Enablers, barriers, and paradoxes of successful systems leadership in public health: a qualitative interview study

BACKGROUND: Many challenges facing the public health system have causes and solutions that are complex and contradictory. Overcoming these requires leadership across systems, yet little is known about what factors influence successful public health systems leadership. This study aims to identify key enablers and barriers to public health systems leadership in England. METHODS: Semi-structured interviews were conducted with leaders working in the English public health system to identify enablers and barriers to success. Interview data were analysed using an inductive approach based in grounded theory to identify key themes and dimensions. RESULTS: Enablers and barriers to successful systems leadership were constructed under four dimensions: the importance of the individual, the importance of the systems leadership team, overcoming organizational obstructions, and managing system tension and enabling success. Three paradoxes were identified where leaders need to adapt their approach based on the specific context and where success will require the use of enablers from each of the four dimensions. Findings are brought together into a novel conceptual framework to support public health systems leadership. CONCLUSIONS: The framework provides a tool to support public health professionals and leadership teams identify their systems leadership strengths and weaknesses, and balance areas of paradox and uncertainty.