Reflecting on the current winter crisis in the NHS, manifesting in ‘critical incidents’ being declared by a number of Hospital Trusts, I was reminded how complex ‘leading’ in the NHS has become. The focus of this article is on how action learning can provide a powerful process to support NHS commissioners as they grapple with complexity, change and difficult choices.
Dealing with complexity and change in NHS commissioning
Working in 2014 with a number of Clinical Commissioning Group (CCG) leaders on strategy development and service model design, I could see the real challenges of prioritising resources today with the need to implement whole system change over the next five years in order avoid the kind of crises we are hearing about this winter. Whilst grappling with budget limitations and in some cases inherited deficits, CCGs’ own resources are limited. CCG leaders are stretched, working across portfolios and are often involved in day-to-day operational matters as well as strategic commissioning and leading change.
In health and social care we are seeing an unprecedented level of complexity facing commissioners relating to whole system change whilst managing in today’s environment (see side bar). Overlaid on this are the current budget challenges, the political and public involvement in strategy and service prioritisation and the ongoing re-forming of NHS governance and structures.
The pressures, confusion and dynamics of the environment are massive for these leaders. Where can they go to step back, to make sense and meaning of this complexity and change?
Action Learning as a space to explore complexity, change and leadership
In an action learning set we have a number of leaders participating who will bring issues to work on through the group-led action learning process. This is essentially a process of inquiry into the issue and has the effect of enabling the person bringing the issue to explore its different facets. This could involve their own impact and feelings about their role in addressing the issue, exploration of the wider system dynamics and stakeholders and thinking through what is needed to achieve results. This exploration in a set of peers is reflective, supportively challenging and facilitates new thinking and perspectives – leading to action.
We work with the idea that in an action learning set, each participant is bringing their experience of the ‘system’ into the room. This means in a set of peers – in this case health and social care commissioners – there is shared understanding of the system and how it works. The action learning process however, encourages participants to identify and suspend assumptions and to focus on the issue through ‘inquiry’ – open questioning and reflection. This enables the issue bringer to open up to new ways of experiencing and thinking about their issue, and also, under the surface, all members of the group are opening to new ways of experiencing and thinking about their specific issues. This creates a rich process for collective learning about leading complex change. Specific time in the action learning set is available to share this learning and what it means for leading change.
An action learning set working in this way has the potential to learn together through this inquiry–action–reflection cycle across sets and the issues explored. The learning together will be about leading change in the complex health and social care system. The role of the set facilitator is to support both the individual and the group learning process – to enable insights about system change to surface and explore what these mean in taking forward action.