Leading by sharing and learning. By James Mountford & Inge Kristensen

As a leader in health and social care – why attend a conference on quality improvement?

Leading for better health is ever more complex and challenging, yet also ever more exciting since we have a constantly growing base of evidence and experience on which to draw.

Constantly exploring what “leading well” looks like today in a complex world with multiple needs and aims is increasingly necessary for leaders. We need new ideas, grounded in evidence about what works, when and where, and we need to explore and learn together to better meet the needs of service users and staff. This work is hard and relentless: we also all need some energy and inspiration.

The International Forum on Quality and Safety is the largest improvement-focused annual event outside USA, with around 3,000 participants.  It is a melting-pot of people from wide variety of settings, seniorities and countries. The conference continues to emphasise healthcare, but is increasingly integrating broader themes, aiming to broaden its focus to consider what helps people flourishing and live a healthy life.

Over recent years, awareness has grown that teamwork and a need to focus on staff wellbeing pair with the more technical sides of improvement, and these themes have been woven into the programme. Leading isn’t a one-off sprint, but more like a marathon: so content from the conference needs to be constantly available and built on, so a strong link between the forum and BMJ Leader is beneficial.

Three ‘red threads’

At the International Forum 2024 in London we aimed to integrate some of the challenges and solutions as a thread in all sessions in the leading stream.

First and foremost we changed the name of the stream from leadership to leading, signalling action and motion, instead of position, role and hierarchy. A mid-career doctor once said to one of us: “I’m not a leader; I just want to make my service better”. This reflected an odd theme in medicine that “leadership” is more the collection of trophies or rewards linked to seniority, rather than the service that comes with action. So rather than have an audience for speaker sessions or workshops, the shift from noun (leadership) to verb (leading) emphasised the fact that everyone can and should lead, even if it’s ‘just’ the small team around us, or even just ourselves.

Secondly we very deliberately and systematically integrated younger leaders into the programme – from the planning stages, to co-delivering sessions and chairing sessions. One example of this was when some emerging leaders shared their perspectives on leading and the contribution they wanted to make with around 50 CEOs and other senior leaders. The emerging leaders emphasised their often greater proximity to “work-as-done” and the lived realities at the coalface of care, and their strong will to improve. A fascinating discussion and dynamic unfolded, using a “Fishbowl” methodology[1], whereby to contribute people move forward to occupy one of a group of chairs, vacating their chair after contributing, making way for the next person. This enables many people to participate in an evolving discussion, and resulted in the CEO of the NHS in London asking to bring the emerging leaders into London’s decision-making forums.

Leading is in part determining whose voices are heard and have most influence. Thirdly, therefore, we invited people with lived experience to co-chair every session in the stream. Thereby people with lived experience became central to the design of each session, and indeed the stream as a whole, laying a marker that the future of health and social care be truly co-designed and co-led by patients and citizens in real partnership with professional staff.

So – did we succeed?

As with all improvement work we experienced failures: the plan was not fully clear from the beginning, and ideas emerged during the design process. This left some chairs with very time to plan, and so little opportunity to actually (re)shape the content of their session.

On the other hand, we found that the sessions were very popular with forum delegates – half of the sessions in the leading stream were fully booked before the event, with 12 of 15 attended by over 100 people. These included sessions on emerging/next generation leaders; a session drawing from tenets of Greek philosophy to guide how we lead today; a session explicitly focusing on people reflecting on their failures – “what I wish I’d known”; and several sessions focusing on getting improvement into the mainstream of organisations, systems and professional cultures.

The engagement and hard work from the co-chairs and presenters has left us both humbled and inspired. It is quite simple: at a conference there is always more insight, ideas and wisdom “out in the room” than “on the stage”; so involving more people gives more ideas and a better result. Since the conference one of the co-chairs has even developed a checklist for co-chairs – sampling “best practice” for co-production of sessions, improving both the content and the format of future sessions.

Moving forward – Utrecht 2025

Leading better is a quest which will never run out of road as we try to discover better for sustainable, safe and equitable health and social care.

We want to learn and build on the insights gained in London in April 2024 to develop and improve the stream, making it as relevant as possible. If this appeals, or if you have ideas, please get in touch. For the International Forum 2024 in London the Leading Stream received more than 100 submissions. The Forum convenes again in May 2025 in Utrecht, the Netherlands. We encourage everybody to submit a proposal on what insights and questions they have to share on “leading well” in today’s complex world where we need to balance multiple needs and aims.

Submissions should include co-produced, creative solutions and strategies which are of practical use to people working toward better health – be they community organisers, ward team leaders or executives in large systems, charities or other organisations. And submissions which are grounded in practice and real-world application, not only in theory. We particularly encourage submissions which draw on experience across multiple countries and from younger, emerging leaders.

The call for abstracts is open from today to July 29th via this link: Call for Speakers – Utrecht 2025 (bmj.com).

Leading demands learning, networking, curiosity and courage. Engaging with fellow colleagues, emerging leaders and service users to meet our mutual challenges is not the whole solution, but we think an important part of it. Please send in a submission, and be part of the sharing and learning in Utrecht next year.

[1] For more on the Fishbowl methodology, see: https://library.hee.nhs.uk/patient-information/patient-information-resources/fishbowl-conversation

*Inge and James together curate the Leading stream at the BMJ/IHI International Forum.

Photo of Inge Kristensen

Inge Kristensen, CEO, Danish Society for Patient Safety. M.Pol.Sc., MPA.

Inge is a long-standing leader and manager with experience from the social and health sector and research institutions in municipal, regional and state auspices.

Declaration of interests

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

Photo of James Mountford

Dr. James Mountford, Editor-in-Chief, BMJ Leader

James is a healthcare leadership and quality improvement practitioner and educator working in health professional education for Galileo Global Education.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: Editor, BMJ Leader.

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