Inspiration and challenge from health and education leaders

Our public health and school education systems have much in common. Both attract people who are motivated to help others. Both are challenged by a high tempo operating environment characterised by increasing expectations and scrutiny.

Health and education also share a growing focus on outcomes – for patients and students – as a key measure of success. And in both sectors, there is a growing body of evidence on the crucial role of leadership in lifting outcomes. Not just within a single school or health service, but at the system level.

Yet in both sectors the practical challenges of system-wide leader identification, development and management are significant. Progress has been constrained by complex systems, resistant cultures, limited data and a history of under-investment.

Nous’ work in hospitals and school systems has highlighted the exciting potential for shared learning and greater collaboration across sectors to address the challenge of system leadership. This paper explores the new approaches and ideas that some policy-makers, researchers and leaders are employing to develop great leadership and better outcomes, at scale.

Our health and education systems share the challenge to improve experiences, outcomes and value

The imperative to improve system performance in schools and hospitals has never been greater. In healthcare, heightened expectations from patients, funders and the community require that hospitals deliver greater value from investment in the healthcare system – in terms of safety, quality and efficiency. In Australian education, plateauing student outcomes and declining performance against global comparisons – after a decade of increasing school funding[1] – are increasing pressure to lift performance at a system level.

Yet across both sectors the path to success is complicated by strikingly similar challenges:

• complex systems, regulatory and funding structures
• emotive, personal and often political issues
• outcomes that are difficult to measure
• entrenched organisational cultures and ways of working.

In this environment, leadership development in both health and school education has been constrained by a history of under-recognition and under-investment. Support and career pathways for current and aspiring leaders have been variable and, compared to other industries, the link between leadership and performance remains relatively unrealised.

Great leadership can drive high performing systems

There is a growing body of evidence globally linking quality leadership with improved outcomes in health and education.

In health, Michael West’s work with the King’s Fund highlights the positive impact of compassionate, collaborative leadership on patient and financial outcomes, organisational culture[2], safety and quality outcomes in hospitals[3], as well as innovation[4]. Similarly, Nous’ recent research with the Australian Commission on Safety and Quality in Health Care found great leadership to be amongst the most important organisational attribute of high-performing, person-centred health services, in Australia and internationally[5].

Equally, when things go wrong in healthcare, an absence of leadership – across organisations and systems – is frequently identified amongst the root causes of adverse outcomes[6].

In education, a global study of the world’s top performing school systems showed the causal link between school leadership, quality teaching practice and student outcomes[7]. In particular it is instructional leadership, with a strong focus on the quality of teachers and teaching, that impacts student outcomes[8].

Four common priorities cultivate leadership that lifts system outcomes

At Nous Group our work with a range of clients across health and school education has identified specific ways that stewards of both systems should think about leadership to improve system performance. We recently discussed these with four leading thinkers representing both sectors:

• Steve Munby, former Chief Executive, the UK’s Education Development Trust and National College for School Leadership
• Professor Christine Kilpatrick, Chief Executive, Melbourne Health
• Dr Jim Watterston, Dean of the Melbourne Graduate School of Education, University of Melbourne
• Professor Euan Wallace AM, Chief Executive, Safer Care Victoria.

1.     Set a clear direction that balances vision with pragmatism

Lifting leadership across a system starts with a clear strategy and a comprehensive framework. Think holistically to establish the overarching objectives and required performance change. Talent identification, development and management each play a key role.

Implementation then requires pragmatic choices to be made that reflect the local context and resource constraints. Focus on the initiatives that can deliver quick wins, and build evidence, momentum and support for more ambitious change.

Importantly, scaling thoughtfully is as much about working with the dynamics of the system – where the demand surfaces, where the energy develops, where the priorities shift – as it is it about implementing an infrastructure of development and support. The work of cultivating great leadership seems, in the cases we discussed, an adaptive practice, rather than a carefully executed march to an “end state”.

2.     Service leadership that supports others to improve

Most teachers and health care providers are trying to do the right thing. Sometimes, they just aren’t sure what the best thing is and can do with some help.

The type of leadership that helps teams continually improve their performance is leadership that listens, helps and coaches. By contrast, when people experience leadership as a function that only observes, measures and punishes performance, they can’t do their best work.

Importantly, ongoing improvement is enabled by a climate of psychological safety, in which people can suggest improvement, acknowledge failures and share lessons[9]. This can be hard to achieve in highly scrutinised, risk-averse settings, but our panel shared examples of how it can be achieved.

For Christine Kilpatrick, this is achieved through a greater focus on leaders and building a culture that provides a safe environment for every staff member to come to work every day to deliver the best outcomes to patients. The safety of staff is critical and works hand in hand with patient safety.

3.     Set the course for improvement, for all

System improvement has sometimes meant recognising the top performers and intervening in health services or schools that are struggling. Often, under-performing leaders are replaced. Often, the performance of high performing schools or hospitals plateaus. The system as a whole does not get better.

Not only has this approach not worked at a system level, it is also unsustainable. There are insufficient “top performers” to go around, unless we invest in growing those leaders from within.

Supporting all leaders to get better is about helping all schools and health services – regardless of their current performance – to set an improvement agenda, and giving them the support they need to execute upon it.

Jim Watterston shared an example from his experience as Director-General of the Queensland Department of Education of ’inverting the pyramid‘ – putting those directly delivering student outcomes at the ‘top’, with the rest of the system working to support them to be the best teacher they can be in the classroom.

The role of measurement is interesting. No one believes that schools or hospitals should be entirely driven by metrics that are measures or indicators of the outcomes they strive for – this stifles innovation, contextualisation for local conditions, etc.

Steve Munby shared the example of the Welsh school system, which abolished compulsory tests, replacing them with more teacher assessment in 2004. The unintended consequence was that teachers and therefore the system lacked focus. This prompted a reversal, leading to a greater stress in the system and a narrowing of the curriculum around what is tested. Now officials are developing a middle way, co-designed with school principals, that includes accountability based on data but also peer review and local indicators of success that relate to context.

The moral of the story: clear outcomes and focus are vital enablers of purposeful, ongoing improvement.

4.     Develop lateral leadership with peer challenge

The most successful education systems in the world are highly networked. Munby has written recently about the transformational power of networked educational leaders[10].

One of the most positive insights from recent research has been that when schools help each other to improve, they all get better. The ‘good’ school with great outcomes that helps the struggling school, itself improves through the act of helping. Both schools’ performance improves faster than the national average[11]. This is preferable to dismissing the underperformer and trying to find a higher performer to replace them, especially given the difficulties of finding that replacement.

The notion of ’leading from the middle‘, across formal boundaries and authoritative powers, to improve outcomes is an exciting alternative to the polarised approaches of full autonomy versus central control.

Communities of Practice (CoP) can cultivate lateral leadership. The Victorian school system, in partnership with Nous, has developed geographic networks of schools as CoPs. These bring leaders together to agree and pursue priority objectives collaboratively using centrally provided tools that scaffold ongoing improvement.

Munby spoke about lifting school performance in the UK through peer learning and lateral leadership. By offering high status and system-level influence, they managed to attract hundreds of applications from school leaders to become system leaders. Selected principals were then specially trained to provide peer review and mentoring to another school leader.

The learning and improvement benefits experienced by both schools have meant that the UK’s National Leaders of Education Program, which started with 68 principals, has now grown to over 1,800.

Opportunities exist for greater cross-sector collaboration and improvement

Greater cross-sector collaboration offers an important opportunity to advance leadership development, thereby improving outcomes in schools and health services. Nous believes the opportunity can be progressed via:

• an ongoing system-level dialogue that brings policy-makers and system leaders together to share learnings and explore new ideas on system leadership
• building a shared evidence base on ‘what works’ across the sectors to provide guidance on leading practices and programs that can be adopted locally or systemically
• support for local collaboration that creates stronger peer networks between school and health service leaders within regions or communities.

Progress on these initiatives is underpinned by an increasing recognition of the value in cross-sector collaboration among the leaders of both sectors.

Nous is keen to foster an ongoing leadership dialogue in health and education

There is growing evidence that we can lift outcomes across complex systems through leadership that shapes a supportive, improvement-oriented culture and connects leaders across a system to improve together.

Nous is keen to pursue the rich opportunity to continue the dialogue across sectors to share successful practices and lessons.

Get in touch to find out more about how we can work with you to foster great leadership throughout our health and education systems.

Written by Penelope Cottrill during her time as a Principal at Nous. 

[1] Grattan Institute https://grattan.edu.au/news/why-we-need-a-feedback-loop-for-schools/

[2] West, M., Eckert, R., Collins, B., & Chowla, R., 2017. Caring to change: how compassionate leadership can stimulate innovation in health care

[3] Squires, M., Tourangeau, A., Spence Laschinger H.K. & Doran D., 2010. The link between leadership and safety outcomes in hospitals.

[4] Michael West et al, “Leadership and leadership development in health care: The evidence base

[5] Australian Commission on Safety and Quality in Healthcare (2018) Key attributes of high-performing person-centred health services.

[6] Multiple healthcare reports including Towards Zero and various NHS reviews.

[7] Michael Barber & Mona Mourshed, How the world’s best school systems come out on top”, McKinsey 2007.

[8] Australian Council for Educational Research (ACER) research paper.

[9] West, M., Eckert, R., Collins, B., & Chowla, R., 2017. Caring to change: how compassionate leadership can stimulate innovation in health care.

[10] Steve Munby & Michael Fullan, Inside-out and downside-up: how leading form the middle has the power to transform education systems, 2016

[11] Bentley and Cazaly, 2015.