1. North East Leading Improvement and Health and Well-being Leading whole Systems: learning from Total Place and partnership working Robin Douglas Sept 2010

2. The conversation, the challenges:  Most public partnerships focus on process not outcomes – many consume more value than they add.  It is impossible to really understand outcomes without user/citizen perspectives on their needs – this is difficult  People achieve outcomes, services don’t  System thinking and action is distorted by organisational pressures  Total Place supports whole system thinking and action – But real change is required

3. Some problems are so complex that you have to be highly intelligent and well informed just to be undecided about them. Laurence J. Peter

4. A conventional model of organisational leadership  Designing the appropriate organisation  Deploying resources  Negotiate relationships  Creating a framework within which others can shape change  Building capacity  Achieving outputs/outcomes

5. A systems focus:  Separating problems from dilemmas  Learning about the real purpose  Recognising mind traps  Challenging assumptions  Understanding other’s agendas  Working beyond the boundaries of the organisation – the system not the role

6. The real business of leadership: ….from the illusion of control to the reality of influence.

7. Leadership in systems  Is relational not positional – negotiated not imposed  About effective process achieving outcomes not personality  Moving from individual qualities to the process of creating leadership space  Using ‘leaderful’ situations which encourage leadership behaviour in others  Focused on aligning and engaging the efforts of others to achieve outcomes

8. Three mind sets for Leadership The Metaphor is: The Focus is: 1.‘Newtonian’Clock/mechanical Planning, systems & outcomes 2.‘Darwinian’Evolutionary/ Learning, organic growth, ecological scenario choices 3.‘Post-Modern’Heroes in chaos Political, opportunist, rule breaking, short life systems

9. Why have a partnership? There are 3 ways to get things done:  Independently…go it alone  Co-ordinated…we need to talk  Co-operation…we need to work together Are all your partnerships really necessary?

10. Partnerships are contested space Outcomes need to be negotiated Power and legitimacy is unequal and often unacknowledged Each individual/organisation brings their own assumptions about ways of working With limited agreed rules of engagement …and there is plenty of history

11. A Partnership is an experimental space It offers the possibility of breakthrough: “By exploring the differences between diverse perspectives and experiences, partnerships can locate obstacles based on partial vision, limited goals or fixed thinking” “If organisations and individuals emerge from partnerships unchanged – the partnership has failed.”

12. Leadership in partnerships  Helping to negotiate the outcomes, purpose and ‘rules of engagement’ for all the partners  Creating an environment where relationships can succeed  Enabling a strategic approach, not just a plan  Encouraging learning, developing space to experiment, room for creativity..

13.  Brokering relationships between different belief systems  Using creative tension – drawing strength from difference –negotiating solutions – conflict resolution  Creating trust – mutual accountability – enough to risk committing resources

14. Key features that enable closer working:  Are the outcomes clear and accepted? What is the partnership for?  A recognition of task dependency. Do we need you?  Building cultural understanding and acceptance. Do we understand one another?  Building consensus about ends and means. Do we agree what we are to achieve?

15. and…  Building upon mutual awareness. Do we understand what forces and drivers act upon us?  Using our experience of collaboration, resource exchange. What have we learned?  Is there a shared recognition of our ‘place’?

16. Active partnerships: an effective process needs  Active commitment and energy from key people of influence  Clear and constructive leadership  Shared purpose, values and priorities  Shared information and flexible systems  Effective communications

17.  Recognition of the tensions between the partnership and the component organisations  An explicit and accepted position on resources  Orientation to shared learning and experimentation  Building a positive focus on history between partners  Acknowledgement and celebration of achievements

18. Three key dimensions of authority in partnerships ‘Positional’ Based on Role & Organisational Position Given ‘Wisdom’ Based on the Belief & Trust of Others Earned ‘Knowledge’ Based on Personal Capacity Experience & Understanding Acquired

19. Some details about Total Place ‘ We need to be more radical in the way we join up departments, authorities, agencies and sectors, to offer services that are built around client needs; we need to devolve power to devise new solutions closer to the frontline; we need to be better at influencing citizens to change their lifestyles and so reduce the pressure on public services’ Sir Michael Bichard 6 th May 2009 The Guardian

20. And now:  ‘Local authorities must not wait for central government legislation before implementing Total Place...maintain the momentum to convince the new government this can not be let go’ Lord Michael Bichard 21 st May 2010 Total Place Review

21. Principles, process and partnership working:  Working and thinking together is learning – people don’t start from the same place  Think and act with systems, not just organisations  Working and building partnerships is messy and uncertain  Purpose and outcomes should lead process - not vice versa  The process needs to be –  Convergent and divergent  Open and led  Planned and emergent

22. People in partnerships:  Listen to real people – it’s about their experiences and voices  It’s about your people and places, not just organisations  From the language of formal Partnerships to professional friendships and joined up leadership  The Pilots provided people to help, challenge, shape and enable the processes locally  It costs in terms of time, energy, commitment and influence – but for many, it has been worth it to develop real and effective partnerships, with improved outcomes and some efficiencies

23. Learning from Total Place  Expectations for speedy progress from the centre can create tensions in local relationships  Talking to people/citizens is crucial…’emotional buy- in’ and a real focus on outcomes  The count is interesting, but has no answers in itself… the big numbers can be distracting  Pilots are at many different places… lots of history, some using previous work well, others starting afresh, some bogged down

24. and…  Real improvements in collaboration are possible… local innovation and new relationships are still emerging  It is clear that many services can and should be radically changed… working through the lens of Total Place with a focus on outcomes can challenge assumptions  Many players haven’t understood the potential & the need for radical change… particularly senior managers, politicians and Whitehall  ‘you can’t start from here’… you can’t legislate for trust…it has to be earned

25. In summary: The pilots were all different but...  All found potential and significant efficiencies  Built on customer/citizen insights to achieve improvements and savings  Emphasize the need for long-term commitment  Signal areas where invest-to-save will be needed  Need strong and active links with central government  Call for real cultural and behavioural change throughout local systems  Will require new ways to work in and between organisations

26. The 13 pilots were:  Leicestershire/Leicester City  Birmingham  Durham  Kent  Coventry/Solihull/Warwickshire  Lewisham  Croydon  South Tyneside/Gateshead/Sunderland  Dorset/Bournemouth/Poole  Greater Manchester Region and Warrington  Blackburn  Luton/Central Bedfordshire  Worcestershire………….plus a number of ‘shadow’ projects

27. For more details, see  Total Place: a practitioners guide to doing thing differently  Total place website and communities of practice:  www.communities.idea.gov.uk www.communities.idea.gov.uk  www.localleadership.gov.uk www.localleadership.gov.uk

28. Discussion  Using your experience, what needs to be done to make leadership at the whole system level work?  we will now explore actions and ideas to make your partnership working more effective

29. Two processes to explore your experience of leadership in partnership: 1. A time-controlled analysis  Groups of 6 people form  An issue holder is identified  10 mins for them to describe issue (no interruptions)  10 mins group questions to help understanding  10 mins to discuss group’s reactions (no interruptions from issue holder)  10 mins open discussion to identify learning.

30. 2. A co-consulting process  Groups split into 3s  Identify issue-holder, interviewer and observer  Interviewer asks questions to help issue- holder describe their concerns for 10 mins  Use active listening to focus on issue holder’s answers  Observer listens and offers feedback to interviewer on their questioning  Switch roles if time.  Groups reflect on learning about partnership/systems leadership

31. Plenary feedback  What are we learning about leadership in partnership/systems?  What does this mean for us as leaders in health improvement?