1. LGA Event: What is the role of HR and OD in radical service transformation? Workshop WS3: Systems Leadership – the holistic approach to transformation Debbie Sorkin National Director of Systems Leadership, The Leadership Centre Local Government House, 17 th March 2015 Debbie.sorkin@localleadership.gov.uk @DebbieSorkin2

2. Systems Leadership: the holistic approach to transformation Context: why leadership matters, and why Systems Leadership matters especially Thinking about systems: making sense of what we see Thinking about leadership: making leadership a practical reality and driving a leadership culture in your organisation Leading beyond your organisation – Systems Leadership Learning for OD and HR from Systems Leadership research and place-based programmes Putting it into practice

3. The starting point: Integration/constant change Health & Social Care Act 2012 and Care Act 2014 – new duties on LAs to promote integration, emphasis on prevention, re- ablement, person at the centre The NHS Five Year Forward View – emphasis on new models of care, integration and prevention to manage demand New structures - Clinical Commissioning Groups, Health and Wellbeing Boards, new role for Public Health National Reviews: Barker, Oldham, Kingsmill Welter of new models/pilots: Health and Social Care Pioneers, Better Care Fund, Accelerate Programme, New Models of Care, Systems Leadership – Local Vision projects

4. Taken with other factors, this means increasing complexity and difficulty Everyone is struggling to match growing demand with smaller resource pot: e.g. £30bn putative health service shortfall; £3.53bn taken out of social care budgets 2010-14 (ADASS 2014) At the same time, people are having to deal with issues not of their own making (e.g. knock-on effects of cuts/welfare changes) People are having to build new working relationships with different providers, regulators and other stakeholders And they have to navigate changes to the system and a mass of new organisations whose function is not always clear and whose knowledge is imperfect

5. Taken with other factors, this means increasing complexity and difficulty

6. Leadership is seen as a way of dealing with this complexity and difficulty “Collaborative leadership is the critical behavioural factor in successful transformation.” Better, Bolder Braver: Service Transformation Challenge Panel, November 2014 “I’m committed to ensuring that NHS England plays its part in shared system leadership…it’s not a few heroic individuals…it’s a different type of leadership and a more nuanced range of management skills and behaviours.” Simon Stevens, King’s Fund Annual Leadership Summit, Nov 2014 “GPs and social workers share a common interest in leading and creating system change that will support better outcomes and be economically sustainable.” GPs and Social Workers: Partners for Better Care, October 2014

7. Thinking about systems: making sense of what we see A system: a set of individuals, organisations or bodies working together or interacting in some way as part of an interconnecting network; a complex whole

8. Thinking about systems: tools for making sense of what we see Maturana & Varela – evolutionary biology Organisms, from single cells to eco-systems have a variety of characteristics in common They have evolved to be in a perfect relationship with their environment It is a symbiotic relationship, the organism/organisation defines the environment and the environment defines the organism Organisms are self-referencing, they act to preserve their own identity (autopoeisis) If there is an external source of perturbation the organism acts to kill it, be it internal or external. If the organism is held perturbed for sufficient time it adapts to this new condition.

9. Thinking about systems and issues: tools for making sense of what we see Tame and Wicked issues (after Keith Grint) Tame Issues: can be managed o Relatively straightforward o Known, familiar o Use established methods already proven to work o Can be solved Wicked Issues: need leadership o Complex o Not familiar – no ‘right’ answer o No tried and tested methods o Can‘t be solved, only progressed

10. Thinking about systems and issues: tools for making sense of what we see Blue box or yellow circle (after Ralph Stacey)

11. Thinking about leadership: making it practical through the way it’s defined Not just about authority at the top of organisations It’s a practical understanding – and awareness – about how you do what you do, and the impact on others So it’s about behaviours, and taking responsibility for them And it’s everyone’s business – people working at all levels in all sectors It therefore enables you to lead across organisational boundaries “

12. Systems Leadership – cross-sector, shared, ceded, partial, transformational About leading: when you’re not in charge when you need to ask when it’s complex when you have no money Systemic – i.e. not piecemeal or divided into silos - and based on shared ambition Participative – i.e. involving many people’s energies, ideas, talent and expertise Emergent – i.e. allows for partial/clumsy solutions, able to work with uncertainty...and based on trust/relationships – In other words, based on behaviours

13. Tools to help you think about Leadership: levers to pull – frameworks that put leadership behaviours into practical form

14. Lessons from Systems Leadership: research, leadership development, practice Research: Systems Leadership: Exceptional leadership for exceptional times Leadership Development: Leadership for Change Future Directors Practice: Systems Leadership – Local Vision; Pioneers

15. Systems Leadership research Ghate, D., Lewis, J., and Welbourn, D., Systems Leadership: Exceptional Leadership for exceptional times. The VSC, Nottingham, UK, 2013 Synthesis paper brought together evidence and case studies from 7 source papers from England, USA, Canada, Australia and Denmark Research includes literature review, in- depth interviews with 29 leaders working across public services; case studies; reviews Key findings identified ways of describing Systems Leadership; the best ways to achieve it; personal leadership styles of people who did it well; and conditions it needed to flourish

16. Lessons for OD and HR from Systems Leadership research: factors that enable it to flourish Common vision or ambition: willingness to cede organisational goals Focus on place-based initiatives and outcomes Strong/honest relationships; accountability; allow for different views Combination of political and organisational commitment Role authority not sole source of legitimacy: influence, not power People tolerate risk and accept multiple potential pathways

17. Lessons for OD and HR from Systems Leadership research: Your workforce – things to look for Willingness to align around a shared purpose or ambition Able to build engagement/relationships and really listen 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

18. So one lesson from Systems Leadership research is: develop your people If leadership is for everyone, and Systems Leadership is not solely about role: Think about who might be suited to Systems Leadership, at any level Try it out – set people a wicked issue and ask them who might be in the system, what might work, what they might see Focus on behaviours/relationships Use coaching and support networks

19. Lessons from Systems Leadership practice: Systems Leadership – Local Vision; Pioneers; BCF National programme c. 50 projects around England Projects focus on integration or wider wellbeing issues Topics also include mental health, inter-generational obesity, alcohol abuse and social isolation Support via Enablers on the ground; access to networks/ information; extended to Pioneers and BCF places

20. Learning for OD and HR from Pioneers and Local Vision programmes: 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 You need to see yourself as a central enabler of system transformation – not just ‘going along with yet another initiative’ Powerful organisational imperatives can trump integration vision Hence the value of Enabler role in holding people to the work

21. 2) But there has been real progress - real change in Local Vision places and Pioneers Wiltshire: Health and social care coming together in overall Systems Resilience Group; three demonstrator sites for integration; looking at longer-term partnerships with vol sector and better T&Cs for social care. Kent: Proactive care programme for people with long-term conditions; set-up of rapid response service. By 2015, aiming to deliver fully integrated health and social care teams and 24/7 community-based care. Wakefield: Development of integrated model of health and social care; new multi-professional and multi-disciplinary team based around GP practice populations; single point of access and care plan; new network hubs.

22. 3) And this is starting to work its way into OD and Workforce issues LB Islington: ‘Test and learn’ sites focused around primary care; mapping of workforce development needs; integrated community ageing team; integrated psychiatric liaison and assessment team; locality navigators. London WELC: Developed provider collaboratives to co- ordinate services and use single budget for health and care across a population, including creating new workforce roles. Leeds: Developing integrated neighbourhood teams across the city, working from shared data source and the ‘Leeds pound’.

23. General lessons for OD and HR from Systems Leadership work Relationships and shared purpose are crucial – if you have these you can weather the storms Key benefits lie in increased connectivity and broader relationships You need political/senior level support Involve people in communities and go wider than you originally thought – it’s where energy/creativity often lies Think about leadership going from senior to operational level – e.g. LB Merton’s “Do-ers” Group Work out when you stop experimenting and start implementing Get Public Health on board – they can play a central role

24. Systems Leadership in practice: trying it out Base ideas of leadership on behaviours and honesty – hold yourselves to account Develop your people: make Systems Leadership part of OD and CPD Embed strategies and skills for real co-production: have Service Users at the centre Start small and use what you have – often more than you think Use influence – you don’t always need formal power. So make connections and build relationships: think beyond traditional roles and see yourselves as part of a collective leadership with a shared ambition Just look to make progress: give it time, allow for things to go wrong, take adaptive action and keep going!

25. Systems Leadership in practice: reflection and small group discussion Where are your wicked issues? How far are you using Systems Leadership to work with them? What else might you do to develop and promote Systems Leadership in your area? Where might you best use your influence and make wider connections? What opportunities, dilemmas and questions does this raise for you in your role and others in your teams? What does this mean for all of us in OD and HR?

26. What influence/connections do we have? What actions might we take?

27. Feedback and looking ahead What might we want to take forward from here, and how? In our areas As an OD/HR community? Individually?

28. Systems Leadership – more information www.localleadership.gov.uk Debbie.sorkin@localleadership.gov.uk @DebbieSorkin2 The Future will be Improvised - http://tiny.cc/revolutionhttp://tiny.cc/revolution Virtual Staff College research - http://tinyurl.com/VSCSEChttp://tinyurl.com/VSCSEC Pioneers One Year On report: http://tinyurl.com/olfozgxhttp://tinyurl.com/olfozgx Leadership for Change – www.leadershipforchange.org.ukwww.leadershipforchange.org.uk