Tackling physical inactivity and inequalities: implementing a whole systems approach to transform community provision for disabled people and people with long-term health conditions.

BACKGROUND: Physical inactivity is a global public health priority. There are known health and well-being consequences of being inactive, and the benefits of being physically active are well established. However, there are persistent inequalities when it comes to how physically active people are, with disabled people, people living with long-term health conditions, and people residing in areas of socio-economic deprivation being particularly affected. Methods such as whole system approaches (WSAs), which are dynamic, multifaceted, and engage all relevant stakeholders, have gained momentum as an approach to address such complex public health problems. However, evidence relating to the implementation of WSAs to address physical inactivity is lacking. The aim of the Prevention and Enablement Model (PEM) was to take a whole system approach in Essex to encourage and support disabled people and/or individuals living with long-term health conditions to be more active, happier, and to live more independently. METHODS: The aim of this study was to explore the enablers, challenges, and reflections associated with the process of designing and implementing the PEM. Semi-structured interviews (n = 12) were used to collect data from people involved in the PEM's design, implementation and/or delivery. Data was analysed using Braun and Clarke's reflexive thematic analysis. RESULTS: Four themes were identified: (1) Working collaboratively: Specific enablers of time and space were identified as important in the planning and implementation of a WSA (2) Leadership and planning: Distributed and flexible leadership was identified as central to successful implementation (3) Re-orientating practice: Highlighted the transformative potential of a whole system approach and how it contrasts with conventional work practices, and (4) Reflection and learning: Informing ongoing refinements and further implementation of successful system change. CONCLUSIONS: These findings highlight the challenge and complexity of implementing a WSA that involves diverse stakeholders from across adult social care, the NHS, and the third sector. Several important enablers are identified, such as leadership and planning, and the challenges and discomfort that can arise whilst changing systems. Ongoing efforts are required to ensure that different elements of the system collaborate effectively to address inequalities in physical activity participation, through the implementation of a WSA.

Opportunities to engage health system leaders in whole systems approaches to physical activity in England.

BACKGROUND: Physical activity plays an important role in maintaining good health and wellbeing, non-communicable disease prevention and can improve healthcare outcomes. Some progress is being made on incorporating physical activity into routine care, but less on engaging health system leaders in the 'whole systems' approaches which are increasingly recognised as important for addressing complex public health challenges such as physical inactivity. This commentary builds upon the findings of a recent study and aims to identify opportunities for engaging National Health Service (NHS) systems leaders in whole systems approaches to physical activity. OPPORTUNITIES FOR ACTION IN ENGLAND: Pockets of good practice exist from which lessons can be learned, but there are systemic issues that discourage and create barriers, and a need for meaningful engagement, leadership and action at national, regional and local levels. National and regional actors like Sport England, NHS England, health professional bodies, Active Partnerships, the Local Government Association and the Office for Health Improvement and Disparities can encourage and support government and the NHS to change policy drivers, culture and practices. Emerging opportunities include the 2021 White Paper Integration and Innovation, development of local integrated care systems, leadership from health charities and investment in non-clinical interventions ('social prescribing'). At local level, public health and physical activity specialists and other organisations have a key role as champions and facilitators of local whole systems approaches and engagement of local NHS leaderships. Finally, although whole systems action is about collaborative leadership, individual champions of physical activity can make a difference in influencing NHS leaders at every level towards whole systems working.

How do you develop systems leadership in public health? Insights from a scoping study.

OBJECTIVES: Systems leadership is widely acknowledged to be needed to address the many 'wicked issues' challenging public health systems. However, there is a lack of evidence on how to develop public health professionals into effective systems leaders. This study scoped the possibilities for developing the systems leadership capacity of public health specialists in England. STUDY DESIGN: This was a mixed-methods qualitative scoping study design. METHODS: The study involved three stages. In the first, a rapid literature review mapped key documents in three relevant areas: systems leadership theory and practice, the changing context of public health in the UK, and training and development for UK public health professionals. In the second, 29 stakeholders were consulted to understand the context and needs for systems leadership development in public health. A third phase involved stakeholders codesigning a potential development framework for the project commissioners. RESULTS: Four main themes were identified: the nature and purpose of systems leadership; development needs and opportunities for public health specialists; the enabling environment; and wider contextual factors impacting public health. CONCLUSIONS: Key principles of, and a framework for, a systems leadership development approach are identified, which could be applied to any public health system.

Systems leadership in practice: thematic insights from three public health case studies.

BACKGROUND: 'Systems leadership' has emerged as a key concept in global public health alongside such related concepts as 'systems thinking' and 'whole systems approaches.' It is an approach that is well suited to issues that require collective action, where no single organisation can control the outcomes. While there is a growing literature on the theory of systems leadership in a number of fields, there remains a lack of published empirical studies of public health systems leadership for professionals to learn from. The aim of the current project was to conduct cases studies in UK public health to provide empirical evidence on the nature of effective systems leadership practice. METHODS: Three system leadership case studies were identified in the key domains of public health: health protection, healthcare public health and health improvement. A total of 27 semi-structured interviews were conducted. Data were thematically analysed to identify the components of effective systems leadership in each case and its impact. RESULTS: The thematic analysis identified themes around 'getting started,' 'maintaining momentum' and 'indicators of success' in systems leadership. In terms of getting started, the analysis showed that both a compelling 'call to action' and assembling an effective 'coalition of the willing' are important. To maintain momentum, the analysis identified themes relating to system structure, culture and the people involved. Regarding culture, the main themes that emerged were the importance of nurturing strong relationships, curiosity and a desire to understand the system, and promoting resilience. The analysis identified three components that could be used as indicators of success; these were a sense of enjoyment from the work, resource gains to the system and shifts in data indicators at the population level. CONCLUSIONS: This study has provided insight into the nature of systems leadership in public health settings in the UK. It has identified factors that contribute to effective public health systems leadership and offers a thematic model in terms of establishing a systems leadership approach, maintaining momentum and identifying key success indicators.

Health literacy, governance and systems leadership contribute to the implementation of the One Health approach: a virtuous circle.

One Health is an important approach to addressing health threats and promoting health through interdisciplinary health, policy, legislation and leadership research to achieve better human and animal health and better outcomes for the planet. The Covid-19 pandemic has triggered an urgent awareness of the need to develop innovative integrative solutions to address root causes of such threats to health, which requires collaboration across disciplines and amongst different sectors and communities. We explore how achieving the Quadripartite Organizations' One Health Joint Plan of Action can be supported by the concepts of 'One Health literacy' and 'One Health governance' and promote both academic and policy dialogue. We show how One Health literacy and One Health governance influence and reinforce each other, while an interdisciplinary systems leadership approach acts as a catalyst and mechanism for understanding and enacting change. Based on our understanding of how these elements influence the implementation of the One Health approach, we describe a model for considering how external triggering events such as the Covid-19 pandemic may prompt a virtuous circle whereby exposure to and exploration of One Health issues may lead to improved One Health literacy and to better governance. We close with recommendations to international organisations, national governments and to leaders in policy, research and practice to enhance their influence on society, the planetary environment, health and well-being.

Redefining leadership within the NHS' complex adaptive system.

The NHS is continuously evolving and with it, traditional notions of leadership and management must be reimagined and redefined. In order to be effective leaders, however, we must first gain a deeper understanding of the context in which we lead and recognise how to navigate the system's intricacies. This article explores the characteristics of Complex Adaptive Systems and how we can understand the patterns of these systems through our experiences leading in the NHS. It then analyses leadership approaches both past and present and considers how future leaders can be effective in tomorrow's NHS. Finally, this article identifies potential barriers and challenges that leaders must overcome as they adapt and tailor their leadership approach to meet the needs of a dynamic health service.

Vaccinating a billion people against COVID-19: India's quest for systems leadership in exceptional times.

PURPOSE: In January 2021, India launched the world's most extensive vaccination campaign against COVID-19. It is estimated that India would need to vaccinate over a billion people to achieve herd immunity. Even though the Indian Government focuses on improving and delivering its vaccination programme, significant challenges still exist. This paper aims to discuss current challenges to scale up India's vaccination campaign and addresses strategies for achieving this. DESIGN/METHODOLOGY/APPROACH: The paper is based on a review of secondary sources, including journal articles from scholarly and grey literature and information available in the public domain. The search focused explicitly on the COVID-19 scenario, vaccination programme, public health management and systems leadership in the Indian health care system. FINDINGS: The analysis revealed that various factors have disrupted India's vaccination campaign, including shortage of vaccine doses, mandatory prior online registration, lack of infrastructure, safety concerns for older people, untrained workforce and absence of a solid public health framework. Furthermore, India appears to have struggled to reduce tensions and instill trust in its ability to effectively manage the COVID-19 pandemic and vaccination programme due to a lack of cooperation between union government, state governments and other stakeholders, namely, policymakers, hospitals, industry and community. ORIGINALITY/VALUE: The findings indicate that scaling up India's anti-COVID vaccination programme would require system-level leadership strategies that work within the country's limited resources. Deeper reforms in vaccine development, storage, delivery, training and regulatory frameworks are also needed to extend the world's largest anti-COVID-19 vaccination campaign.

Beyond healthcare leadership? The imperative for health and social care systems.

PURPOSE: This paper aims to make the case that there is a need to move beyond a focus on an approach to leadership development which is confined to health care only. It argues that, given the economic, financial, social and organisational context within which health and social care organisations in the UK operate, there is a need to develop leadership within health and social care systems, rather than within the existing "siloed" sectors. DESIGN/METHODOLOGY/APPROACH: The paper considers the context within which health and social care organisations in the UK operate; examines the nature of those organisations; makes the case for focusing on the health and social car system through systems leadership; and identifies the need for leadership, rather than leader development. FINDINGS: There is a danger of health and social care organisations "walking backwards into the future" with eyes fixed on the past. The future lies with treating health and social care as a system, rather than focusing on organisations. The current model is individual leader focused, but the emerging model is one of collective multi-agency teams. ORIGINALITY/VALUE: The paper seeks to go beyond a health-care-only focus, by asserting that there is a need to regard health and social care as a single system, delivered by a multiplicity of different organisations. This has implications for the kind of leadership involved and for how this might be developed.