Reflections on System Leadership during COVID-19

The COVID-19 crisis has created significant new challenges for system leaders but it has also created, new opportunities to learn. Here are four positive reflections on what we’ve learned from working with our clients who are system leaders over this period.


1) System leaders drive the pace of change like never before

One of the common things that our clients have recently been telling us is that, as system leaders, they have been able to affect change of a range and at a speed that they never had anticipated was possible. We have supported clients in the development of the NHS Seacole Centre at Headley Court, a new 300-bed community hospital, developed from concept to taking on patients in a matter of weeks. In a similar way to the development of the Nightingale Hospitals, the clear ‘burning platform’ has allowed for an unprecedented pace of change. Where we have supported the development of new hospital buildings in other times, we have planned on a 2-year process. There are inevitably some trade-offs in creating something in such a compressed timeframe, but the aspects of processes and models that were by necessity not perfect when the centre opened will be revised and refined as we learn more about what works.


2) System leaders are making really difficult decisions, and staff and patients empathise with that

System leaders had to make difficult decisions – such as completely reforming staffing within hospitals to meet the influx of critically ill patients and moving many aspects of care online. Such decisions would be difficult to make in ordinary circumstances and the risks of how staff and patients would react to such upheaval may lead to a cautious approach to roll out. With the circumstances around COVID-19, these changes have been put in place rapidly – in just a matter of a few weeks. What has been surprising is that staff and patients have been remarkably understanding of the changes made, even enthusiastically embracing such changes. For example, a large number of outpatient appointments have moved online within just a few weeks – a move which would have taken months to plan in ordinary circumstances.


3) It is possible to streamline governance

In pre-COVID times, for such changes the governance processes alone – often complex where integrated care and therefore a large number of organizations are concerned – would have taken months to get through. What has happened to allow these processes to be set aside for this period to allow such great change to be affected at such great speed? Organisation have had to trust each other, they have had to not get involved in every detail of the process, and they have had to know that the colleagues and the organizations they represent have the experience and knowledge of the system to be able to hold the needs of all partners in their hands and to make hundreds of tiny decisions on their behalf. [Individual responsibility]


4) The next few weeks are absolutely critical

We are at a critical point now, where some of the changes we’ve had to make because of circumstances could be adopted as part of the permanent culture and ways of doing things. There is a gravitational pull back towards old ways, unless leaders can recognize the value they have created by working together in different ways.