In September I joined an ‘Indaba’ facilitated by the Leeds University Centre for Innovation in Health Management (More participants’ blogs are here). Indaba is word from Zulu and Xhosa culture in South Africa, meaning a gathering for an important conversation; the approach of gathering together a small, diverse group to discuss public service challenges was pioneered by the CIHM’s South African associates. The participants in Leeds from the UK, Holland and South Africa shared a belief that something more fundamental was needed to save our healthcare system than shaving a few quid off what we do now. As one participant said, ‘We know what we are doing just isn’t working’. So what to do instead?

The conversation helped to identify two different directions which people come at this challenge from at the moment. At the moment people coming from each direction collide in the middle. We need instead to meet and talk.

The dominant way of thinking for many years has been from an organisational perspective. It addresses the challenge of how to do things on a large scale, efficiently using public funds to meet big challenges. The people who find it easiest to get their voices heard are generally those who are in charge of large amounts of money, manage large numbers of workers and serve large populations. If those are your responsibilities, you have to think big and broad and it is hard to create the space for deeper engagement with very diverse and personal experiences. People thinking this way seek efficiency, economies of scale and evidence.

Rapidly emerging is a perspective which wants to think at a more human scale. These voices are being heard more, partly because mass communication is open to those on a small or even no budget and partly because the stories they tell are often very compelling and speak to the human in all of us, regardless of our job titles. These voices are often driven by personal experience. They have depth and can sometimes see a more holistic picture at personal or community level, but they can struggle to think broadly and in big numbers.

I (fairly obviously) find myself coming from the second perspective by temperament and by virtue of working in a small organisation on behalf of members who do something very personal and personalised, but I think most people in leadership positions of some kind at times have to think in both ways.

People like me need to be able to set out how individually effective and often very diverse approaches can become the norm (“That’s lovely, but can you scale it up?” is the usual challenge). People who think organisationally need to be able to see the fuller, as well as the bigger picture, in order to address real challenges such as unhealthy lifestyles, rather than challenges interpreted through the lens of what, traditionally, an established service can do.

Two principles emerged from the Indaba: redefining the mission and having new conversations. The new mission needs to be for wellbeing at scale and it needs to be shared by us all. The conversations have to be new in terms of who is involved (citizens, communities, businesses large and small), how we talk to each other and what we talk about (creating wellbeing at scale, not fixing illnesses). An organisation in which the leadership team only think big and broad whilst the frontline workers only think deep and narrow is frequently going to find itself stuck or fractured.

There are many skills we will need to develop in order to have our own Indabas. Listening and empathy are two. But what might be hardest to develop is the ability to work with uncertainty, divergence and at times chaos and not to revert back into the false reassurance of bureaucracy.

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