Health Education East of England Launching our OD Network: Systems Leadership and Cultural Change Part 1: How Systems Leadership supports cultural change: learning from research and practice Debbie Sorkin National Director of Systems Leadership, The Leadership Newmarket, 7 th July 2015

Health Education East of England: launch of the OD Network Systems Leadership and Cultural Change Overall purpose : To offer you an opportunity to: o hear about some of the learning from research and practice in Systems Leadership – joint leadership development and place-based projects – and how it supports cultural change o think together about what this means for you, and how you might use this learning with your own challenges o learn about a particular Systems Leadership tool – framing and reframing – and apply it to your own wicked issues

Part 1: How Systems Leadership supports cultural change: learning from research and practice Context Integration and change: working with complexity and wicked issues Systems Leadership Definitions and explanations Learning from research and learning from practice Virtual Staff College research; Leadership for Change; Systems Leadership – Local Vision; Health and Social Care Integration Pioneers; what this might mean for you Reflection and discussion Using Systems Leadership in practice

Context: increasing complexity and a changing environment Health and care issues deep-seated, multi-layered and stark Not just a question of health: wider determinants of wellbeing Strong cultures reinforced by structures…. …Exacerbated by struggle to match growing demand with smaller resource pot Additional fluidity brought about by plans for devolution Broadening range of stakeholders and audiences – more routes Difficulties in demonstrating public value and having it acknowledged by the public, at the same time as cumulative effect of changes in public expectations – personalisation, co-production, independence

Result: Integration becomes the Holy Grail: but putting structural cart before cultural horse NHS 5 Year Forward View Integration and prevention to manage demand Health and Social CareLegal duties to promote integration: Act 2012, Care Act 2014 emphasis on prevention, re-ablement and the person at the centre New structures Clinical Commissioning Groups, Health and Wellbeing Boards, new role for Public Health Welter of new models/pilots Health and Social Care Pioneers, Better Care Fund, Accelerate, Vanguards, Systems Leadership – Local Vision PM’s Challenge Fund, PSTN National reviewsBarker, Oldham, Kingsmill

Systems leadership is seen as a way of working with complexity to shift cultures and make change “Leaders are struggling to innovate, integrate, manage demand and find new solutions.” “Leaders are wrestling with ‘wicked issues’ that shape-shift and defy resolution, and which cannot be resolved by single agencies acting alone.” “We are…applying systems thinking to the practical reality of trying to achieve complex change.” Sue Goss, ‘A View from the Bridge’, OPM May 2015

Systems Leadership: Table discussion What words do you think describe Systems Leadership?

Defining Systems Leadership – cross-sector, shared, ceded, partial, transformational “Systems Leadership: the collaborative leadership of a network of people in different places and at different levels in the system, creating a shared endeavour and co-operating to make a significant change.” About leading: when you’re not in charge when you need to ask when it’s complex when you have no money About shared ambition/relationships: participative/partial/emergent

Tools to help you describe leadership: levers to pull – frameworks that put leadership behaviours into practical form

Learning from Systems Leadership: research, development and place-based projects to support integration/wellbeing Research: Systems Leadership: Exceptional leadership for exceptional times Leadership Development: Leadership for Change Future Directors Places: Systems Leadership – Local Vision; Pioneers

Learning from research: Six dimensions of Systems Leadership Ways of feeling - about strong, personal values Ways of perceiving - about listening, observing and understanding Ways of thinking – about intellectual rigour in analysis and synthesis Ways of relating – the conditions that enable and support others Ways of being – personal qualities that support distributed leadership Ways of doing - behaving in ways that lead to change – includes narrative and reframing skills

Learning from research: when it flourishes: what to look for Willingness to align around a shared purpose or ambition Able to build engagement/relationships and really listen: able to reframe/influence Preference for outcomes over processes Not being bound up with role and with a willingness to take risks Able to work reasonably well with conflict and uncertainty Having a strong commitment to a service in a particular place

Learning from practice: place-based projects Systems Leadership can make a real difference to changing mindsets, culture and behaviours Relationships are key, and it takes time Patients, service users and carers are crucial – have them at the centre of your shared ambition It requires a combination of purpose + flexibility It starts with a coalition of the willing Be willing to cede leadership/give away ownership Start small: start where you are, use what you have.

Learning from practice: developing Systems Leadership in places through joint learning Key benefits lie in increased connectivity and broader relationships You need political/senior level support Get Public Health on board – they can play a central role Involve people in communities and go wider than you originally thought – it’s where energy lies Think about leadership going from senior to operational level – e.g. LB Merton’s “Do- ers” Group – and start implementing

Learning from practice 1) No-one said this was easy… Places are finding it challenging to shift from a shared purpose/ high-level vision to a more detailed version – there comes a point where you need to put cards on the table Geography really does make a difference Powerful organisational imperatives can trump integration vision So you need to see yourself as a central enabler of system transformation – not just ‘going along with yet another initiative’ And hence the value of Enabler role in holding people to the work

2) But real progress is possible: examples of culture shift from Leadership for Change LB Croydon: Sign-up from across local authority and health system for adoption of Early Years strategy for children: helped by willingness to breach hierarchies and frame issues in terms all could sign up to: led to fully endorsed successful funding bid to DCLG. Blackpool: Real partnership across broad range of stakeholders to take up roles in relation to Big Lottery funded- project: entailed ceding power and role to different protagonists to get them onside. Solihull: CCG and local authority combined to make real progress in health and social care integration, despite scepticism from earlier failures – narrative around ‘Solihull Together for Better Lives.’

Examples of culture shift from Systems Leadership – Local Vision Gloucestershire: reducing obesity Project turned out to be about much more than obesity: involved public health and HWBB working with communities, JobCentrePlus, planning and regeneration – jobs and built environment. Cheshire West and Chester: social isolation Worked with local communities: identified different cohorts of people suffering social isolation and developed community-led approaches involving social care, housing associations, faith groups – included working-age adults alongside older people. Wiltshire: integration Health and social care coming together, with home care playing key role: three demonstrator sites for integration; looking at longer-term partnerships with VCS and better T&Cs for social care staff.

3) Thinking in systems ways is starting to have workforce implications Leeds Pioneer: Developed database of all health and social care staff in city – geo-mapping where people live and work, and forming integrated neighbourhood teams across the city. Shropshire CCG: Funding Lead Nurse to go into care homes and home care services to train care staff – acting as ‘early warning system’. Waverley DC/Birtley House: Looking to develop new roles in social care settings, including the Elizabeth Nurse – more flexible across health/social care

4) And thinking in systems ways can even have implications for IT and data sharing… Reproduced by kind permission of Waltham Forest CCG

Effectiveness of Systems Leadership in places borne out in recent independent evaluation “There is no doubt that Local Vision has enabled some significant shift in mindset and resulting behaviours for some, which has led to new, more inclusive ways of working within the community.” “…with realisation among many of the potential for collective leadership as part of a wider system and accompanying intent for new ways of working.” “One important finding is the way in which Local Vision appears to have opened up space for new leaders to emerge, working in non- hierarchical ways, building links and partnerships across organisations.” “Reframing, Realignment and Relationships: Interim Evaluation of the first place- based programmes for Systems Leadership – Local Vision” University of the West of England, June 2015

General learning from Systems Leadership: what this might mean for you as Systems Leaders Be values-driven – align around shared purpose or ambition and be clear Seek diverse perspectives and build engagement/relationships Be willing to suspend certainty and embrace uncertainty Think beyond your role - it’s a system and you’re a central enabler of change Have the courage to experiment : allow for things to go wrong and adapt Be willing to give time – time you commit yourself; time for the programme Start anywhere, go everywhere

Systems Leadership: Discussion on tables and feedback Given the learning from the Systems Leadership work: I.What are you doing, or what might you do, to use or develop Systems Leadership to change cultures in your place? II.What might you use or find out more about from the examples shared? III.What opportunities, dilemmas or questions does this raise for you? What might help and what might hinder?

Systems Leadership – more information The Future will be Improvised - Virtual Staff College research - Pioneers One Year On report: Interim Evaluation – Leadership for Change – Sue Goss, A View from the Bridge – The Art of Change-Making –