Networks are increasingly important in addressing many of the challenges we face across health and care. 

I first started to realise the power of networks about ten years ago. At the time, I had been recruited by Cincinnati Children’s Hospital to manage a research project to study how network approaches could be used to improve healthcare. We sought to answer questions including: how might we better harness the motivation of our clinicians and researchers? Are we using the knowledge and intelligence of patients and their families? Could we create a better care system if we did? We partnered with the ImproveCareNow network to test and learn together.

What we found was that complex problems cannot be solved by any single discipline. We wanted a system that allowed patients and physicians to share information and collaborate to solve problems. We needed networks to bring people together from different disciplines, build relationships and enable them to collaborate effectively. We created such a system using learning networks and measured our success in the outcomes we improved. 

I’ve been very fortunate to work with several sophisticated networks and had the opportunity to learn from and observe highly skilled network leaders. Here are six things that I’ve learned that effective network leadership requires:

1.  Champion purpose.  Networks need a clear purpose and vision in order to unify members. Network leaders must ensure that initiatives or any asks of the members always serve the purpose of the network. There needs to be clear progression towards that purpose too, and it falls to network leaders to refocus conversations and ideas when they stray.  It’s essential to motivate members, drive action and overcome inertia. The ImproveCareNow network starts most of its meetings by having a network leader state the network’s purpose and reviewing progress towards it. This helps to ensure that the overarching purpose drives activities, discussions and decisions.
2. Translation and common language.  Skilled network leaders bring together people from different disciplines. That will mean they use their own professional vocabulary, jargon and often use the same words to mean very different things. This confusion prevents effective communication and collaboration and hinders the development of trust. Network leaders need to be sensitive to this and be able to translate across disciplines and help people with different backgrounds, calibrate around language and build shared understanding. 
3. Credibility.  Networks often rely on discretionary effort and voluntary contributions from members. So leaders must often appeal to people’s motivation to contribute to something bigger than the organisation they work for. Network leaders typically do this without formal authority but use their influence and persuasive powers to convince skeptics, recruit new members and ask members to contribute further and serve the network. This often requires credibility that comes from independent accomplishment within the field.
4. Spread the credit.  Networks rely on a culture of generosity and contribution that is set and signalled by network leaders. Successful network leaders frequently and liberally praise members for their contributions and make sure that all recognition of the network’s achievement is attributed to the whole network. I first found out that the ImproveCareNow Network had received the prestigious Drucker Prize when I received a phone call from one of the network leaders congratulating me and thanking me for my contributions. In addition to the positive recognition I felt, the call also increased my feelings of ownership of the network encouraging me to contribute further. 
5. Take responsibility. It seems obvious, but it is worth repeating that strong network leaders are also willing to take responsibility when things go wrong and use set-back as an opportunity to model reflective practice and learning from failure.
6. Develop more leaders. The best network leaders constantly seek to develop more leadership from the community and are delighted when opportunities to share responsibility present. It is about being comfortable with letting go of control to share power and decision making with others. This involves proactively giving people the opportunities to take on more responsibility, motivating and empowering them to contribute as much as possible.

Leadership of networks is hard and requires a different approach from the traditional command and control style found in hierarchical organisations. It involves almost constant communication to champion the network and keep up the drumbeat of activity as well as putting in the time to convince skeptical stakeholders of the network’s value and possibilities.

But the benefits are worth the effort. The potential networks offer to transform care means that networks are particularly well-suited to responding to complex challenges. Using a flexible and distributed structure is especially effective when navigating uncertainty and rapidly changing circumstances, and things have rarely been as uncertain as now. 

George Dellal

George is an expert in learning network design and support. His background is in healthcare improvement, innovation and consulting. Before joining Kaleidoscope he spent eight years as a Senior Quality Improvement Consultant at Cincinnati Children’s Hospital, working on the design, and implementation of several learning networks. He has also worked with diverse stakeholders to design and develop chronic disease networks for diabetes, cystic fibrosis, inflammatory bowel disease and other conditions. Including the award winning ImproveCareNow network, acclaimed as one of the world’s leading improvement networks. @georgedellal

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.