Director of Systems Leadership,
Recently I attended a presentation on progress towards new ways of working in a region. As in many other areas, people were looking to join up different aspects of acute and community healthcare with GPs, social care and other sectors, all with a view to getting more access to information and joined-up services that worked better for patients and service users.
The joining-up, in terms of the kinds of data being shared and the systems involved, was exactly the same across the region. What was striking was the difference in take-up by professionals. In one area, there was almost 100% commitment, and nearly all had some degree of sign-up.
But there was one area that showed zero – yes, zilch, zero, de nada – adoption. If an area could fold its arms, cover its ears and close its eyes at the same time, it could not have made its views clearer. What this shows – at least to me – is that data-sharing isn’t just, or even mainly, about the data. The fundamental requirement is to have robust enough relationships at different levels so that people feel able to talk with each other, offline, about the difficult issues, and to do real work. This is as opposed to the many things people can do to avoid work – having lots of pointless formal meetings that change nothing, giving the problem to people who aren’t in a position to do anything about it, pointing the finger of blame at hapless individuals, or hiring expensive consultants.
This is because we’re dealing with complex systems – interconnected networks of organisations, individuals and information, where the issues are new and multi-layered, there isn’t a natural start or stop point, and uncertainty is part of the mix. There’s a nice phrase that ‘systems move at the speed of trust’. So if you want to get real movement and progress, you need to build the trust, which in turn means taking time to build the relationships.
In other words, you need Systems Leadership – the kind of leadership you use when no one person is in charge, you need to ask a lot of other people for their views, and you need to work across boundaries. For the past three years, there’s been a national Systems Leadership programme, backed by the NHS, Public Health England, the LGA and social care, and providing on-the-ground support in some 60 places around the country. You can read more about this in a recent report, The Revolution will be Improvised II, and in an independent evaluation, The Difference that makes the Difference.
Much of this work involves health and social care integration, and the support involved includes coaching people to strengthen their leadership capacity and build relationships across traditional divides.
One project we worked on involved a Multi-Agency Safeguarding Hub (MASH) in Nottinghamshire, where data-sharing was a central issue. The MASH involved partners from the NHS, police, fire service, probation service, education and adults’ and children’s social care. Initially, although there was real commitment to joint working, performance fell back because of bottlenecks, and different agencies found an impressive number of ways to blame each other. The way out came not through new technical solutions – although new processes were an outcome – but by people taking the time to listen to each other and understand how the world looked through other standpoints. In other words, it was about creating relationships. The upshot was a much better-functioning MASH, with information being shared better, earlier and more appropriately. The key to the approach now is that information is used to work out joint solutions, rather than being ‘lobbed over the fence’ for someone else to sort out.
So if you want to share data, start with the system and get some Systems Leadership going in your place. It might take time, but we know it can make a real difference in how, and how widely, information gets shared and used in practice.
Debbie Sorkin is Director of Systems Leadership at the Leadership Centre. Debbie.firstname.lastname@example.org, @DebbieSorkin2
 This originally came from Kelechi Nnoaham, Director of Public Health in Plymouth.