Systems leadership for quality in health care: from principles to actions

Background: Improving quality and safety is a major concern in the complex adaptive system of healthcare. Hierarchical models of change have not been effective in moving the needle on the 60:30:10 challenge of appropriate, wasteful, and harmful care for more than three decades. The World Health Organization (WHO) 2030 action plan is a complex challenge requiring a different approach. The purpose of this study was to explore Systems Leadership (SL) concepts and practices to address challenges of implementing quality and safety improvement initiatives. Methods: Insights were gathered from international experts, researchers, and physicians alongside other participants through an international workshop, using the fishbowl method and an interactive World Health Leadership Network (WHLNet) broadcast on SL and quality/safety in healthcare in the third quarter of 2024. The summaries of expert presentations, fishbowl deliberations, and broadcast group discussions (notes, chat summaries and video recordings) were analyzed to generate themes. Results: The key challenges in translating SL concepts into concrete actions include the mindset of leaders, agency, and translating generalizations into practical actions. Suggestions for enacting SL include (i) embracing individual work (requiring a mindset change and exercise of agency) and (ii) enhancing collective (distributed and shared) leadership involving work at all levels in the system including national, sub-national, inter-organizational, and organizational levels. Work at inter-organizational and organizational levels includes conduits and networks for information flow and knowledge-sharing, collaborative relationships, and collaborative learning across the continuum of health professions’ education. Organizational work includes leverage, safety culture, implementation, and resilience. Conclusions: Translation of SL into action plans involves leaders—both individual leaders and collective distributed leadership, engagement with multiple constituents and alignment of work at different levels of the system adjusted to complexity properties of self-organization, emergence and adaptation. These considerations and utilization of specific techniques and tools would assist the leaders in translating high-level concepts into concrete action plans.