Peace, reconciliation and system leadership in health and social care in England

I worked in community relations promoting peace and reconciliation in Northern Ireland for four years prior to coming to work with the NHS in England in 2015. I wasn’t quite sure how my skills and experience would translate to the NHS; how is community relations work in a country emerging from conflict with the loss of three and a half thousand lives relevant to the cut and thrust of a modern health and social care system in England? As it turns out, more relevant than I imagined.

In a previous role as a good relations officer with the Irish Churches Peace Project, I focused on working with church leadership in a particular geographical area. My task was to engage the local leadership, tap into the common imperative for peace building within their shared traditions, and support them in setting an example of compassionate and collaborative leadership that would cascade through their communities.

These leaders were seen as our gatekeepers to creating more integrated and cohesive communities and we encouraged them, across denominations, to get to know each other, share their differences, acknowledge their commonalities and successes, lead, learn and be great neighbours together.

Committed to the spiritual wellbeing of their congregations, they had developed their leadership skills in an environment where they competed against other denominations for their congregations in a climate of ever constraining resources, convincing them that their spiritual truths, expertise and interpretation of the Bible would offer the best spiritual wellbeing outcomes.

Contrast this to my current post where I focus on working with NHS and Local Authority leadership across a particular geographical area or Sustainability and Transformation Partnership. My task is to engage, support and develop leadership, tap into the common imperative for improving health and social care and support leaders in setting an example of compassionate and collaborative leadership that will cascade through their teams and organisations.

These leaders are seen as our gatekeepers to creating a more integrated and cohesive health and social care system and we encourage them, across organisational boundaries, to get to know each other, share their differences, acknowledge their commonalities and successes, lead, learn and be great partners together.

Committed to the health and wellbeing of their populations they have developed their leadership skills in an environment where they compete with other trusts and LAs to be the best in a climate of ever constraining resources, convincing their patients/service users/customers that they have the expertise and interpretation of National Institute for Health and Care Excellence guidelines that will lead to the best physical and mental health wellbeing outcomes.

While there are clearly huge differences in the two contexts, the similarities I see are quite striking, and it’s not just in the context; it’s also in the type of leaders I encounter. Let me highlight three types of leaders I came across in ICPP and now in the NHS/LAs.

1) Open collaborators

Leaders who believe that the spiritual/physical/psychological wellbeing of their respective populations can be enhanced through learning from, and cooperating with, leaders from stakeholder organisations. They recognise the changing realities of the context in which they work and are willing to reach out, build relationships, take risks and explore how they can work more collaboratively and deliver more effectively on their wellbeing commitments to not just their own populations but to the wider community. They recognise that unity of purpose does not have to mean uniformity in practice, but it does mean actively seeking to learn from and cooperate with each other where the benefits are tangible.

2) False collaborators

Leaders who believe that through their experience and training, they have acquired something of a monopoly on how best to lead an organisation or initiative. They demonstrate behaviours which frequently patronise and antagonise other leaders and teams, often oblivious to their impact. They commit to meeting shared obligations by telling others to simply “do what I tell you”. They espouse the benefits of collaboration, then marginalise and undermine the collaborative by their actions, pursue with their own agendas, and cry wolf when others come together on initiatives that they have excluded themselves from. They are engaged in building their own mini empires, fixated on control, and genuinely believe that they are the exemplars of excellent leadership.

3) Guarded collaborators

Leaders who recognise the value of pursuing shared objectives as a collaborative but feel somewhat ill equipped or threatened by the possible implications. They have been practicing their leadership skills in competitive and siloed environments for many years. If the competencies for collaborative system leadership had been part of the person specification for their current post when they applied, they may not have gotten the job. Insecure in their own limitations and nervous of the intentions of some of their colleagues, they see the benefits in collaborating but aren’t sure quite how to lead effectively in this new world. They dip their toes in, testing the temperature, wanting to jump in but fearful of what lurks in the deeper waters of collaborative commitment.

If you buy the argument that there are enough similarities in context and examples of the types of leaders above, then you might also consider that lessons learned from working with one set of system leaders may apply to another set of system leaders. So, here are three simple lessons that I think health and social care can learn from peacebuilding with church leaders in Northern Ireland.

1. Build Relationships

In the context of peace and reconciliation in Northern Ireland we rarely started any meeting with an agenda and call to get down to business. We knew that down the line really difficult and challenging conversations were coming, possibly life changing conversations that affected whole communities. Before any difficult conversations could start, we had to get down to the serious business of trust and relationship building.

Jumping into difficult conversations before building trust and relationships meant that when things got difficult, people either put up barriers and withdrew, or attacked and antagonised. When trust and relationships had been built, we often still experienced some of these behaviours, but we also experienced breakthroughs, new understandings, a growing mutual respect and cooperation.

Working with LA and NHS partners, difficult and challenging conversations are coming with life changing implications that will affect whole communities.

The leaders and project managers who demand ”we get down to business” before doing the work of trust and relationship building aren’t showing leadership and haven’t grasped how system leadership works. Building relationships and trust isn’t fluffy organisational development, it’s the dirty hard work of establishing strong foundations that will stop the house blowing down at the first serious storm.

2. Talk to people, don’t hammer them

I met Ian Paisley about a year before he passed away and was fortunate enough to engage in a compelling discussion. One thing he said struck me as something I wished he’d applied as a leader many years before, and it was this “When you are talking to people, you aren’t hammering them.”

When working with health trusts and local authorities, people with different agendas and priorities, we often talk about and not to each other. My experience of the public sector is that culturally we are scared stiff off conflict, which paradoxically creates more conflict. Instead of turning away from conflict and misrepresenting the other, we need to approach conflict with an honest, open and curious mind. Conflict is an opportunity to do things better: we need to talk to, not hammer.

3. Love your leaders

Open collaborators are our advocates, our drivers, our champions, and it doesn’t matter if they are clergy in Northern Ireland or NHS leaders in England. Support them, encourage them, help them up when they fall, they aren’t super human. They need us to help them through and they, in turn, will make a huge difference to influencing improved health and wellbeing outcomes.

False collaborators still deserve our respect; they didn’t get to where they are without being very good at what they do. Being confrontational to, and critical of, them is playing to their strengths and reinforces a view that this is a competition to be survived, skewing the focus to “winning” and away from our health and social care goals.

If we want to promote compassionate and collaborative leadership we have to live it, even when others don’t reciprocate. I can’t guarantee our false collaborators will change if we do this, but I can guarantee that if we don’t, they won’t.

Guarded collaborators have the advantage that they have the emotional intelligence to understand their limitations. It is not their fault that someone has changed the rules of the game after they started. We need to support them, challenge them, guide them and stand up for them, building their confidence and empowering them to be the best collaboraive and compassionate leaders they can possibly be.

Finally, I attended a leadership event in Taunton last year where in a chat with author and speaker Margaret Heffernan she told me that the “NHS needs more people who have worked in peace and reconciliation” and I was bemused.

Now I believe for system leadership to work in the public sector, for us to achieve our STP goals, for us to deliver better health and social care outcomes for our shared populations, we could do worse than learn from some of the lessons of peace and reconciliation in Ireland.