Systems leadership in North Islington: what we’re learning so far

20 May 2019

Systems leadership in North Islington: what we’re learning so far

I spend a lot of time these days writing and teaching on systems leadership, but it is always most exciting to be working with projects that are trying it out for real.

 

In Islington, the Council, Hospital Trust, Mental Health Trust, CCG and community sector have come together with an ambitious plan for prevention and early intervention. They want to find a way of working more closely together to support residents before problems become critical, and make sure people don’t fall between the gaps.

Their experiment in North Islington brings together front line managers across organisations – the ground-force group – to lead this work, as well as a more senior group of decision makers to remove obstacles and take the learning into their wider organisations. At all levels, staff and managers have  stepped forward with ideas and have been creative, generous and curious. Initiatives such as ‘walkabout meetings’ (where service users, professionals, clinicians and managers spend several hours together walking the patch) give space for one-to-one conversations which spark ideas and share thinking. Drop-ins on community projects help everyone understand what each project does, and to make connections.

As we go, of course, we learn. Here are some thoughts on our key learning so far:

  • Just getting to know each other makes a difference. Proper conversations start to build trust and generate ideas.
  • Using case studies is a great way to share learning about how the different organisations work and what goes wrong in-between them.
  • It takes time to get started. Each individual needs to find something that can drive their own commitment and purpose. Corporate communications seldom reach the front line with any real force, so staff need time to explore and test what they are being asked to do.
  • Empowering people is not easy. They face stressful workloads, KPI’s, targets, spending cuts and competing priorities – so an honest, practical conversation about prioritisation and sequencing is essential.
  • Sustaining attention is hard. Organisations are easily distracted, key people keep changing and the day job takes up most of the time. But if enough people in the system are trying to keep this moving – and finding it useful – that helps everyone to stay engaged.
  • It is tempting to keep the third sector and service users waiting in the wings ‘until we’ve sorted ourselves out’ but that’s a mistake. Sometimes they can inject the fresh thinking and support that can make change happen – so public sector colleagues need to be bold and bring them into the conversation while things still look messy.

 

How can we address these challenges? Here are six ideas for systems leaders to keep in mind:

  • Keep experimenting: enjoy the mess and be willing to change what happens – for instance, be prepared to rethink meetings half way through, or to discard ideas and start again;
  • Be relentlessly persistent – but patient: recognise that system leaders need to understand and trust each other, and challenge each other to stay on track, but also recognise that this takes time.
  • Listen carefully to staff as they become engaged, and be willing to change and adapt what you’re doing to help them stay involved and achieve impact. Leading across a system doesn’t mean keeping everyone rigidly in line, but constantly recalibrating the approach to hold everyone and their energy together. This might also mean negotiating goals – decision makers have the legitimacy to set priorities, but listen to the priorities of front line staff too.
  • Keep a channel open between the ‘doers’ on the front-line and decision makers behind them, but recognise that it’s not just ‘top’ and ‘bottom’ that need to engage – managers in the middle also need to understand what’s driving change and their role in enabling it.
  • Share learning – the failures as well as the successes. It’s better to try things and change them fast if they are not working rather than to ‘perfect the diagrams’ whilst always deferring real action.  
  • Make sure you have an ‘observing eye’ so that you can watch for patterns of behaviour or system problems. It’s easy to become fixated on our part of the system and our role in the project, but we all need to share responsibility for stepping back and looking at what the whole system is doing – and then intervening if something needs to change.

 

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