Authors
February 28th, 2025
Mental Health, Addictions and Intellectual Disability Services
The Aotearoa health system is one of high demand, chronic underfunding and constant
change. As a senior clinician observed, “It’s a perfect storm. More demand, more complex
needs, higher consumer expectations, a negative media and chronic staff shortages. The
staff are fantastic, but it can be hard to keep your head above water.” It is very humbling to be involved as consultants in this work. The system is held together by networks of
committed staff working under high pressure and contributing over and above the formal
requirements of their jobs. It has been important to us that any interventions we make
respect people’s time and add real value to their work.
Over the last decade, we have worked with senior clinicians and leaders across the West
Coast and Canterbury District Health systems. More recently, we have supported the
Southern Specialist Mental Health and Addictions Service as it responds to major sector
changes and moves toward a more integrated way of operating. The focus has been on
clarifying purpose and strategy and supporting the senior managers and clinicians in their
leadership of change.
Helping people to get a clear sense of purpose and strategy was a crucial foundation in this
process. This is a time-poor system that is dominated by short-term demands and crises.
Finding space to lead, particularly to lead whole systems change, is incredibly challenging.
As one senior manager noted, “I feel drowned in a whole lot of doing. There is always busyness, and sometimes it just feels impossible. There are always crises, and I just don’ have time for leadership!”
With this reality in mind, we introduced Heifetz and Linsky’s concept of moving “back and
forth from the balcony to the dance floor”. Of the many change leadership concepts we
presented, the balcony/dance floor metaphor was far and away the most impactful. At one
stage, we included some more sophisticated models around complexity, but these didn’t
land nearly as well. There was a lesson here about the usefulness of a few straightforward
leadership concepts in supporting a change process.
To orientate the change process, we began by facilitating a series of codesign workshops
explicitly orientated to the “balcony” task of defining vision. We always opened these
workshops with karakia and mindfulness practices to help create a space where people
could leave their day-to-day demands behind and attend to the bigger-picture work of
strategy and change. These workshops became more effective as we included front-line
clinicians and leaders. On several occasions, we had around 35 people involved. The product of these workshops was the Purpose, Strategic Priorities and Values graphic shown in Figure One below.
Figure 1
The co-design process ensured good acceptance of the Purpose, Strategic Priorities and
Values and it became an important anchor for the broader change process. As the General
Manager observed:
“I’ve attended a number of [front-line] team planning days where we’ve talked about the Purpose and Strategic Priorities and how we got there with Leadership Lab’s involvement.And it’s gone down well. And people say, Well, how can we contribute to that? And I just say, by being aware of them and applying them in your everyday practice. The Strategic Priorities emphasise a person-centred approach and embracing te ao Māori focus. And the more we have this in the forefront of our thinking, the more we will pick up and run with it. And so that all feels good.”
The work on purpose, strategy and values was part of a broader change process of creating
“an integrated, person, whānau and community-centred system”. To help guide the
process, we developed a “Leading Change: Five Tasks” model. The formation of the co-
design teams and the creation of the vision shown in Figure One were Tasks 1 and 2 in this
model, which is shown in Figure Two below. The Five Task model was referenced at each
workshop to reconnect people with the broader change process and support “balcony”
thinking.
With the vision formed, the co-design workshops were used to develop projects to address
Tasks 3 and 4 of the Five Task model. The projects were developed and supported in the co-design workshops and then implemented across the service and sector. The Leadership Lab team provided coaching for the project leads and facilitation support for the projects. Front-line project workshops were framed around the Purpose, Strategic Priorities and Values (Figure One). This served to communicate the vision and provide a framework for
developing new ways of working to support strategy implementation and culture change.
Figure 2
About a year into our engagement the process really gained momentum. The co-design
workshops with the core change leadership team became more energised and a range of
well supported change initiatives emerged across the service and sector. These included
work on pathways clarification, MDT processes and relationship building across the broader sector. We were particularly struck by a statement by one of the change team participants who had initially been very resistant. She spoke about her initial scepticism but said, “I’ve come full circle and feel part of something meaningful. I can see the positive impact it’s having on my service team and on our relationships across the service in general”.
Our engagement concluded at the end of 2024. About the same time the General Manager
who was a key sponsor of the process retired. As 2025 begins there are a numerous change
initiatives in train. These cover both the strategy implementation and culture shaping
aspects of Figure Two above. The initiatives are led by line managers and well supported by front-line staff. The following comments give an indication of the impact of the change
process.
“After what felt like treading water for many years, I finally feel that we have a direction. We wouldn’t be here if it wasn’t for Leadership Lab and for the organisation investing in their people leaders.”
“Our team [has] a renewed sense of purpose and a clear direction for the coming months. They recognise the challenges ahead but express confidence in their ability to work together to improve mental health services across the Southern Region.”
“The Purpose and Strategic priorities and the wider support that Leadership lab have provided both individually and with DLT and SLT’s feels really good to me. It’s also something that we’re taking to the wider NGO sector now as a basis for greater collaboration. And now we can all work more effectively. So some good work in that space.”
“We’ve talked about a platform for moving forward and the work we’ve been doing with
Leadership Lab has been a really important part of that platform This work is a journey, not a destination. But despite all the challenges that we have across the sector this Directorate feels in a strong position because of this work. So its all good stuff.”
This feels to us like a successful change process in a really challenging environment. The
holistic approach outlined in Figure Two is part of the reason for its success. Many change
leadership processes emphasise strategy implementation, or culture shaping or leadership
development individually. In this process we were able to address aspects of all three
simultaneously and to do so in the context of the Purpose, Strategic Priorities and Values
shown in Figure One. Nothing would have been achieved however, without the
commitment, energy and expertise of the managers, clinicians and staff. The co-design
process was able to draw on that expertise and importantly strengthen the relationships
between them. Our hope is that the strengthened relationships and the initiatives now
underway will sustain the journey to a more integrated, person, whānau and community-
centred system.
This piece was written by Pete Cammock, Leadership Lab Director.
Team members Pete Cammock, Moira Mallon and Ross Denton
You can read more stories of impact as well as thought-provoking pieces from across our Leadership Lab ecosystem by signing up for this monthly pānui (see bottom of www.leadershiplab.co.nz) or by connecting with us on our Leadership Lab LinkedIn and Facebook . Thanks heaps for your interest.
February 28th, 2025
Mental Health, Addictions and Intellectual Disability Services
The Aotearoa health system is one of high demand, chronic underfunding and constant
change. As a senior clinician observed, “It’s a perfect storm. More demand, more complex
needs, higher consumer expectations, a negative media and chronic staff shortages. The
staff are fantastic, but it can be hard to keep your head above water.” It is very humbling to be involved as consultants in this work. The system is held together by networks of
committed staff working under high pressure and contributing over and above the formal
requirements of their jobs. It has been important to us that any interventions we make
respect people’s time and add real value to their work.
Over the last decade, we have worked with senior clinicians and leaders across the West
Coast and Canterbury District Health systems. More recently, we have supported the
Southern Specialist Mental Health and Addictions Service as it responds to major sector
changes and moves toward a more integrated way of operating. The focus has been on
clarifying purpose and strategy and supporting the senior managers and clinicians in their
leadership of change.
Helping people to get a clear sense of purpose and strategy was a crucial foundation in this
process. This is a time-poor system that is dominated by short-term demands and crises.
Finding space to lead, particularly to lead whole systems change, is incredibly challenging.
As one senior manager noted, “I feel drowned in a whole lot of doing. There is always busyness, and sometimes it just feels impossible. There are always crises, and I just don’ have time for leadership!”
With this reality in mind, we introduced Heifetz and Linsky’s concept of moving “back and
forth from the balcony to the dance floor”. Of the many change leadership concepts we
presented, the balcony/dance floor metaphor was far and away the most impactful. At one
stage, we included some more sophisticated models around complexity, but these didn’t
land nearly as well. There was a lesson here about the usefulness of a few straightforward
leadership concepts in supporting a change process.
To orientate the change process, we began by facilitating a series of codesign workshops
explicitly orientated to the “balcony” task of defining vision. We always opened these
workshops with karakia and mindfulness practices to help create a space where people
could leave their day-to-day demands behind and attend to the bigger-picture work of
strategy and change. These workshops became more effective as we included front-line
clinicians and leaders. On several occasions, we had around 35 people involved. The product of these workshops was the Purpose, Strategic Priorities and Values graphic shown in Figure One below.
Figure 1
The co-design process ensured good acceptance of the Purpose, Strategic Priorities and
Values and it became an important anchor for the broader change process. As the General
Manager observed:
“I’ve attended a number of [front-line] team planning days where we’ve talked about the Purpose and Strategic Priorities and how we got there with Leadership Lab’s involvement.And it’s gone down well. And people say, Well, how can we contribute to that? And I just say, by being aware of them and applying them in your everyday practice. The Strategic Priorities emphasise a person-centred approach and embracing te ao Māori focus. And the more we have this in the forefront of our thinking, the more we will pick up and run with it. And so that all feels good.”
The work on purpose, strategy and values was part of a broader change process of creating
“an integrated, person, whānau and community-centred system”. To help guide the
process, we developed a “Leading Change: Five Tasks” model. The formation of the co-
design teams and the creation of the vision shown in Figure One were Tasks 1 and 2 in this
model, which is shown in Figure Two below. The Five Task model was referenced at each
workshop to reconnect people with the broader change process and support “balcony”
thinking.
With the vision formed, the co-design workshops were used to develop projects to address
Tasks 3 and 4 of the Five Task model. The projects were developed and supported in the co-design workshops and then implemented across the service and sector. The Leadership Lab team provided coaching for the project leads and facilitation support for the projects. Front-line project workshops were framed around the Purpose, Strategic Priorities and Values (Figure One). This served to communicate the vision and provide a framework for
developing new ways of working to support strategy implementation and culture change.
Figure 2
About a year into our engagement the process really gained momentum. The co-design
workshops with the core change leadership team became more energised and a range of
well supported change initiatives emerged across the service and sector. These included
work on pathways clarification, MDT processes and relationship building across the broader sector. We were particularly struck by a statement by one of the change team participants who had initially been very resistant. She spoke about her initial scepticism but said, “I’ve come full circle and feel part of something meaningful. I can see the positive impact it’s having on my service team and on our relationships across the service in general”.
Our engagement concluded at the end of 2024. About the same time the General Manager
who was a key sponsor of the process retired. As 2025 begins there are a numerous change
initiatives in train. These cover both the strategy implementation and culture shaping
aspects of Figure Two above. The initiatives are led by line managers and well supported by front-line staff. The following comments give an indication of the impact of the change
process.
“After what felt like treading water for many years, I finally feel that we have a direction. We wouldn’t be here if it wasn’t for Leadership Lab and for the organisation investing in their people leaders.”
“Our team [has] a renewed sense of purpose and a clear direction for the coming months. They recognise the challenges ahead but express confidence in their ability to work together to improve mental health services across the Southern Region.”
“The Purpose and Strategic priorities and the wider support that Leadership lab have provided both individually and with DLT and SLT’s feels really good to me. It’s also something that we’re taking to the wider NGO sector now as a basis for greater collaboration. And now we can all work more effectively. So some good work in that space.”
“We’ve talked about a platform for moving forward and the work we’ve been doing with
Leadership Lab has been a really important part of that platform This work is a journey, not a destination. But despite all the challenges that we have across the sector this Directorate feels in a strong position because of this work. So its all good stuff.”
This feels to us like a successful change process in a really challenging environment. The
holistic approach outlined in Figure Two is part of the reason for its success. Many change
leadership processes emphasise strategy implementation, or culture shaping or leadership
development individually. In this process we were able to address aspects of all three
simultaneously and to do so in the context of the Purpose, Strategic Priorities and Values
shown in Figure One. Nothing would have been achieved however, without the
commitment, energy and expertise of the managers, clinicians and staff. The co-design
process was able to draw on that expertise and importantly strengthen the relationships
between them. Our hope is that the strengthened relationships and the initiatives now
underway will sustain the journey to a more integrated, person, whānau and community-
centred system.
This piece was written by Pete Cammock, Leadership Lab Director.
Team members Pete Cammock, Moira Mallon and Ross Denton
You can read more stories of impact as well as thought-provoking pieces from across our Leadership Lab ecosystem by signing up for this monthly pānui (see bottom of www.leadershiplab.co.nz) or by connecting with us on our Leadership Lab LinkedIn and Facebook . Thanks heaps for your interest.
Authors