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Freewheeling leadership? Not likely…

Last week our Managing Director Deborah Evans won an NHS South West Leadership Award. Here are her reflections on leading system transformation…

The last time I won an award was the cycling proficiency. Perhaps it’s a fitting analogy, as that’s what I did then and still do. Every day.

The same applies to system leadership – it’s just been what I do for many years at work. It doesn’t feel half as free as when I’m on my bike, and unlike being a cyclist and enjoying unconscious competence (that’s my claim!), system leadership needs constant, conscious work.

I felt happy and honoured to have won the South West Leadership Academy’s ‘Leading Systems Transformation’ award and now I feel it’s my responsibility to reflect on Leading System Transformation.

It’s not just about positional power: the ten years as a PCT chief exec and the four years leading the AHSN. It’s about being able to use those positions, in concert with others, to make large scale change. A few examples:

  • It was re-commissioning community children’s services across Bristol and South Gloucestershire to create a national exemplar service worth £100 million over 5 years;
  • It was working with all the chief executives in the South West to re-commission (and decommission) a variety of specialised services, such as bariatric surgery, plastic surgery, specialist paediatrics, low secure mental health
  • It was a number of large scale public health programmes in Bristol and beyond
  • It was chairing the multi agency children’s trust in Bristol in support of a talented city leadership team and councillors
  • And more recently it’s been about working with passionate clinicians and talented managers to bring system wide improvements across the West of England in quality, safety and the use of data for patient benefit.

So what were the scars and what are the lessons from my personal experience?

Firstly it’s about being prepared to commit to a shared enterprise even though it’s tempting to put your own organisation first. I remember feeling very apprehensive when an assessment of Bristol City’s Children and Young People’s Services in about 2002 said that the Council’s potential for improvement lay principally with its partners. And I realised that meant me; and I had no idea how. But as a group of partners (head teachers, the police, Barnardos, social services, young people) we went on to achieve great things.

It’s about realising that one has to commit to other organisations’ agendas. When we wanted the South West Ambulance Trust to adopt the National Early Warning Score we realised that they needed help first on gaining engagement and support from clinicians and trusts for their Electronic Patient Record. So we worked hard at that. Sometimes you just have to help with a partner’s agenda for no obvious gain. It’s about building relationships for the longer term.

It’s about good, genuine engagement and sound processes. Negotiating changes to specialised services with 14 overview and scrutiny committees across the South West was essential but never quick.

Of course it’s about securing and developing a good team. But, for senior leaders, it’s also about visible partnership, modelling behaviours and being willing to follow as well as lead. In these highly pressured times I sometimes see partnerships fracturing and blame squirting everywhere.

System transformation is also about belief. It’s very hard to demonstrate confidence and hope at the moment. However I’ve seen enormous changes accomplished in my years as a chief executive and I’ve been part of health communities that have worked their way out of huge financial deficits and restored compromised services through radical change. It’s not fun; it requires determination and stamina and it takes years.

However we have the skills we need to make transformational change happen. And its like cycling – the more you do it, the fitter you get. So with system wide working and partnership – the more we practice, the better we become.

If we are to make transformational changes, we need to develop a vision with the widest possible engagement. We need to do things differently, draw on innovation and focus on adoption and spread of pre-existing evidence of best practice.

In the 50 years I’ve been a cyclist I don’t think I’ve fallen off my bike more than half a dozen times. But in system leadership it happens a lot, and sometimes there’s a full blown road traffic accident. And when that happens we have to get out on the road again, quickly.

Put your helmets on!


Posted on November 17, 2016 by Deborah Evans, Managing Director, West of England AHSN

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