collaborative care for depression? Process evaluation of a trial utilizing the Normalization Process Model. Implementation Science, 5:15

Gronn P (2002) Distributed leadership as a unit of analysis. Leadership Quarterly, ISSN 10489843, 13: 423–451.

Lave J and Wenger E (1991) Situated learning: legitimate peripheral participation. Cambridge: Cambridge University Press.

Marion R and Uhl-Bien M (2001) Leadership in complex organizations. Leadership Quarterly, ISSN 10489843, 12: 389–418

Marion R and Uhl-Bien M (2003) Complexity theory and al-Qaeda: Examining complex leadership Emergence: Complexity Issues in Organizations and Management. ISSN 15213250, 5: 56–78

The Kings Fund Commission on Leadership and Management in the NHS (2011) No More Heroes: the future of leadership and management in the NHS. Report: London: The King's Fund

Welbourn D, Ghate D and Lewis J (2013) Systems Leadership: Exceptional leadership for exceptional times. England: Virtual Staff College.