Nothing like showing my colours early on – yes, I have a vested interest. One of my brothers is kicking his heals at home – he’s in the Illinois National Guard, and they’re not getting paid. Another got made redundant a couple of years ago so lost his health coverage, and now works for a company at a quarter of his previous pay and with minimum benefits. Health is not high up the list of those benefits.
It is easy to take the NHS for granted – until it’s not there. Which is why the Affordable Care Act (to use its real name) can be seen to benefit many people in the position of my family, and why it’s so infuriating that the American system doesn’t work. However, don’t be surprised. It was Winston Churchill who observed, “Americans always do the right thing after they have exhausted every other alternative”.
But there’s still some exhaustion to take place in Congress. Were it so simple as the exchange between the prison warden and Paul Newman’s character in the movie Cool Hand Luke: “What we’ve got here is a failure to communicate”. Of course communication is at the core of effective system working, but there’s much more to it, as the impasse in Congress shows.
We explored these system issues at the recent National LDP Development Event in Leeds. This brought together staff from the Leadership Academy’s ten delivery partners from across England, focusing on aligning local leadership delivery with national strategy, and sharing learning. One of the common themes over the two days was system working. It’s increasingly important for a number of reasons.
First, my view is that the problems facing the NHS cannot be solved in isolation. Demand for A&E is related to the work of GPs, the infrastructure in place locally for dealing with non-emergency cases, and health determinants, among many other reasons. Delayed discharges are also down to many reasons outside the control of providers. OK, providers may be darned inefficient in many areas, but it’s no good whacking them over the head because they can’t meet their targets when the solution pretty much lies with others.
Second, the way the NHS is now designed gets in the way of system working. FTs have been established to think that they have freedoms to do things. Get real. They’re merely suppliers of services that will be influenced and shaped by purchasers and users of those services. Purchasers, in turn, namely the new clinical commissioning groups, just don’t know how to tackle the seemingly intractable problems in their acute hospitals. It’s like David and Goliath. But we know who won in the end.
Third, system working is really difficult. Look at Congress. That’s because we’re not dealing with organisations, but rather individuals. The handful of Tea Party anarchists just don’t want to play. Thankfully we’re seeing nothing of this order of magnitude in the NHS, but there are certain people that make life difficult. These folk have certain mindsets that are conditioned by the behaviours they see in others, the way they are performance managed themselves, and the environment they have grown up in. Sadly the past two decades have brought to the fore behaviours that, at the simplest, can be described as ‘I win, you lose’.
Life does not work like that however, as Congress fully illustrates, anybody in a relationship of any kind knows the destructive nature of that type of behaviour. Yet we seem to think that it’s OK to behave in this way when we go to work.
We explored these system issues in a session with the LDP leaders. We tackled the leadership across systems equation, and identified a number of key leadership behaviours that are essential to make system leadership work. While there’s nothing new in these behaviours, it is helpful to see them as a whole, with the continuous focus on seeing the evidence of these behaviours in action. Here they are: Courage, Trust, Awareness, Accountability, Resilience, Relationships, Collaborative, Influence.
I’ll send this list to my Congressman. I think the NHS could teach Congress a thing or two about system working.