I have the privilege of co-presenting a webinar tomorrow (2nd November 2017) with Harry Rutter on complex systems approaches in public health, organised and convened by the Health Foundation. You can find more details here and my slides for the event can be found here. What I intend to do in the time available is basically spell out what I think complex systems approaches can do in Public Health, and my journey, with colleagues, in applying them.
I’m not claiming this approach is better than others, or that I am an expert, but I am claiming they have value. And I intend to give practical examples, and share what I have learned.
Systems Approaches in Public Health
A group of us have come together to produce a website and blogspot on Systems Approaches in Public Health. The intention here is to provide practical resources and materials for people in public health as a starter place. We also want to encourage you to write for this and share your experience and issues.
The growth of systems thinking
It may just be me but in more places I look I see people considering systems approaches. I had a meeting today with police colleagues on how we identify opportunities to prevent crises for people with mental health issues, and found the senior police colleagues in the room taking a systems approach, explicitly. Yesterday I had a meeting with six elected members across three different portfolios and officers from each of them where we all, explicitly, adopted a systems approach to the issue of air quality. I see more people applying this.
To be honest, I see systems approaches as another set of very useful tools in my toolbag. They are both a technical tool and a leadership opportunity. I feel the same way about quality improvement methods, and the Generation Q Fellowship the Health Foundation has kindly given me, combined with what I am learning at Ashridge, is stuff I constantly can see applications for.
The Danger and the opportunity
The great danger of the rush to systems thinking is it becomes a superficial fad, and even worse, that Public Health somehow thinks it invented this. We need to guard against this. The opportunity is that systems approaches reflect the reality of the world we work in better, and can make us more effective. Diverse people and players can, if brought together effectively, have an impact on issues which are complex in their nature, made more complex by the often still to siloed nature of the public sector. Don’t get me wrong, I love the public sector, but we need to continue to strive to find new ways.
I look at my core public health colleagues working on tobacco control, on young peoples’ health, on suicide prevention and on environment and planning just as examples, and each of them is using a systems approach. For me this is a hallmark of their effectiveness.
The attributes of leading in systems
Finally, over the last few weeks I have spent time with a number of our graduate trainees in local government. This is a band of people who are fairly fresh to local government, passionate about public service (which frankly makes me love being around them) and passionate about value for money and value for people. It’s a joy, a challenge and a privilege working with this bunch. They energise, challenge, critique and roll their sleeves up.
In one series of conversations we were talking about the fact a few of them feel the public sector has great things but could be much better. My view is “hold onto that instinct, trust it and let it energise you.” This got us musing on the attributes of effective public leadership in the future. On 14th November I will be spending time working on leadership with people already in the system seeking to achieve registration as public health practitioners.
What I’ve learned from all this, and what I’ll be reflecting on 14th, is that the leadership challenge is changing rapidly at present. I think the world we are in needs five hallmarks or attributes of public leaders for the future, who can work effectively in systems. And here they are:
- The leader has a value base of service (the moral purpose of public service)
- The leader has a hunger for better outcomes, better value, better equity (what’s the point otherwise? Isn’t that why we all joined public health?)
- The leader has a preventive mindset – can think and deliver on how we keep people as healthy and independent as possible. I would argue not only is there a moral need to do this but an economic case too.
- The leader has a systems mindset – can apply systems thinking effectively, with purpose and outcomes
- The leader is comfortable and adept at leading across distributed and sometimes chaotic systems. The leader as part of this can orchestrate a range of disparate and diverse contributions to a shared purpose with benefit for all – from siloes to symphony.
I could add a sixth, which is sometime the leader needs to disrupt where things are really dysfunctional.
This is probably hopelessly optimistic for some of you. And indeed this is no small ask, is it? But it’s what I want to try to achieve.
I think it’s where the policy environment and fiscal climate is leading us. We are in a place in the UK public sector where national policy and the financial climate make realisation of local ambitions for our residents seem an almost impossible dream. It feels like a perfect storm, and counsels of despair are ever greater from many corners. The great temptation is to give up or hunker down and weather the storm in our siloes until things blow over. That seems a deceptively easy-looking option. And it’s the wrong one.
The challenge is to find a way of doing what we can to address ever more complex problems – mental health at population level, for example – and to do this with decreasing funding.
I believe working in a systems way, and working in the ways I have described above, are a promising way forward to weather the storm. We’ll see whether or not I’m right.
Anyway, we’ll see what tomorrow’s webinar brings!