The task put to us was simple, if daunting. “What you would have done differently as a Leader today had you known what your imagined future would look like 30 years from now.”
It was a powerful exercise which exposed our own deep-seated anxieties and uncertainties about the health for future generations.
What would the geopolitics look like in 30 years?
We feared that future generations would have to face problems we have not such as climate change, mass migration and more polarised politics.
What issues would dominate a future health leader?
We spoke of new pandemics, nutritional challenges related to both food insecurity and over-consumption and the health consequences of increased adverse-weather events.
Would the next generation have better health outcomes and life expectancies?
We were worried they might not. It was sobering but also exciting to think about the types of leadership which are needed now to face some of these issues. It was the sort of conversation which we don’t often have but is probably a familiar conversation to be happening within the walls of Schloss Leopoldskron in Salzburg, the home of the non-profit organisation, Salzburg Global.
Becoming a Salzburg Global Fellow on the Sciana Health Leaders’ Programme has enabled me to collaborate with colleagues across Europe on these issues which are important for us to be thinking about today. The origins of Salzburg Global, founded in the aftermath of the Second World War, arose from a mission to build a “Transatlantic Cultural Bridge” bringing leaders and thinkers together for the last 75 years. As a result of sponsorship and philanthropy, Salzburg Global now has 40,000 Fellows from 170 countries and has delivered hundreds of programmes in many sectors to try and shape a better world. A “home” was acquired from the time of the earliest Seminars: the “Schloss” or “Castle” had been seized in the Nazi annexation of Austria leading to the flight of its Jewish owner, theatre impresario Max Reinhard, which at the time was part of allied-occupied Austria. It is a beautiful and history-rich building which makes a fabulous setting for learning and living together for the residential sessions.
Sciana is a portmanteau word from the Esperanto words ‘scias‘ (to know) and ‘sana‘ (healthy) and the programme is now in its 5th Cohort, made up of 18 leaders from sponsored by The Health Foundation (UK), Careum (Switzerland) and Bosch Health Campus (Germany). Our cohort met remotely and at residentials over the 2 years of the programme and comprised community leaders, innovators, patient representatives, clinicians, academics, economists and public health experts. We were exceptionally well supported by facilitators from the Foundations and the Salzburg Global Team.
Our early sessions focussed on understanding something of our own background, motivation and passions, before coalescing to work around the themes of “workforce”, “health literacy” and “digital” through the lens of “One Health”. “One Health” is a term I hadn’t heard of before and is advocated by the World Health Organization using a transdisciplinary collaborative approach looking at the co-dependencies of animal, human and planetary health. The aim is to harness a wide range of expertise and experience to design and implement novel health policies, achieve better public health outcomes and address health threats in the animal-human-environment interface an all-to-familiar theme from our experiences of the COVID-19 pandemic. A programme was co-created to help us to learn and understand more about how to use this “lens” to open up new opportunities and possibilities. There have been some tangible outputs from this work, and will be more in the future, however, the most important impact of the programme has been an individual development opportunity and the network of Sciana and Salzburg Fellows to whom we are now connected.
It has been humbling, and at times overwhelming, to hear local and global leaders talking about their experiences of trying to enact “change” in their work. There are of course different cultures, health systems and political and economic drivers across the 3 countries and potential solutions in one system do not necessarily work elsewhere. Using action learning approaches, we have supported one another, offering feedback and new insights to familiar problems. An overarching theme emerged of how to work with citizens and the users of our health systems. We spent time exploring power differentials and health inequalities, considering how to amplify One Health heath literacy and governance with the aim of being better prepared for further global challenges. It became clear to us that the issue of “trust” was a key theme and helping individuals, communities and nation states to understand the importance of this, requires a focus on relationships, understanding power and co-design principles which will be necessary in leading any change with stakeholders.
System leadership was, of course, an overarching theme which we came back to again and again. Thinking about our leadership choices, we recognised the need to be inclusive and collaborative, to be agile and innovative and to show compassion and humility in our leadership behaviours. We also recognised, with relief, that there were options to do things differently to mitigate or manage threats to health. We discussed the inherent power of people to adapt, to find other ways of “being”, to take collective action resulting in change for the good and to care for one another when supported and empowered. The technological and digital advances open to us to address health challenges was a source of hope, and whilst many of us expressed frustration with the complexity and speed of adoption of these, we also recognised that we are in the early phases of a digital revolution which could lead to transformative approaches to promoting health and managing health and illness.
The need to think differently about the workforce of the future was also a recurring theme. “Health services” in most parts of the world are actually designed as “Disease services”, focussing on fixing things once they are broken. We played out “thought experiments” on how to flip this – what would it look like if we focussed on prevention and self-management as well as fixing and curing? And what sort of “health” workforce would we need to invest in to achieve this “left” shift?
So how has the programme changed things for me and the communities I serve? I found the Sciana Fellowship to be transformative in ways which play out in a range of different elements of my professional life, as clinician, educator and leader. I have been able to introduce new ideas into conversations in the organisations I work in, developing teaching sessions for students, healthcare workers and leaders on how to expand the concepts of system leadership, expanding my own sphere of impact, strengthening my own systems approach, encouraging collaborations across communities, public health, primary and secondary care. I am learning to think differently about how to engage across academic disciplines which I would never have thought were in my “territory” such as academics working with adverse weather conditions, antimicrobial resistance, healthcare management and new roles and artificial intelligence. I have promoted concepts of health literacy, transformation and population health and have gained confidence to challenge complacency about climate change, supporting work on the NHS Green Plan. I have also engaged with programmes to radically shift the delivery of mental health alongside physical health interventions at neighbourhood level with communities and promote healthy behaviours and activities.
It has also become clear that we need a very different workforce, nationally, across Europe and globally to address the health challenges of the 21st Century. There are worldwide challenges in healthcare workforce and the “market” is significantly disrupted as a result of movements across the world of workers, which risks further destabilising areas where there is greatest need. There are opportunities for us to change this, ensuring our current workforce are skilled in such a way as to help them recognise the importance of social and commercial determinants of health, to consider how to get better value from the workforce through integrated, holistic and preventative healthcare measures. In addition, we can value the lived experience and values of our workforce as well as the need for it to be representative to maximise trust, engagement and value for communities.
I have been able to explore concepts of system leadership as being much broader than I had previously understood. I am building relationships which will provide a network of wider disciplines and themes and have been able to share my successes and challenges within the wider Sciana Fellows group. The Programme has inspired and enriched me, enabling me to offer support and hope to others back at home. It has been a pleasure also to have supported other Salzburg Global Fellows, and I look forward to continuing to support other programmes. It has been a privilege and a worthwhile endeavour which has resulted in many new friends and allies, the power of which will sustain me for years to come.
Author:
Dr Helen Crimlisk
Dr Helen Crimlisk is a Consultant in Community Psychiatry, Medical Director at Sheffield Health and Social Care NHS Foundation Trust and Associate Director of Teaching at the School of Medicine and Population Health at the University of Sheffield. At the RCPsych, she has been Associate Registrar for Leadership and is currently Specialist Advisor for Workforce. She undertook leadership training with the Generation Q programme supported by the Health Foundation. Her interests include system leadership, quality improvement, service user engagement & experience, education, sustainability, digital and workforce.
She oversaw the development of the FMLM accredited RCPsych Leadership and Management Fellows programme which offers a high-level experience for ambitious SpRs and SAS psychiatrists to develop leadership competencies and chaired the Leadership and Management Committee for 5 years and has supported the development of a number of new roles in mental health as well as new models of care. She trained at Guys and the Maudsley, undertaking research in Neuropsychiatry at Queen Square, London before completing her training in South Yorkshire following a period living and working in Germany. Whilst now working full time, she has trained and worked part-time as both a trainee and a consultant. Out of work she enjoys running, cycling and gardening and a variety of (very) amateur artistic interests. She is a Health Foundation Q Member, A Senior Fellow of the Academy of Medical Educators, a Senior Fellow of the Faculty of Medical Leadership and Management and a Salzburg & Sciana Global Fellow.
Declaration of interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: None.