Systems leadership in practice: thematic insights from three public health case studies

Abstract

Background ‘Systems leadership’ has emerged as a key concept in global public health alongside such related concepts as ‘systems thinking’ and ‘whole systems approaches.’ It is an approach that is well suited to issues that require collective action, where no single organisation can control the outcomes. While there is a growing literature on the theory of systems leadership in a number of fields, there remains a lack of published empirical studies of public health systems leadership for professionals to learn from. The aim of the current project was to conduct cases studies in UK public health to provide empirical evidence on the nature of effective systems leadership practice. Methods Three system leadership case studies were identified in the key domains of public health: health protection, healthcare public health and health improvement. A total of 27 semi-structured interviews were conducted. Data were thematically analysed to identify the components of effective systems leadership in each case and its impact. Results The thematic analysis identified themes around ‘getting started,’ ‘maintaining momentum’ and ‘indicators of success’ in systems leadership. In terms of getting started, the analysis showed that both a compelling ‘call to action’ and assembling an effective ‘coalition of the willing’ are important. To maintain momentum, the analysis identified themes relating to system structure, culture and the people involved. Regarding culture, the main themes that emerged were the importance of nurturing strong relationships, curiosity and a desire to understand the system, and promoting resilience. The analysis identified three components that could be used as indicators of success; these were a sense of enjoyment from the work, resource gains to the system and shifts in data indicators at the population level. Conclusions This study has provided insight into the nature of systems leadership in public health settings in the UK. It has identified factors that contribute to effective public health systems leadership and offers a thematic model in terms of establishing a systems leadership approach, maintaining momentum and identifying key success indicators.

Critical Essay: Wicked problems in the Age of Uncertainty

“…Moreover, most problems facing the world – which are tame – do not require the removal of hierarchy, they simply require the deployment of technical skill; and the last thing a fire in a theatre needs is for the removal of a hierarchy and the constitution of a leaderless or even leaderful group to investigate what should be done about the fire, after a consensus has emerged presumably. And while everyone seems persuaded that systems leadership is necessary for addressing wicked problems, and the number of publications favouring this approach has grown markedly in the last two decades, there are precious few empirical cases to justify the clamour for abandoning vertical hierarchies altogether and simply adopting a more horizontal approach (see Bigland et al, 2020; Van de Mieroop et al, 2020). And this is the point: wicked problems are unlikely to be resolved just by everyone collaborating, even if that is a precondition of progress.…”

Global public health leadership: The vital element in managing global health crises

“…At the national level, Nigeria’s response to Ebola in 2014 saw strong political and public health leadership build on a pre-existing commitment to strengthening public health capacity to rapidly contain the outbreak, which resulted in only twenty cases and eight deaths [ 13 ]. At the local level, insight from three UK case studies identified factors grouped into “ getting started ”, “ maintaining momentum ” and “ indicators of success ” themes that contribute to success in systems leadership [ 14 ]. One of these cases was the 2018 Salisbury Novichok poisoning response.…”

A importância da visão sistêmica para lideranças em contextos complexos, uma revisão integrativa da literatura

“…Neste sentido, James (2010) contribui com Bigland et al (2020) ao dizer que o caos e a incerteza são normais, são sinais de mudança e que contribuem com as oportunidades de inovação, sendo, portanto, necessário perceber que as organizações têm um senso de identidade e sua imprevisibilidade no contexto VUCA é influenciada por valores coletivos. Percebemos, então, que os sistemas adaptativos complexos compartilham muitas "propriedades e regras comuns, no entanto, eles são imprevisíveis, resilientes e inovadores devido a sua natureza orgânica".…”

“…Weberg (2012) cita que a liderança nesse contexto ocorre em circunstâncias nas quais os grupos precisam sair de situações e problemas que são imprevisíveis, por isso é necessária a interconexão, pensando sobre os impactos do sistema e obtendo competências para a inovação. Bigland et al (2020) acrescentam ainda à liderança os conceitos relacionados ao pensamento sistêmico para lidar com a complexidade, tendo em vista a ênfase colocada nas relações entre as partes que formam o sistema. Além da necessária compreensão das partes individuais e do sistema separadamente, faz-se necessário olhar para as organizações como um sistema inteiro.…”