Abstract
Effective management and leadership are essential for everyday health system resilience, but actors charged with these roles are often underprepared and undersupported to perform them. Particular challenges have been observed in interpersonal and relational aspects of health managers’ work, including communication skills, emotional competence and supportive oversight. Within the Resilient and Responsive Health Systems (RESYST) consortium in Kenya, we worked with two county health and hospital management teams to adapt a package of leadership development interventions aimed at building these skills. This article provides insights into: (1) the content and co-development of a participatory intervention combining two core elements: a complex health system taught course, and an adapted communications and emotional competence process training; and (2) the findings from a formative evaluation of this intervention which included observations of the training, individual interviews with participating managers and discussions in regular meetings with managers. Following the training, managers reported greater recognition of the importance of health system software (values, belief systems and relationships), and improved self-awareness and team communication. Managers appeared to build valued skills in active listening, giving constructive feedback, ‘stepping back’ from automatic reactions to challenging emotional situations and taking responsibility to communicate with emotional competence. The training also created spaces for managers to share experiences, reflect upon and nurture social competences. We draw on our findings and the literature to propose a theory of change regarding the potential of our leadership development intervention to nurture everyday health system resilience through strengthening cognitive, behavioural and contextual capacities. We recommend further development and evaluation of novel approaches such as those shared in this article to support leadership development and management in complex, hierarchical systems.
Highlights
To strengthen the capacity of the health system to absorb, adapt and transform in the face of challenges, and thereby be ‘resilient’, health system actors must embrace the system’s complex and adaptive nature (Gilson et al, 2017)
We draw on our findings and the literature to propose a theory of change regarding the potential of our leadership development intervention to nurture everyday health system resilience through strengthening cognitive, behavioural and contextual capacities
We considered the potential of reflective practice and experiential learning to support the spread of leadership capacities among health managers at facility, sub-county and county levels and the implications on the practice of everyday health system resilience
Summary
To strengthen the capacity of the health system to absorb, adapt and transform in the face of challenges, and thereby be ‘resilient’, health system actors must embrace the system’s complex and adaptive nature (Gilson et al, 2017). We saw the potential value of the course for our manager colleagues, and worked with them to adapt the course for the Kenyan setting We named it ‘Understanding Dynamic Health Systems’, and ran it in partnership with a local University. The revised course included engaging with managers in reflecting upon and discussing why and how to practically develop relational leadership abilities through improved communication skills and emotional competency ( providing an introduction and link to the second course, described in the following). We added group work on unpacking a health system challenge and dedicated an entire day to teams working through identifying strategic priorities to address a health system challenge they were facing and developing work plans to address those challenges For the latter, we drew on the Challenge Model (https://www.msh.org/resources/the-challenge-model) which provides a logical process of identifying and achieving desired measurable results. Important new elements included an introduction to systems thinking and health system complexity (Ortiz Aragon, 2010; De Savigny and Adam, 2009; Sheikh et al, 2011), including the interaction of hardware and software elements within any organizational system (Table 1)
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