Commissioning in health and human services requires a new kind of leadership | 🕒 7-min read.
The fundamental shifts around commissioning and service delivery in health and human services require a new kind of leadership.
Markets, delivery models, technologies and consumer expectations are moving fast. Leaders – and their teams – need to be equipped with new skills, capabilities, and approaches to succeed. Agencies that fail to transform their leadership won’t be able to keep up with the pace of change, which could ultimately put service outcomes at risk.
The pace of change in the health and human services sector is accelerating. Organizations need to be agile enough to keep up with demands for improvement from individuals and society. As part of the move towards market-based reforms and commissioning, technology is playing an ever-increasing role in policy and delivery. New leaders must have an understanding of the new tools available, such as data, analytics and social media, to drive evidence-based policy and seamless delivery for a digital age.
As more services are integrated at the point of delivery, the different organizations involved need to present a single, coherent ‘face’ to consumers. This requires leaders who can effectively lead disparate teams across different organizations towards a common goal, so that consumers experience one joined-up service. At the executive level, leaders also need to be adept at forming and maintaining effective cross-agency partnerships, while maintaining the ethos and values unique to their own organization. This takes a new style of leadership.
The days of leadership based solely on hierarchy or job title are long gone. Leaders need the skills to empower and inspire their teams, while also being comfortable with a much greater degree of devolved responsibility and self-management. A beacon of innovation in this area is the Buurtzorg home care provider in The Netherlands, which has self-managed teams to provide nurse-led care to patients1. Successful leaders need to be able to adapt to these evolving models of devolved care, to nudge and steer their teams in the right direction without micro-managing every step on the journey.
Leaders in health and human services traditionally lead teams of similar people, for example, a team of physiotherapists or a team of social workers. These teams tend to respond in similar ways to certain leadership styles or approaches. New models of delivery, however, will rely on disparate teams of people with different skills and priorities. Leaders need to be agile enough to adopt leadership styles that appeal to and motivate diverse teams.
Increasingly, when working with integrated organizations or teams, leaders will be responsible for people they do not directly manage. This requires new skills, like influencing and persuasion, to empower and motivate people who are outside their direct line of management.
A common weakness of leadership development in the public health and human services sector is that leaders do not receive adequate or appropriate training.
In health, many people reach ‘leadership’ positions based on their technical skills – such as a surgeon who becomes a Medical Director – without being given the chance to develop the core leadership skills required.
In human services, the contrast between technical skills and leadership may be less visible. People move into leadership positions for a range of reasons, including professional and engagement skills, but often still lack the formal training and support in the development of required leadership skills.
The award-winning NHS Leadership Academy is beginning to change this. The Academy provides a range of programs from a universal course for foundational leadership skills to a dedicated program for new CEOs. It develops leadership skills across the workforce from graduate trainees, through first time leaders to people progressing to senior roles. It also runs specific programs for black, Asian and minority ethnic (BAME) colleagues to promote diversity in leadership and sustainable inclusion within the NHS. In helping to co-design and co-delivery the Academy, KPMG in the UK led a consortium of consultants, UK and international academics, and technology and design experts, and recently won gold at the EFMD Excellence in Practice Awards.
Increasingly, governments are looking to reforms to improve outcomes and to drive improved public value. This is fundamentally changing the relationship between government, service providers and consumers, and presenting new challenges for leaders.
Implementing effective leadership in this environment requires leaders who are equipped with balanced personal and professional skills.
Key personal skills – Confidence and persuasive skills balanced by authenticity. Saying, “I am not sure” occasionally, and then helping to identify the answer, enhances credibility and makes the overall message more compelling
Key professional skills – Focused purpose and resilience balanced by agility and an understanding of the organization and their team. Great leaders feel the pulse of the organization and are in tune with the mood and energy of their teams enabling them to set the direction and empower their people to deliver.
Organizations must create supportive, nurturing environments that encourage leaders to upgrade their skills to tackle new challenges, and provide a skills and training framework that enables them to do so.
Regardless of background or professional experience, it is unrealistic to expect people to automatically possess the skills needed to be successful leaders in new health and human services environments. You can't simply give people a new title and a book and expect them to get on with it. It is said that you need to practice for 10,000 hours to gain mastery of an issue. Leadership is no different.
In recent years, this has been recognized by organizations around the world. In Canada, public sector leaders in Ontario are participating in a series of ‘commissioning boot camps’ to gain the knowledge, skills and understanding to lead effective market based reforms in human services. The NHS in the UK has the Leadership Academy, and the South Australian health system has invested in a 2-year development program for its top 250 leaders.
Leaders also need to be given time to develop the required skills. In Harvard Business Review’s recent study of the top global CEOs2 , the average tenure among the top 100 was 17 years. In contrast, in the UK and Australian public health sectors, the average tenure is around 2 years3 . How can the public sector experience improve? Firstly, by providing leadership development support that doesn’t wait until people are in leadership positions. The work that is now underway in Canada, the UK and Australia points the way to a future where people are given the time and tools develop skills prior to a leadership role.
Diversity must be embraced, too. If you always ask questions to similar people, you end up with similar solutions. As well as reflecting the population you are trying to serve, a more diverse range of leaders can help to challenge and push an organization to think better, deliver more effectively and achieve greater heights – even if it is uncomfortable getting there. There are emerging organizational role models in other industries that can be a beacon for public bodies. The key here is that leadership can drive diversity by words and actions.
Finally, organizations must foster environments that are designed to unleash innovation. Today’s challenges need smarter, ‘second order’ solutions. First order solutions are about working harder to extract greater efficiency, like the way an airline manages the flow of its check-in queue at the airport. Second order solutions rethink this completely: ‘what if consumers checked in themselves online, eliminating the need for a check-in desk entirely?’ In human services, first order solutions are about how to get greater efficiency in the current system to reduce waiting lists and improve access. Second order solutions might involve putting funding in the hands of the consumer and allowing them to shape the market through the choices they make.
Second order solutions are already transforming service models in the health and human services sector. But leadership also needs to be transformed, to implement and embed the changes necessary for long term success.
The world we are working in today may be changing, but those changes are only going to get faster. The health and human services sector needs leaders who have the skills to build on the opportunities of change, not be frustrated by the challenges.
1The History of Buurtzorg
2Harvard Business Review, November 2016.
3Leadership vacancies in the NHS, Ayesha Janjua, December 2014, The King’s Fund.