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Adaptive leadership of the COVID-19 challenge in health and care

Andrew Liles and Philippa Darnton from Wessex AHSN share the features of adaptive leadership needed to respond to COVID-19 and future system-wide challenges

COVID-19 presents a new reality for health and care systems that needs to be met through innovation and a change in all of our values and beliefs in how care is provided. Recent workshops by Wessex AHSN, supported by Q as part of their work to aid rapid learning and improvement during the pandemic, provided insights into how 300 health system leaders in Wessex have responded to the challenge. In particular, this revealed ways in which they have adapted their leadership approach to this new reality.

Looking through the lens of Heifetz’s work on adaptive change and leadership, we identified five features of adaptive leadership that are likely to be important for building the capability of systems to respond to such challenges now and in the future.

Like everyone else, COVID-19 meant the working world for Wessex AHSN changed completely in March 2020. We chose to quickly re-orientate our priorities and how we supported our member organisations by providing rapid insight into the changes they were making to respond to unparalleled challenges. Our offer was to work alongside them to capture learning and help them understand the changes they would want to keep and develop in the longer term.

Fast-forward six-months and we have held workshops with 300 system leaders and worked with clinicians, professionals and patients to complete a range of deep-dive case studies on remote consultations and discharge from hospital. We have also run a successful workshop to bring together leaders from across Wessex and representatives from national organisations to reflect on all that has been learnt so far. We have been fortunate to have the support and involvement of The Health Foundation’s Q initiative and NICE Field Team in this work.

COVID-19 is an adaptive challenge that needs adaptive leadership

Heifetz defines an adaptive challenge as one that can’t be met by the existing technical fixes or repertoire of management responses. This challenge requires new approaches and innovation, and importantly, changes in the values, beliefs and assumptions of people and organisations. He describes the central purpose of adaptive leadership as mobilising people to tackle tough problems and to meet their new reality.

Five important features of adaptive leadership

Through our work with leaders in Wessex, we have uncovered examples of five features that are important to adaptive leadership when responding to challenges like COVID-19:

1. Frame the challenge as adaptive

Leaders quickly made it clear that a different kind of response was needed, and they used this to stimulate engagement and thinking.

In Wessex, we identified three common themes that capture how our local systems have understood and framed their COVID-19 challenge as different to their usual pressures:

  • It is a challenge that is shared and owned by the system.  All of our insight work demonstrated the response to COVID-19 is being driven and led within the system (health, care and public sector). New shared common purpose is giving this energy, and improved system relationships and greater levels of collaboration are common. National framing and simplification of system working has helped this.
  • The response requires a fast pace and agility. People describe greater delegation within their system and a sense of empowerment and less bureaucracy. Similarly, they have seen a greater tolerance for trying new things, encouraging creativity and adapting approaches. Top down clarity has released bottom-up agency.
  • The response requires more technology and innovation. We have measured significant improvements in the perceptions of digital innovation in primary care during the response. Much of the response has been planned and delivered by people working remotely in new collaborative teams.

2. Give the work back to the people

Adaptive leadership mobilises people across organisations to think, learn and work together on tackling problems – crossing traditional boundaries and hierarchies.

In Wessex, adaptive leadership has released a wave of stronger and more collaborative clinical leadership and cross sector team working. Staff who are part of this describe being energised and motivated ‘to do the right thing together’.

3. Regulate the pressure for change

There are practical and psychological demands for this crisis that need to be understood and managed by leaders, to keep the right balance between creative tension and giving up.

For Heifetz, the pressure that comes from an adaptive challenge provides leverage for mobilising people to learn new ways to deliver their service in the new reality – but leaders have to regulate this.

We have heard from staff that the things that added the most pressure during the peak of the first wave of the pandemic included back-to-back virtual meetings, information overload, the pace of change and having to change direction as guidance changes. The things that helped the most were good communication from their organisation and the support of their peers, family and friends. This is informing plans to support staff through a second wave.

4. Protect the voices of leadership without authority

Adaptive leadership engages people who are closer to the detail and who are able to influence the people that need to change.

In the North and Mid Hampshire local system, a ‘Friday zoom meeting’ began in late March and brings together c.100 clinicians from all parts of the system. It is informal and hosted by the CCG Clinical Chair and acute Trust Medical Director. Clinicians share their experience of COVID-19, offer support and advice and volunteer to take projects forward. It has continued to evolve and provides a platform for distributed system leadership that can go beyond the COVID-19 response.

5. Avoid distractions

The challenge for adaptive leadership is to avoid the things that distract from the real task and continue to support the conditions for people to learn and adapt to the new reality together.

Adaptive change isn’t easy. People hold their values dear and it can be painful to change or lose your role, routine or purpose. Heifetz warns against avoiding the hard work of adaptive change by getting distracted by – for example – blaming authority (externalising the enemy), wishful thinking (that it might go away) or focusing on less stressful actions (that won’t meet the challenge).

It is clear that there will continue to be significant adaptive challenges over the coming years. Our belief is that those that build their adaptive capacity now will be best placed to respond to this.

Read the full paper by Wessex AHSN

We’ll be hosting a session sharing this work and more on the topic of Leading and learning across an integrated care system at Q’s annual community event. If you’re a Q member, register now for the virtual event on 18 and 19 November, and book a space at this live workshop with teams from Wessex.

To keep learning more about adaptive leadership, you can also join the Acting into an Emerging Future webinar on 1 December, organised by the Exploring Adaptive Space – community of practice.

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