Last week I attended a session on High Impact Leadership at the Institute for Healthcare Improvement Annual Forum in the US. It brought back memories from early in my career, working as a Demographer for Shire County Councils in southern England. I produced population projections, and household forecasts, to help inform future plans for public services, and house building.
This was, and remains today, part of a highly political debate between the undoubted need for more homes, particularly for local people in rural areas, and the desire to protect our ‘green and pleasant land’ from unbridled and unnecessary development.
What impressed me at the time was the way this debate took place very much in public. As part of my role I was questioned at an ‘Examination in Public’ by a panel, led by a planning inspector. The panel questioned assumptions I had made as part of my method, to establish their validity.
The public, mostly in the form of local pressure groups, or housing developers, could also ask questions via the panel. This process meant that there was a high degree of confidence in the eventual Council decisions and often, significantly, local cross-party support.
Coming back to the High Impact Leadership session, the theme was ‘leading across boundaries’. We in the NHS know that this will be a crucial requirement in the coming years if we are to build new care models and realise the visions of the Five Year Forward View, the Dalton Review, or any other strategic ambition for the NHS.
My early career came to mind because of the way in which this need for cross-boundary leadership was framed in the US, which was rather different to the way it is often characterised here in the UK. We recognise that it is difficult, and talk much about the need to develop a locally shared purpose for the future. We talk little about why it is difficult – understanding this is key to future success.
In the US the challenge, as might be expected, was framed from a business perspective. I think this could help us to understand better some of the challenges facing those seeking to lead across boundaries. Three key reasons were suggested why cross-boundary leadership is difficult, and this led to a framework for thinking about how we can be successful with it.
- Firstly, those we are seeking to work with have their own ‘business models’, and they are different to ours. We need to understand, and respect, those models before we can work with others effectively. There is a reason why these models have developed and they may be highly successful. My example of how local authorities operate, in just one area, shows the degree to which they value transparency and public engagement as key elements of their, essentially political, ‘business model’. In the NHS we will need understand and appreciate the value of this if we are to make meaningful, lasting, relationships with local authorities.
- Secondly, we need to build a relationship strong enough to be able to question the business models of others and to work together with them to design a future business model better for a ‘cross-boundary’ era. This is more than a shared purpose – it is a practical mechanism to deliver on that purpose.
- Finally, and probably the area where least thought is currently applied, we in the NHS, at whatever level, need to understand that our own business model may be challenged by those we are seeking to work with as future partners. Our existing way of working, even if it has strong evidence of current value, may not be the best way in a ‘cross-boundary’ future.
Are you ready to take on these three challenges of leadership for the new future of health and care in England?