Whether we want to change ourselves, our teams, our organizations, our sectors or wider systems, true transformation requires us to connect the visionary with the actionable, to embrace rather than resist complexity and, most importantly, to be willing to create change within ourselves first. This is easier said than done, however. Most of us are not taught to think systemically, instead approaching problems from a linear, often siloed perspective. Yet, with a growing number of existential challenges facing us, it is vital we rapidly grow the number of people who can embrace systemic thinking and create radical change.
It was this shared belief in the potential power of system change leadership that first brought the Johnson & Johnson Center for Health Worker Innovation (the Center) and the School of System Change together. In 2021, with funding from Johnson & Johnson Foundation, the organizations collaborated to launch Basecamp for Health System Transformation, a pilot program with the goal of growing system change capacity for health system transformation. The program included a six-month learning journey for 20 health innovators, social entrepreneurs and change leaders from across the globe. Together, these leaders undertook activities to help them connect around their shared goals and challenges and learn new tools and methodologies to help them expand their thinking and approach transformation through a system lens.
Basecamp draws on a wealth of concepts and methodologies from practitioners across the world, supporting a systems-and-complexity-informed approach to evaluation.
A collaborative learning journey
Each participant brings to the course a core challenge from their active projects, enabling them to start to implement new thinking, tools and frameworks and hear reflections from their fellow innovators. This social learning approach supports health system leaders to shift their mindsets and find new ways of being in the face of complexity, in the context of a deeply change-resistant field. Embarking on this learning journey with others allows participants to move through overwhelm to a sense of agency and to make a renewed commitment to contributing to meaningful change, in the full knowledge of what that requires.
Lynda Toussaint is the CEO of Unjani Clinics NPC, a non-profit company that implements an enterprise development initiative called the Unjani Clinic Network, the only nurse-led initiative of its kind in South Africa. The clinic empowers Black women who are professional nurses to own and operate primary healthcare container clinics in the country’s rural and township communities. Unjani focuses on entrepreneurial development, creation of sustainable micro-enterprises and job creation but, most importantly, improving access to an alternative, affordable, quality private healthcare service. Toussaint participated in the first Basecamp for Health System Transformation driven by a desire to change the way she approached core challenges.
“I didn’t know much about systems thinking before doing the program but in the work I was doing, I battled to think differently. I wanted to learn how you step away from doing the same thing over and over again to see if you could do it more effectively.”
For Toussaint, connection with others formed the heart of her Basecamp experience. “I got so much more out of the program than just thinking differently about how I approach problems,” she says. “It was inspirational and aspirational engaging with so many people from across the world and learning how they coped with the situations they found themselves in. Even though we were doing the program virtually, by the end there was a deep cohesion amongst us all.”
“The biggest thing I took away from the program was that we don’t have to do everything ourselves—we need to stop siloed thinking and collaborate with other organizations, use the systems already out there,” says Toussaint. “For example, there is a real need for mental health support in communities. Our nurses focus on primary healthcare—they are not mental health specialists. So how do we engage mental health providers to bring their practitioners into our space? This is what we’ve been focusing on. And the same thinking applies to dentistry or eye health—creating a nested system so that the community receives what they need.”
Her fellow participant, James Radcliffe, Head of Public Affairs and Influence at Platfform, came to a similar realization: “It has struck me that if we can facilitate conversations between our traditional partners and those who we would have regarded as 'the enemy' there is potential for systemic change across a number of fields.”
Becoming comfortable with complexity
In order to embrace complexity, we must first accept that unlearning is as much a part of the leadership journey as learning. While participants finish the course with a number of new skills and ways of thinking to support them in their work, the biggest realization for participants is that this is just the start of a lifelong learning journey.
“It’s about embracing complexity and spreading that learning throughout the communities of health workers you engage with,” adds Toussaint. “It is a continuous learning journey, and you will get thrown new challenges—times change, technologies change, and you have to change your path forward in response.”
Irrigating system change via peer-to-peer influence
The School of System Change and the Center are mutually committed to accelerating a paradigm shift towards embracing complexity in order to rehumanize health systems. To do this, we need to nurture an ecosystem of system change practitioners that would irrigate health systems with new ways of acting, behaving and collaborating.
Basecamp was co-created to increase participants’ capacity to think systematically and discern which approach will be most effective. This, in turn, influences how others view challenges, allowing these skill sets and ways of thinking to spread through teams, organizations and wider systems.
“As soon as I started to change myself, I could see the changes in people around me, first in my team and then in top management,” says Nigar Izmayilova, Public Health Specialist at TABIB and another Basecamp participant. Her fellow leader, Nils van Herpen, Healthcare Innovation Manager at Coöperatie VGZ, agrees: “Understanding the system is very important but [even more important is] to understand the people within the system. It is about understanding what drives other people, what they want for patients and also what matters to them in their personal role in the system,” he says. “Try to find common ground and goals: build trust. And from there you can co-create.”
Together, the Johnson & Johnson Center for Health Worker Innovation and the School of System Change call on leaders everywhere to embrace system leadership and learning in your organizations. Only by investing in people and believing in their ability to embrace complexity can we create a ripple effect, irrigating the power of system thinking worldwide.
For Toussaint, Basecamp has had a life-changing impact. “Before I started the program, I was nervous because it takes time that I didn’t feel like I had. But because I invested that time, I’ve had the opportunity to meet so many amazing people from around the world and have completely changed my outlook. I’m grateful for the opportunity.”