The Call for System Leadership

By: Paul H. Dworkin, MD

I am privileged to serve on the Leadership Council of the North Hartford Triple Aim Collaborative, an important, place-based initiative to promote the health and well-being of all residents of Hartford’s most disadvantaged neighborhoods. In preparation for an upcoming meeting, the convening backbone organization shared an article on system leadership from the Winter 2015 issue of the Stanford Social Innovation Review. The authors, Peter Senge, Hal Hamilton, and John Kania, are experts in systemic change and collective impact.

In calling for system leaders, the authors cite the host of systemic challenges beyond the reach of existing institutions, including poverty and inequity, and extoll the need for unprecedented collaboration among different organizations and sectors. We wholeheartedly agree. System leaders are, in the words of the authors, necessary to “catalyze and guide systemic change at a scale commensurate with the scale of problems we face.”

How do we ensure that our system leaders possess the requisite skills to achieve success? The article is extremely helpful in defining the core capabilities of system leaders. Specifically, they cite three core attributes: the ability to see the larger system, thereby enabling collaborating organizations to jointly develop solutions evading individual groups and work for the good of the whole system; fostering reflection and more generative conversations, enabling all to hear viewpoints different from their own; and shifting the collective focus from reactive problem solving to co-creating the future by building positive visions. Honest reflection should encourage those of us who are leaders to consider how we rate on these attributes, and encourage all of us to view our leaders through the lens of these core capabilities.

The authors note that system change requires more than data and information. In fact, the authors cite the frequency that “…interventions go awry through aiming at short-term improvement in measurable problem symptoms but ultimately worsening the underlying problems.” While our processes and efforts at system building are refined and enhanced through continuous quality improvement efforts, such as the Institute for Healthcare Improvement’s Model for Improvement, system leaders recognize the importance of distinguishing between short-term and long-term effects of interventions, and the extent to which collective wisdom emerges over time and results in new ways of thinking.

The authors suggest a number of tools that may assist in system building, such as systems mapping to promote a comprehensive understanding, peacekeeping circles and dialogue interviews to generate conversation, “peer shadowing” and “learning journeys” to bring disparate organizations together, and such multi-stakeholder initiatives as the Appreciative Inquiry Summit to get the “right people in the room” to shift from reacting to co-creating the future.

We are keenly aware of the need for a systemic orientation to address societal challenges. In our quest for real change, we embrace helpful tools and processes. Yet fundamental to success is the engagement of skilled system leaders. Our better understanding of critical core capabilities should enable our support for and encouragement of those best able to provide collective leadership.

REFERENCE 
Senge P, Hamilton H, Kania J.  The dawn of system leadership.  SSIR 2015; Winter issue.

Paul H. Dworkin, MD is the executive vice president for community child health at Connecticut Children’s, the director of Connecticut Children’s Office for Community Child Health and the founding director of the Help Me Grow® National Center.  Dr. Dworkin is also a professor of pediatrics at the UConn School of Medicine.  Learn more »

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