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What it takes
Prof Becky Malby
The Health and Social Care Dilemma
What the NHS Experiences
• Increasing complexity
• Desire to create control
and simple solutions
• The need for certainty in
Based on experience in
leading in transactional
What the NHS needs
• Adaptive capability
• Creative solutions
• New capacity and
through relational culture
What the Future Looks Like?
What sort of organising?
In Malby R, Anderson –Wallace
M, 2016. Networks in Healthcare
– Managing Complex
What the Future Looks Like?
What sort of organisations?
1. RED – short-term, reactive, thrives in chaos, power at
the top to keep people in line. Metaphor: Wolf pack
2. AMBER – Hierachial pyramid, command and control,
values stability. Metaphor: Army
3. ORANGE – Goal is to achieve growth, through
innovation, management by objectives but freedom on
‘how’. Metaphor: Machine
4. GREEN – focuses on culture and empowerment to
achieve employee motivation. Metaphor: Family
5. TEAL– focus on purpose, self-organising teams, peer-
based, no hierarchy. Metaphor: Living system
(Laloux F 2014.Reinventing Organizations)
Linear cause and effect models (the basis for most of our
planning) assume that:
• The environment can be simplified enough to be
modelled into a limited number of variables.
• The environment will stay constant such that the
variables stay the same.
• The system will be predictable in how it reacts to these
variables, no matter what the feedback loops are telling
it, no matter what is going on internally.
Faucheux and Makaridakis (1979)
• Standardised/ replicable
• Cooperative structures
• Peers – reciprocity/ exchange
• Knowledge function core
• Complex/ Wicked
• Adaptive collective responses
• Intended and unintended consequences
• Temporary – issue based
“A system is a perceived whole whose elements ‘hang
together’ because they continually affect each other over
time and operate towards a common purpose”. Peter
• Unified whole in service to a collective purpose.
• The whole is different from the parts, and no amount of
understanding of the parts illuminates the whole.
• Organised around shared principles.
“Leadership is becoming increasingly complex with a
growing need to deal confidently with volatility, uncertainty,
chaos and ambiguity” (Ghate et al 2013 p 4)
• Collaborative leadership of the system to achieve the
• In health and social care it usually means leadership of
• It can be an issue.
The capabilities of systems leaders
Summarised by Senge et al. (2015) as:
• Ability to work at the level of and see the nature of the
• Ability to see issues through the eyes of diverse players
in the system, which encourages openness in others.
• Listening in order to build trust and collaboration.
• Able to work with an emergent approach, freeing others
• Balances longer term value creation with short term
reaction, co-creating the future with and through all the
System Leaders critical role:
• Clarifying purpose and providing clear expectation
• Enabling system players to make sense of the context in
which they operate
• Leading decisions that are congruent with the purpose
• Questioning the underlying assumptions that govern the
• Sustaining processes that make the most of the system’s
capacity to adapt
• Bringing in diverse people and perspectives to find new
possibilities for action
Doing all this as a peers
(Malby and Fischer 2006)
• Can grasp what the future could look like.
• Create clear expectations of behaviour, and model this.
• Are prepared to do the work of generating a shared view, realising the
potential of diverse perspectives.
• Are willing to give up territory for the common good.
• Can lead as peers (understanding others perspectives, reaching
agreements together that stick, in service to the whole).
• Distribute leadership, based on agreed principles for decision-making.
• Stay focused.
• Are prepared to sort out the systems issues that are their responsibility
(that often arise from the frontline).
• Practice relational behaviours of openness, listening, questioning, learning
to create the potential of new possibilities and solutions
• Generate evidence to underpin decisions.
• Know how and when to work with citizens (when to be accountable to
citizens, when to seek feedback, and when to coproduce/ share