Making the move to system leadership

by Ewan King

18 April 2019

Leaders need to develop range of skills for integrated care systems

I recently presented some research we produced for the NHS Leadership Academy to an HFMA masterclass on system leadership in the NHS.

The focus of the research was particularly on integrated care systems, which seek to bring organisations together to improve population health, and which will be England-wide by 2021. 

As someone who works mainly in social care, and rarely with finance directors I was a little apprehensive. Would they be interested in the research? Is it financial enough?

But I shouldn’t have worried. The research I presented describes a new reality for leaders in the NHS, one where they will have to increasingly share power, work across organisational boundaries and focus on population outcomes. As one participant put it: ‘we will need to stop getting one over the other guy from down the road.’

Leaders in ICSs will need a range of skills. They will need to be able to identify innovation and then be able to implement it at scale. They will need to have a strong focus on outcomes – and not just those of patients treated by individual organisations, but the outcomes for the whole population.

This will require strong relationships with other leaders, which will entail working with them informally to develop joint priorities and plans. Governance structures will also be needed to drive change faster, initially taking that change forward in the places where the commitment and energy are strongest.

Leaders will need to understand the importance of cultural change and set the overall outcomes and expectations on behaviours, but then hand day-to-day decision-making to others.

Learning as we go will also be important. So leaders will need to ensure there is a framework in place to evaluate changes and share experience across the system.

Finance professionals will need to possess these skills and characteristics as they take a leading role in implementing these new ways of working.

The masterclass addressed a number of scenarios covering winter crises, implementing personalised care, cost saving exercises and hospital mergers.

One common question emerged from all these discussions. How do we work together across the system to tackle these challenges? But they also highlighted a number of other lessons.

  • Different professional groups use different languages and have different cultures. We need to take time to get to know one another 
  • We need to adopt a culture of ‘no surprises’ - communicating early and openly with our colleagues before meetings or announcements
  • Joint training and leadership development with other professional groups can help to grow trust, understanding and shared commitment 
  • We need to be open and transparent about our own organisational finances - however counterintuitive – and we need to move towards open book accounting.

Integrated care systems are here to stay and will pose huge challenges for leaders.  I am confident that senior finance professionals will rise to the challenge.


Slides from Ewan King’s presentation to the HFMA leadership masterclass, along with other presentations, can be downloaded here