Centre for Innovation in Health Management

Category: News

Reflections from the Leadership Indaba

Alex Fox reflects on the learning from the Leadership Indaba.

This much we know

We know that we need prevention not crisis response – but that commissioners will not invest consistently in prevention, however much we want them to.

We know we need workers to act autonomously and take risks in the individual’s best interests – but that most large organisations will create systems which rule this out (because risks to organisations invariably trump the risks most important to individuals).

We know we need people to see themselves as sharing responsibility for their own health and wellbeing – but that the majority of professionals will feel they should look after the people ‘in their care’, and will risk criticism if they don’t.

We know that the most effective interactions are those we have with people we have had time to get to know, which can only ever be a small number – but that planners will always seek to work at the largest possible scale and see contact time as a reducible unit cost.

We know that to do the right thing consistently, we all need to act as if we are group of humans, but that we all act like we are the subjects of an all-powerful system.

In fact, there’s no such thing as the system: there’s only us and the relationships we have. So we don’t need to – and can’t – try to change the system. Instead we need different relationships with our peers and new relationships with people we haven’t previously thought of as our peers.

Here are four things I think we can do if we’re serious about radical change:

Shift power in the form of money: through handing control of money wherever possible to individuals and small groups, and spend money currently spent on procurement giving them the support they need to spend it creatively.

Shift power in the form of knowledge: through collecting data about the outcomes which matter most to local people and making it available to them in usable ways.

Shift power in the form of accountability. If now we feel accountable first and foremost to inspectors and finance managers, instead we need to ensure we account for ourselves regularly to groups of people who use services and other taxpayers, face to face.

If we do these things, we might just create spaces in our public services for the emotions which make the most difference: empathy, compassion, love.

Alex Fox, 21 June 2015

First published on alexfoxblog.wordpess.com

Alex is CEO of Shared Lives Plus, the UK network for Shared Lives and Homeshare. Alex helps lead on Building Community Capacity for the Think Local, Act Personal partnership and is working on the prevention agenda for the Social Care Transformation Group, having been the co-lead on prevention for the social care White Paper engagement exercise. He Chairs the NHS England, Dept. Health and Public Health England review of the Voluntary, Community and Social Enterprise Sector and is a member of NHS England’s Integrated Personal Commissioning board. He was one of NESTA and The Observer’s Britain’s New Radicals. He is a trustee of the Social Care Institute for Excellence and VoiceAbility.

Alex is an Honorary Assistant Professor at Nottingham University, Research Associate at ResPublica and a Fellow of the Royal Society of Arts (RSA), for which he edited The New Social Care. He has a regular column for Local Government Chronicle, blogs at alexfoxblog.wordpress.com and tweets as @AlexSharedLives.


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Innovation and Public Services: Insights from Evolution

Innovation and Public Services: Insights from Evolution

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Murray Anderson-Wallace

Murray Anderson WallaceMurray Anderson-Wallace is an experienced strategy advisor, independent media producer and writer with a background in nursing, social psychology and organisational communications research.


He specialises in the implementation of collaborative strategies in complex human systems, drawing heavily on his research and development work in relational psychology and the social dynamics of organising. His current portfolio is exclusively focused on the health and social care sector and includes strategic advisory work with several national organisations, campaign groups and networks including the Health Foundation, the Clinical Human Factors Group, the NHS Institute for Innovation & Improvement and NHS Quest.


Over the past 5 years he has developed expertise working with quality and safety issues in healthcare particularly focused on understanding new ways of working with patients and professionals who have been seriously affected by error and avoidable harm in healthcare. Murray has a specific interest in the moral and ethical dimensions of professional practice in this domain and has recently contributed to the Public Inquiry into the failings at Mid Staffordshire NHS Foundation Trust. He is Executive Producer of www.patientstories.org.uk, a social enterprise that has produced a series of short drama-documentaries to stimulate debate about quality and safety amongst healthcare professionals.


During the previous 10 years he worked on numerous consultancy and research projects in health, social care and urban development at local, regional and national levels and also gained valuable private sector consulting experience with AT Kearney, BP Amoco, London Underground and the Mott MacDonald Group specialising in strategic relationship management and cross boundary collaboration in large infrastructure projects.


Murray also has very considerable international experience, having been significantly involved in projects such as the Federal Government Initiative on digital development within tribal communities in the USA (sponsored by a Presidential Board) and a major research initiative with the Confederation of Danish Industry and the Central Trade Union of Denmark to foster cross boundary working in Industrial settings.


In the academic domain, he has taught extensively on postgraduate programmes in the UK, North America, Scandanavia and Ireland and was an External Advisor & Mentor at Leeds Metropolitan University and a Visiting Senior Lecturer at Birkbeck College, University of London. More recently he has lectured at Green Templeton College, University of Oxford as part of their Management in Medicine programme. Murray has published a number of articles and book chapters associated with social and cultural change within complex human systems.

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Seeing our problems with new eyes

Focusing our leadership attention

In the face of the need to improve every aspect of health services where should leaders focus their attention? Of the huge number of priorities usually framed in terms of pre-determined silos or services e.g. urgent care, mental health, co-morbidity in our elder population, long terms conditions, what do policy makers and commissioners focus on?

One of the joys of visiting other countries is that you see your own dilemmas through new eyes, it gives time to reflect on the issues in the UK that are truly local, those that are part of a wider continuum of changes in the developed world, and those that are global related to interdependence.

Talking with civil servants in South Africa they are grappling with similar questions in relation to designing and running health services as we have in the UK (although of course they have a significantly different in terms of poverty, education, and scale).

The common issues are as you would expect

  • how to ensure quality service for all;
  • how patients can be partners in the design of services, and how they can take more responsibility for their own health;
  • how to handle the volume and intensity of need at A&E (although their demographic is very different); and
  • how to support and enable innovation when crippled by the requirements of performance management and regulation.

Change in complexity

It is fascinating that high performing health systems have managed to focus their energy differently – on innovation and quality, leading to a decreasing requirement for and dependence on performance management and controls; and yet in these times of change, in the face of increasing complexity and decreasing capacity to fund services, the intensity of effort and bureaucratic costs remains focused on the latter. The analysis about the problem facing health services has been repeated many times over– in the UK we have been talking for years about our rising elderly population with complex needs, but our solutions have been ‘more of the same’ with no change to the governing systems for health services.  In the face of need for change where it’s not clear what to do – we haven’t chosen as a system what will work, i.e. support for self-organising groups undertaking rapid prototyping of new models of delivery, in an experimental mode which includes the role of policy and governance.

In high performing health systems front-line teams have data at their fingertips to inform decisions with patients, with professional self-regulation forming the framework for peer to peer review of quality and design and implementation of better flow, decisions, and patient experience.

Developing a skill set for the future

If we look ahead, and look at more advanced health systems you find that they have invested in different sets of skills:

(a) Professionals working in partnership with service users and communities in multi-skill teams

(b) Community development skills to reduce dependence on health and social care services and increase local solutions

(c) Data scientists to enable decisions to be based on what’s really going on

Our focus in the UK has been on how we develop clinical practitioners and leaders with a significant investment in future leaders through the Leadership Academy. But what if we don’t need more managers or more clinicians, but we need new professionals within the health system; and new relationships between existing professionals and patients? At Intermountain healthcare the tripartite team in a directorate is the doctor, nurse and data scientist. Their focus on getting costs as low as possible whilst providing excellent quality has led them to a different skill set. In the Nuka system in Alaska the ability to reduce hospital care has been through a focus on community assets.

Here we are facing the challenge now in real time with a skill set in the UK ready to work on the old dynamic. It is not changing the skills of managers that will change the system, it is changing the types of roles we have in the whole team. That coupled with a focus by our leaders on experimentation and quality could actually make a difference.

Becky Malby, Feb 2015

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Darzi Fellow, Rory Conn’s BMA Blog. VOICEBOX – Raising issues facing today’s doctors

I am beginning a 12 month ‘out-of-programme experience’.  Had someone told me what I started speciality training that I would apply for a leadership and management secondment, I would have thought them mad…and I am a psychiatrist, so that is saying something.

Overtly, my motivation was to broaden my training experience. Covertly, I hoped to bolster my CV and extend training, anxious to postpone consultant-hood. I arrived with what I considered healthy scepticism – with little to lose. I would learn how the other half of medicine management lived, but it might be dull and I probably would not gain much. I could not have been more wrong.

I have joined a transformation department. I am immersed in a new world where impressive strategic projects are planned with coherence and purpose. Within a week I was sold on the significance of improvement methodologies.

My team believes passionately in a culture of patient safety; their initiative, ‘zero harm, no waste, no waits’, increasingly pervades working practices across the trust.

It is exciting work: one of my projects is a national collaboration tasked with reducing iatrogenic harm on paediatric wards. There is value in investing in such teams.

Four full-time analysts in my team manage data steamed from clinical environments; potentially harmful events are flagged up in real time and can be averted. Who know such things were possible?

My fellowship comes with perks. People value my opinion and want my involvement in interesting projects. I now understand how the board of hospitals is structured and how strategic decisions are made. I have a greater sense of local and national medical politics.

Opportunities abound: a master class here and a postgraduate certificate there. I am encouraged to link systematically, and have seen organisational resistance to change first hand, so often present but so little discussed.

For too long, junior doctors have felt leant upon by their seniors to complete ‘audits’, usually in areas for which they have little passion. Trainees with no coaching gather small data sets and proposed unrealistic changes before moving on without ‘closing the loop’.

There is a paradigm shift under way. An increasing emphasis on quality improvement projects provides clear intent to enhance patient experience as well as leading that leadership is not a top-down process. Junior staff members must be empowered to effect change themselves.

So what is the downside of quality improvement? Well, I would love to rationalise the number of acronyms. Fortunately, a tool probably exists to do just that.

Rory Conn is a Darzi fellow in quality improvement and patient safety at Great Ormond Street Hospital, London and an ST5 in child and adolescent psychiatry.

Published in BMA, February 2015

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New diagnostic ‘health check’ toolkit for network leaders

NHS Improving QualityNetwork toolkit and Leeds University’s Centre for Innovation in Health Management are working in partnership on a new diagnostic toolkit, which will help the growing number of health and social care networks to be as effective as possible.

It is estimated there are now more than 100,000 networks in the NHS alone. They are springing up on an almost daily basis because of changes in health care delivery and the growing need for more informal, collaborative arrangements.

They range from small local bodies set up for specific short-term objectives to long-standing regional or national bodies. And they involve a diverse membership that can include professionals at every level, the voluntary sector and members of the public. Most tend to be more democratic, diverse and fluid than traditional hierarchical organisations.

The new online resource, launched on 12th November 2014, is a direct response to the demand from network leaders themselves for more information and support to make the most of their potential once they have been set up.

It brings together in one place all the current evidence and research on networks. At its heart is a ‘health check’ toolkit which enables networks to diagnose their strengths and weaknesses and develop an action plan. It also contains a ‘knowledge broker’ capability to ensure network leaders have the latest information. And it offers an online community of practice, allowing leaders to share challenges and observations with others.

The toolkit was developed as a result of needs identified by The Health Foundation network programme Organising to Connect, which worked with a sample of 30 managed, clinical and improvement networks.

Georgina Earle, Faculty and Networks Programme Manager at NHS Improving Quality, said: “We are really excited to launch this toolkit which will enable networks to ‘health check’ their capabilities. I am sure it will prove to be a key resource in the system used to help maximise the effectiveness and impact of networks.”

Rebecca Malby, Director of the CIHM, said that although networks were mushrooming, many remained uncertain about how to take them forward. “The website brings together all the latest intelligence and evidence on networks and will help leaders and champions understand the ebb and flow and life cycle of a network. It also gives feedback and practical recommendations on some of the key things that make networks thrive to enable networks to make the most of the talent within them.”

To access the tool please visit: www.networksdiagnostic.org.uk

Join the conversation in Twitter: #networktoolkit

Key Contacts:

The Centre for Innovation Health Management


Natalie Leach: n.leach@leeds.ac.uk

 NHS Improving Quality


Georgina Earle: networks@nhsiq.nhs.uk



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Rob Kenyon, Chief Officer: Health Partnerships talks about Leeds Institute for Quality Healthcare in relation to Leeds’ whole system approach to integration innovation

Rob Kenyon, Chief Officer, Health Partnerships, talks about how health and social care organisations in Leeds work together at the Integrated Care Summit on 14 October 2014.

This audio slideshow covers partnership working, the Leeds £, the pioneer programme and Leeds’ whole-system approach and cites the work of Leeds Institute for Quality Healthcare as a characteristic of high performing health and social care systems.

Rob Kenyon: Integrating innovation from The King’s Fund on Vimeo.

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Let’s support and develop the workforce to deliver the aspirations of NHS England’s Five Year View.

The Five Year Forward View published today clearly sets out the changes vital to securing the future of the NHS. Our health services face a challenging future and the only way to ensure that we provide sustainable quality care for patients is to plan seriously for that future. This is a welcome call and one that we support.

The focus must be to develop new models of care that work together to find local solutions for those that deliver and use service and find a new future for general practice.

A brighter future for the NHS is one where patients have more control of their own health; where services are co-produced at a local level with users; and where unwarranted variation is reduced enabling resources to be used in the best interests of patients across the systems.

While we fully support the report and this is definitely the direction we all need to move in, we must consider how we develop the professional workforce to deliver it. This whole system change will not be easy as it challenges current structures, power dynamics, the role of the professional and the public’s attitude towards the NHS.

Responding to the NHS England’s Five Year Forward View, Becky Malby – Director at the Centre for Innovation in Health Management, University of Leeds said:

‘The change set out in this report is absolutely necessary and requires real investment in new knowledge. This means scaling up some of the very effective leadership programmes that develop professional skills in co-production and integration. These programmes bring together clinical professionals, patients and managers to redesign care with and for the local population.’

At the Centre for Innovation in Health Management, our work focuses on changing attitudes, behaviours and leading as peers across primary and secondary care. This forms the foundations that underpin the aspirations of this report. The work we are doing in Leeds through the Leeds Institute for Quality Healthcare is taking steps to unlock the barriers in how care is provided across the city. We are working across the whole health economy, including primary & secondary care and the third sector to redesign care pathways with patients, service users and carers. We are enabling system leaders for make important decisions across the city to ensure better outcomes for patients. We are gathering real localised data across the complete pathway to make better, informed decisions together.

Leeds Institute for Quality Healthcare

Securing improvement in quality care by enabling clinicians to develop shared expertise in innovation and improvement; and developing a rigorous approach to professional accountability using data to review variation and decision-making. This focus creates a culture of best quality clinical care at the best value, with patients, service users and carers as partners in decision-making, across Leeds.

Postgraduate Certificate Co-Producing Health

Health and social care is increasingly moving towards the co-production of services to meet complex needs with users, carers and communities. We believe that where services are co-produced with service users and their carers, the resulting solutions are more appropriate to users’ needs, are sustainable, and achieve better outcomes. Co-production gets better results for service users, carers, providers and commissioners.

 Accountable Care Systems

The Leeds Medical Senate undertook a three day fact finding mission to Utah to explore system-wide shared accountability and clinically led quality. The missions sought to find out what conditions needed to be put in place to secure system-wide change. The visit provided exceptional insights into how to lead a complex system effectively for improved patient outcomes at reduced cost.

Key learning from the visit covered ambition,  attitude, shared accountability, focus on quality, improvement based on professional autonomy, principles of innovation and improvement, mature leadership, consistent narrative, incentivising innovation.


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Shaping Health Systems Network Annual Symposium 2013

In April  2013 we held a Shaping Health Systems Network Annual Symposium focusing on change through peer leadership. As a result of 48 hours together the network has generated a significant work programme as follows:

Establishing a new network for NGOs in health in the BRICS to learn from the UK in terms of partnership work – this will really address the decrease in Aid from overseas and the transition to self sustaining Soc Ents/ NGOs in Brazil, Russia, China, India, South Africa; and how to learn to partner better together. Lead from China

Truong Vihn Long Group

Support to the health system in Vietnam as its transforms to more localised care – we are going to run a seminar for the Ministry in Vietnam to introduce the ideas of community lead change; entrepreneurial innovation – and how to transform from a top down health system to a more distributed model. Let from Vietnam

  1. New partnership with the University of Gothenburg where they have a hospital which has been totally coproduced with the local population, and where they are interested in both coproduction and Leaders for Leeds. Lead from Gothenburg.
  2. Bringing Leeds together with the Bertha Institute for Social Enterprise in Cape Town for their new health innovation event in November, and with the public leadership forum in Stellenbosch – sharing the Leaders for Leeds approach. Lead from GBS Cape Town
  3. A new research bid with Gottenburg, Bucconi and Geneva on coproduction and chronic disease. Lead from Leeds
  4. Running a seminar on franchising health services in the UK– we want to get into the next stage of organising health services. Lead from Leeds with Ottowa.

Latest news:

  1. BRICS network for NGOs we are bidding for a seedcorn fund for this project from Worldwide Universities Network
  2. Vietnam – this is progressing with calls booked to do the first piece of design work
  3. Franchising – this is now in the design stage and we hope to run this in September with dial in facilities for International colleagues
  4. We have submitted a bid to the EU on patient empowerment
  5. Coproducing Leeds is presenting at the Cape Town Health Innovation Summit

Day 2 identified issues







Leading place based change as peers, University of Leeds, UK,  April 21st-23rd 2013

The Shaping Health Systems network is a precise social technology for harnessing the collective wisdom and energy of people working to generate the most effective health systems around the world. The network will produce radical improvement in local health services, and lasting, humane, needs-based social change that feels legitimate to people using those services.

The full programme for the event can be found here:

SHS Network Event – 21st-23rd April 2013 PROGRAMME INFORMATION


Group Myron

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Systems Change


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