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Swimming together or sinking alone

Jill DeBene, chief executive at the Institute of Healthcare Management (IHM), reflects on the challenges to ensure successful place-based care, centred on the patient and built by everyone involved trusting each other and collaborating to make it happen.

Published by the IHM in early January, the ‘Swimming Together or Sinking Alone’ report drives home the profound changes needed among healthcare managers in values, culture and behaviour if the NHS is ever going to work as a system rather than the current poorly connected silos. 

The report by Richard Vize, a commentator on public policy and public services reform for 26 years, was launched at the IHM STP summit and has already had an amazing impact. The summit was attended by Simon Stevens, chief executive of NHS England and IHM Companion, Ed Smith, chair of NHS Improvement, Mark Lloyd, CEO of the Local Government Association, and Duncan Selbie, chief executive officer of Public Health England. It was an amazing event. There was standing room only and the summit and the report was at one point trending at number two on Twitter.  

Trust is the key word 

So what is it all about? To me it is the very essence of where healthcare in this country needs to be going and the true leadership behaviour we need to develop. Trust was the key word. This took me back to 1998 when I completed my MSc at Bristol University. My dissertation was based on my experience of working with two acute care trusts over the future design of services for their shared populations, with the two main hospitals being 25 miles apart. The aim of the work, which mainly involved clinicians, was to get the trusts to collaborate to develop a revised model of service delivery. The key then was the same: trust.  

In 1998, I had to conclude that the collaboration failed and any ‘trust’ that had been developed was undermined when one provider walked away from the collaboration as soon as they got their private finance agreed for a new build. Ironically, in years to come, they were put together into one trust and the clinicians who had been trying to collaborate had the change forced on them. The other reflection I will make now, 18 years later, is that the whole collaboration then seemed focused on the benefits of the services. The idea that it was for the benefit of the patients seemed to be limited to the time spent travelling and, of course, it was focused just on the hospital services. 

Reading ‘Swimming Together or Sinking Alone’, the cry for successful leadership is paramount. NHS is not just about beds or A&E or dementia or old age, it is the whole health and wellbeing of local people living in local places. K. Thomas, writing on Organisational Conflict in New York in 1979, argued that “collaboration requires trust in the other party(s) – trust in the other’s organisation and trust that the other(s) will not exploit oneself”. 

The stories from ‘Swimming Together or Sinking Alone’ reveal just how far the NHS has to travel to reshape itself around the needs of patients instead of organisations. 

The big leap of imagination that each manager needs to take is to see themselves as a leader of the entire system on behalf of the patient, not as a representative trying to negotiate the best deal for their hospital or service. 

The bedrock of systems leadership is trust. Without it there is no system, just individual institutions manoeuvring and negotiating. Trust in turn depends on the values of the individuals and their commitment to doing what is best for patients and communities. 

‘Swimming Together’ has fascinating insights into how NHS managers are coping with local government. Key to getting this relationship to work is engaging council politicians and managers early and openly. This means listening to their views and ideas, not lecturing them on what needs to happen. 

System leadership is essential 

Perhaps the biggest weakness so far is the lack of focus on involving staff and patients in sustainability and transfoation plans (STPs). The timetable has been so hurried that few, if any, areas have had time for meaningful consultations. That will have to change soon if the plans being put to NHS England are not going to be derailed by staff and public resistance. 

Systems leadership is not just another NHS initiative; it is the way the service has to be run if it is to provide a clinically and financially sustainable service. The changes in management practice highlighted in this report need to permeate every part of the health service. 

In some ways, the similarities between my original work in 1998 and the work the IHM has just launched could be depressing. I don’t see it in that way at all. My original research, including work by Moss Kanter (1996 World-Class Leaders: The powering of Partnering) published by Jossey Bass, gives me hope. She talks about “entrepreneurial leaders who are building new models for their industries are thinking across boundaries and leading through partnering, forming networks and managing collaborations”. 

At the IHM we believe the health and care system can make the same progress, and the system-wide leadership will thrive and deliver the change of climate we need. It won’t be easy. IHM will help our members through the NHS and related organisations to understand the challenges and develop the behaviours that are needed to ensure successful place-based care, centred on the patient and built by everyone involved trusting each other and collaborating to make it happen.

For more information

The ‘Swimming Together or Sinking Alone’ report can be accessed at:

W: www.ihm.org.uk

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