Integrated Care Systems – Finding hope: Collective leadership

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 complex ‘eco-systems’ whatever the sector.

Good leadership holds tensions.

Last time, I introduced Kestenbaum’s Leadership Diamond, which proposes that great leadership exists in the space 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).

So, where are you holding the tension of vision and reality? What does it look like in your team? In your organisation or system? Both poles need to be owned and articulated. Otherwise, you miss the tension and its power. It’s easy to focus on one end only.

I had to rehab from an injury last year, something painful tweaked in the knee on a muddy winter park run. My exercises make good use of resistance bands, and working with tension strengthens my muscles. Deliberately working with system tensions can strengthen the collective capacity to cope.

Developing our collective capability comes from working with tensions.

Vision and reality are the worlds of perception and communication, making sense together and for others. It’s really important but not sufficient; we need to deliver to make things happen.

That’s where Kestenbaum’s second tension comes in – courage and ethics. We might shorthand these as just do it and doing it together.

Aligning our actions and words.

The social activist Dr DaShanne Stokes said: “Talk without the support of action means nothing.” We can be great at describing today’s challenges and problems or even painting tomorrow’s picture and opportunities. Still, if we cannot identify and act in the moment, it’s all just words.

This second tension around action reminds us of the difference between just acting as we see fit, albeit with courage and sustained initiative, and working deliberately and effectively with others. This calls to our attention the ‘what’ and ‘how’ of action. Both essential.

It’s not what you do, it’s how you do it.

True. But if I never act because I’m always pondering, always talking and trying to collaborate, nothing gets done. Again, if I act without thinking and reaching out to others, I may cause more harm than good. We need both courage and ethics. Wisdom is knowing when each is called for and how they can be combined. This is a core part of the behaviours needed for good leadership in complexity and messiness.

Towards collective leadership.

As people in a system become aware of these tensions and work with them, it helps to develop ‘collective leadership’. Without losing individual accountability, the collective web of relationships, with people leading and following on different issues, over time creates a web – a leadership capacity and capability at a system. This is a key part of the leadership I believe is needed for integrated systems. Summarising from Michael West and co[1], collective leadership is:

• Responsibility and accountability simultaneously operating at both individual and collective levels.
• Regular reflective practice is focused on learning from failure, exploring new opportunities and continuous improvement
• Avoiding command-and-control displacement onto individuals, scapegoating and a climate of fear
• Leadership from both leaders themselves and relationships among them.
• Formal and informal leaders working collectively in support of goals and embodying values
• Leadership also incorporates the concept of followership – everyone supporting each other
• Everyone taking responsibility for the success of the whole.

I have been privileged to see collective system leadership in action with some clients – it is incredibly powerful and carefully nurtured, and observing it is often noticeably absent.

Where is your organisation or system?

[1] Adapted from Developing Collective Leadership For Health Care Michael West et al. Kings Fund 2014