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System Change for Health and Care

Charlie Penny by Charlie Penny

System Change for Health and Care

System change for Health and Social Care


Healthcare transformed by technology, with robots enhancing patient outcomes and AI promising new possibilities. However, organisational and structural changes haven’t kept up with technological advancements. Covid-19 accelerated system changes, but as the pandemic recedes, health services struggle under pressure. Leaders must focus on both ‘art’ (people and ways of working) and ‘science’ to drive necessary healthcare improvements. Here we share tips on where to start, creating capacity and capability, and how to step back and evaluate.


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Healthcare has been revolutionised by technology. Robots are improving patient outcomes, speeding up surgery times and reducing costs. Seemingly every week, a new drug hits the news which promises to radically change patients’ chances. AI brings untold possibilities. The pace of change has never been faster.

Far slower, however, has been the organisational, structural and systems change needed to enable clinicians and the new technologies at their disposal to do what they do best. In our language, the ‘art’ (people and ways of working) just isn’t keeping up with the pace of change in the ‘science’.

Covid-19 acted as a catalyst for system change. In the UK, NHS Trusts and Health Boards saw changes occur in days which may have otherwise taken years. In March 2020, Q5 supported the building of a 2000-bed field hospital in just 30 days. Thankfully, this facility was not needed, but to mobilise thousands of people, develop a new model of care and rapidly collaborate between the NHS, third sector, local authorities and industry at such pace is a huge achievement.

The unleashing of speed, collaboration and empowerment of on-the-ground leadership was seen around the world.

Since the pandemic has largely ended, our health services have been under more pressure than ever.

As the focus turns to waiting lists and recovery, and the funding made available during the pandemic disappears, our healthcare organisations are quickly losing the ability to change and improve services at pace. We are in danger of not learning the lessons from some of the brilliant system changes brought about by the crisis of Covid-19, and returning to ‘business as usual’.

While we don’t pretend to have all the answers, we have worked with a number of clients on harnessing the system change momentum of the pandemic, and believe that leaders must focus on both ‘art’ and ‘science’ to make the changes our health systems need.

Where to start?

Leaders in the health system need to find the time and space, collectively and individually, to make their departments healthy again. What makes a healthy department? It is one where there is a clear vision, it is grounded in behaviours and actions for everyone, with a clear strategy or pathway to deliver it. There must be alignment between vision, strategy, measures and individual motivations. Leadership is the pivotal force joining all of these.

Reflection and alignment require both art and science. Science is the evidence and data: looking at employee surveys, financial bottom lines, patient data and efficiencies with clear hypotheses and an analytical precision. Bringing this together against the vision and strategy, to make new decisions. Art is the judgment and wisdom that leaders bring to the room. Data mustn’t drive decisions. It can only inform. The lived experience of leaders and their teams allows for meaning, prediction and ultimately compassion.

So where to start? Use science to consider the best clinical service model design. Consider how this needs to be reconfigured for the future, incorporating recent learnings. For example, ensure that the advances made in digital health become embedded in business as usual.

Get all your data together. Don’t go fishing — you may catch something that throws you off course. Develop hypotheses to frame data analytics, such as hypotheses formed from human experience (your team, the patients, community). Look for fresh insights. If the analytics are only reconfirming what you already know, then perhaps you are not asking the right questions of the data.

Consider questions such as:

  • Have the frequency and nature of interactions between people and teams shifted? This may give evidence that staff need to solve operational problems and patient outcomes differently.
  • What data is sitting under the success or lack of success of established measures and targets (in addition to the obvious impacts of COVID-19)?
  • What factors co-exist to drive both positive outcomes for patient experience and staff experience?

Straight away we can see that the art of thinking well is critical to the use of science. Science alone can take us on the wrong path, if not given careful consideration.

The art of thinking, sensing and understanding people is critical to re-establishing organisational health in the healthcare sector. But where to start? Start at both ends of the hierarchy. Leaders need to start by forcing a practice of reflection. This involves stepping back and looking through the lens of our people to understand how we can best develop future leaders, as well as listen and actively respond to the needs of front-line staff. This alone will ensure the long-term health of our health systems and the people who work within them.

But take care not to fall into the mind trap of ‘rightness’. In the words of Jennifer Garvey Berger, rightness occurs when our instinct to believe that we are right closes us off to the ways that we are wrong. Health care is filled with examples of leaders believing in the certainty of their own views even as complexity grows.

Stepping back to step forward

To manage operational pressures effectively and sustainably in the long term, leaders and executive teams must create the space to step back and re-evaluate their system as a whole. While easier said than done, we have seen great progress from executive teams who take time out and are willing to refocus on strategy, as well as shape clear, medium- and long-term plans for recovery and transformation.

The first step to this is ensuring their organisation has a powerful ‘organisational vision’ to work towards, followed up by a clear, measurable delivery plan that provides staff and patients with the clarity to move forward.

COVID-19 brought healthcare leaders together around the single, sometimes bloody-minded purpose of tackling the pandemic that drove change at a pace we rarely enjoy.

Beyond the current crisis, it is now vital for leaders and staff to harness the same clarity of purpose and planning as efforts shift to the recovery and redesign of our clinical services.

Creating capacity and capability

During the pandemic, we witnessed health and social care leaders, both young and old, ‘run towards the fire’ to deliver the world-class performance we needed to care for our populations.

Now it’s time to capture all these learnings and better ways of doing, and use this to invest in our leaders so that they have the skills and networks needed to lead change. The opportunity is now to transform, re-create and realign our healthcare systems and capabilities for tomorrow.

Currently, health services are experiencing a wave of retirements, workers exhausted and exasperated by the pandemic. Now is the time to capture that loss of organisational memory and reflect on the internal networks which are so often relied upon to get things done.

Managers have started to lead in different ways. They harnessed the need, naturally co-designed with their teams and provided exceptional care. Their approach demonstrated the art of looking forward by bringing these experiences into consciousness — to reflect and learn. There was a natural ‘hot housing’ of innovation in nearly all frontline teams to make a difference. There was trust within a framework.

Yet we have observed the resurgence of anger and frustration in many hospitals, as business-as-usual creeps back in. Legacy systems and practices close back in to restrict leaders, and untapped potential is left to fade.

Some of our most recent work has involved bringing together cohorts of frontline leaders — including those who have run towards the fire and are ready for their next mission, and those reaching the end of their careers and investing in their co-development.

We hope to equip leaders with the skills they need to be the next generation of health system leaders, but also create networks which they can rely upon and mentors they can learn from. Investing in ‘pre-retirement groups’ can not only provide these mentors, but may also create opportunities to retain these experts in our services for another few months. This will have a significant impact on recovery efforts and retention of their institutional knowledge.

Using an approach that combines the art and science of organisational health has the potential to transform the healthcare sector beyond just effective operational management. There is a real opportunity to redesign our systems to be sustainable, efficient and fit for the demands of future healthcare services.

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