Leading across complex healthcare systems: Learning from an action inquiry project

To focus solely on organisational management is no longer enough to be effective. Instead, healthcare managers and leaders must also pay attention to the behaviours required to shape organising within complex systems. The author, together with his collaborator, Dr Mark Gatenby, undertook research within a large UK rehabilitation unit over the course of a year. This work combined consulting with action inquiry and explored the challenges faced by healthcare managers and professionals as they grappled with the complex dynamics within their own complex hospital organisation and the wider region. A notable finding was that quite different behaviours are needed to positively impact on a complex system when compared with the behaviours that are often modelled by organisational managers and still taught in management development programmes. Ten relevant behavioural practices are shared, including purposing, empathising, conversing, leading for learning, influencing, role shaping, culturing, storying, languaging and reflecting. The ideas underlying these practices are described and the implications outlined. Suggestions are offered for action along with a few questions for individual reflection. The paper concludes that a refocussing of leadership development is required to stimulate individual interest in system behaviour. When combined with fresh approaches to commissioning management development, this is more likely to produce a new generation of healthcare system leaders.