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New report calls for changes to systems leadership in health care

A team of researchers have produced a landmark review of systems leadership in health care, concluding that the NHS must better define what it needs from its leaders to address emerging challenges and policy changes.

Systems leadership in the NHS in England focuses on leading beyond organisational and professional boundaries to implement policy changes and meet budget requirements. However, despite increased recognition, there is no commonly agreed definition of what NHS systems leadership entails.


The NHS Leadership Observatory commissioned a team of researchers led by Dr Axel Kaehne and Dr Julie Feather from Edge Hill University’s Evaluation and Policy Unit to undertake the review of systems leadership, with support from Professor Naomi Chambers and Professor Ann Mahon from AMBS.

Their report identified that the NHS lacks a clear definition of what systems leadership means and what qualities NHS leaders need to fulfil their roles. It recommends carrying out further studies to close these gaps and writing a clear definition for NHS leaders to adhere to.

Effective leadership

Ann Mahon, Professor of Health Leadership at AMBS, said: “Effective system leadership and greater integration of care offer important solutions to demographic changes, financial constraints, workforce shortages and the gap between supply and demand that the NHS and healthcare systems globally are experiencing in the post-COVID world. It is important therefore to understand more about what good system leadership looks like and how we can support its development.”

The review is set against the establishment of 42 Integrated Care Systems (ICS) across the NHS in England in July 2022. These are partnerships between the organisations that meet health and care needs across an area, aiding in cooperation and planning.

The creation of the ICS means that more than ever NHS system leaders are required to have the skills necessary to steer and manage dynamic transformations across organisations. Adding to this is the need to balance longer term system sustainability with the reality of limited resources, all while improving population health outcomes and tackling health inequalities.


Recommendations in the report include examining the needs of systems leadership within the context of the newly developed Integrated Care Boards; exploring how Equality, Diversity and Inclusion (EDI) can be embedded into business as usual through the lens of systems leadership; and exploring how leaders can embrace technological advances.

Added Professor Mahon: “One of the important findings of our review was an almost universal absence of research on equality, diversity and inclusion as a critical perspective on the development of effective system leadership either from the workforce or the community perspective. This is a serious gap in the research that needs to be addressed.”

Complex set of skills

Postdoctoral Research Fellow Dr Julie Feather, who is part of Edge Hill’s Evaluation and Policy Analysis Unit, said: “Systems leadership refers to leadership attributes, qualities, behaviours, mindsets and actions which have a system-wide impact. This complex set of skills is essential in the modern NHS, but our report identified that leaders in the NHS don’t fully understand their role or the importance of being systems leaders which must be urgently addressed.”

Reader in Health Services Research and project leader Dr Axel Kaehne added: “Our report identifies the complexity of being a systems leader and calls for further analysis to determine what training and development will be needed to ensure NHS leaders are properly supported to be able to steer and manage change in an increasingly unpredictable external environment.”