The practice of system leadership

What skills do you need to be a system leader?

What are the barriers to more collaborative working?

And what more needs to be done to develop system leaders?

The practice of system leadership: being comfortable with chaos draws on the experiences of 10 senior leaders to explore these and other questions. Interviewees include the chief executive of a large county council; people who have led integrated care projects; those working with clinical networks, clinical senates and academic health science networks; a whistle-blower; the head of a large voluntary organisation; the chief executive of a large teaching hospital; individuals who have led (or still lead) NHS organisations at regional and national levels.


The report identifies the best strategies for achieving system change. 


Start with a coalition of the willing, build an evidence base, and build outwards; it is vital to engage clinicians to understand the need for change and lead efforts to deliver it.

Involve patients, service users and carers because they can play an invaluable role in helping to identify how services need to be redesigned.

Strike the right balance between constancy of purpose and flexibility, facilitating conversations about what needs to change and how, being flexible about how that might be achieved, and ensuring the momentum is there to deliver change despite the inevitable opposition.

Pursue stability of leadership, something that has proved very difficult in a context of frequent reorganisation of the provider and commissioning landscape.



The 10 interviewees set out – in their own words – the main challenges involved in bringing about the kind of system change needed so that the NHS can deliver the models of care people want, while at the same time tackling the unprecedented financial and service challenges ahead.