Integrated Care Systems – Finding hope: a different kind of leadership.

The new Integrated Care Systems are developing across health and care in England following their statutory go-live on 1st July. Of course, Wales and Scotland have long had more integrated statutory planning and delivery arrangements.

I reflected last time on the huge challenges of ICSs and the opportunity to engage and mobilise a wide coalition of partners. Today, I’m reflecting on the leadership approach that is needed with all the challenges facing the system.

We know leadership comes in many shapes and sizes, subject to multiple definitions. Everyone acknowledges it’s critical to successful organisational and societal life. We greatly value and search for good leadership, but we still can’t define it. Sometimes, it’s easier to work out what we think about something by looking at what we do rather than what we say we think. Actions speak louder than words.

So, what kind of leadership is needed in the new system?

Leadership is never easy; we always have to hold competition and what often feels like irreconcilable tensions. There are lots of different theories and approaches which describe how we might understand and work with tensions, such as paradoxical thinking, wicked problems, and polarity thinking. They have subtle and important differences, but the basic message is to pay attention to both ends of the tension.

Wisdom is often elliptical – that it embraces truths that can seem contradictory. Think for a minute how justice and mercy, freedom and laws, love and truth play out. I think this is key to good systems leadership now, whether for Integrated Care Board leaders or clinicians, professionals and managers working in the care and health system. For example, how can we focus on delivery now – responding to the challenges of ambulance response targets, elective recovery, and develop strategies to address deep rooted challenges in health inequalities and improving outcomes?

Good leadership holds tension.

One of the most useful leadership models I know is Peter Kestenbaum’s Leadership Diamond. It proposes that great leadership exists where we hold the tensions between the poles of how we see things: vision and reality in one dimension and how we do things in the other: courage (‘JFDI’) and ethics (how we do it collaboratively).

We often tend to favour one of these and emphasise them in our leadership. What’s helpful about the model is that it helps us to embrace all four of these poles – they are all essential. And they all have their respective advocates.

Wisdom is knowing how to embrace the tensions.

Let’s take one of the critical tensions that Peter Kestenbaum highlights: vision and reality. Vision is all about painting the picture of where we need to go. The benefits of being able to achieve that vision. What would it bring to staff, customers, and those we serve and to the organisation itself? Things could be so much better around here. Vision can be a massive enabler and motivator for people.

Powerful vision unleashes organisational creativity and energy.

As JF Kennedy famously said in 1961, “We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard because that goal will serve to organise and measure the best of our energies and skills because that challenge is one that we are willing to accept”. The rest, as they say, is history.

But vision can only be ‘pie in the sky’. The problems of today are real and pressing. If we don’t address them, there will never be time, space, or resources for things to be different.

Grasping reality anchors us in the here and now

We live in the here and now. Fully recognising and embracing the challenges and problems of today are essential. So we can both address them and create the springboard for achieving the vision of tomorrow.

We need both. We need both a firm grip on reality and a vision of how things can be different. And in the gap between them, we will find creativity and energy released in us and those we work with to close that gap.

Where do you naturally look for a vision for tomorrow or the realities of today?

What might you be missing from your favourite?