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Systems leadership: a fad or food for the survival of our NHS?
  1. Louise J Hardy
  1. Department of Postgraduate Clinical Education, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
  1. Correspondence to Louise J Hardy, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth PL4 8AA, UK; louise.hardy{at}

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It is a term we hear more and more in today’s public sector. But what does ‘system leadership’ actually mean, is it important, and if it is, how do we develop ourselves as ‘system leaders’?

This short paper will explore the meaning of system, and then consider what skills are needed to create the conditions for leadership within and across it.

What is a system?

Systems leadership is a relatively recent concept, certainly in academic terms, and we are still considering what we mean when we talk about an organisation in terms of it being a system. The natural world has had it nailed for some time with its realisation that systems can be complex entities, which is to say that if you intervene in one part of it, there will be consequences (intended and unintended) rippling throughout its ecosystem.1 Medics and sociologists have realised for some time that the human body is a complex system. A patient with depression, or diabetes, or even a simple fractured hip is often in the grip of a range of contributory factors (social and health-related) which make clear diagnosis and treatment a tricky thing. Putting it another way, the behaviour of the system cannot be predicted from (or reduced to) the individual parts of that system in isolation.

Is an organisation a system?

Take a hospital. A simple organisation, surely? Not really. We would certainly like it to behave rationally, like a machine with well-oiled, predictable parts2 operating tidily within their own discrete sections. But if you cut the budget for estates and facilities, you will probably create another problem down the line within a clinical service. If your porters work to rule, all your operations will start to fall apart. Now, place the hospital within its wider extended family of social care, primary care, third sector and so on …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.