Integrated Care Systems – Finding hope: belonging

I am continuing to think about the new Integrated Care Systems developing across health and care in England following their statutory go-live on 1st July. The challenges facing them are common to many large and complex systems, whatever the sector. In the last two 1 Minute reads, I explored what sort of leadership such large, complex and messy systems need. I introduced the idea of holding tensions illustrated by Peter Kestenbaum’s Leadership Diamond and the concept of collective leadership.

Today, I want to explore one of the key roles of collective system leadership: to help everyone working in the system develop a shared sense of belonging and identification with the system. We know that a sense of belonging is a core human need alongside the need to feel secure and valued.

Wearing many hats

The reality for most people in large, complex systems is that they have multiple social identities often associated with different roles. So, a nurse may have a primary identification with the ward or community team in which they work but also have a sense of identification with the service or the GP practice that they work in or with, or perhaps the Integrated Neighbourhood Team (INT) which comes together to serve a particular locality. Alongside this there will be a sense of identification with their employer, perhaps a local surgery or NHS Trust. The INT or service is part of a wider place, a local Integrated Care System and, indeed, part of the wider NHS or health and social care system. Many professionals and clinicians will also have a strong sense of professional identity and perhaps an affiliation with the professional association or union.

Weaving together

So, how do leaders in integrated care systems or any large complex system create this sense of belonging to the wider system and the multiple hats people must wear? Some of the concepts I found helpful in this area of learning from clients draw from traditional wisdom from people such as the Maori and Zulu. I recommend a good book, ‘Belonging: The Ancient Art of Togetherness’ by Owen Eastwood, which explores these concepts and applies them, particularly in high-performance sports. Eastwood writes, “When our need to belong in a team is met, our energy and focus pour into the team’s shared mission. 

We can lock into our role and the tasks we are asked to deliver. We are comfortable being vulnerable in our quest to get better. We feel secure enough to help others and point out where we could improve as a team.”

Eastwood describes ‘Whakapapa’ (pronounced “fakapapa”), which is the Māori way of explaining your place in the world and your place in your tribe or family. For Māori people, belonging is important, and a part of belonging is the “story of us”. He explains that a key leadership role in Maori culture is ‘Rangatira’, which means “to weave a group of people together.”

This is a powerful concept. Indeed, several years ago, I had the privilege of working on a project in New Zealand, helping to develop a new community, Waitakere Hospital, northwest of Auckland (and famous for having the first baby of the new millennium born there in 2000). I recall having this concept explained with an invitation that through my work with this hospital serving a diverse local population, I, too, was part of this story. It was as if my story was weaved in with the story of the local place and people. I felt palpably different about this work and my identification with what we were doing.

Together we are

Similarly, in southern Africa, Ubuntu is a Nguni Bantu term meaning “humanity”. It is sometimes translated as “I am because we are” (also “I am because you are”) or “humanity towards others.” Again, I find this a rich concept in thinking about how collective leadership can work to create a sense of shared belonging at multiple levels across systems. It’s worth noticing the inherent tension with the traditional individualistic Western philosophical view from Descartes; “I think therefore I am” (cogito ergo sum). Another tension to hold!

So, what does this look like in practice?

For this to become a reality, leaders across the systems need to develop a shared narrative around ‘us’. They tell stories which illustrate and reinforce the ‘story of us’, celebrating the achievements of others and helping others through their challenges. They help people understand the broader picture and sense of pulling together in different configurations and levels, but with a shared sense of belonging and ambition to improve the health and well-being of the local population.

Where do you feel you belong? And how can you help others?