Occasionally, I have a conversation that changes my world view. Recently, I spoke to a system leader, one I'd neither met before nor even much heard of and the conversation did just that. 

As we spoke, I realised she has a remarkable record of impact. Listening to some of what she has achieved I had two questions: why hadn't I heard of her and would she be willing to share some of her insights with our networks? 

Their answer – which I'm paraphrasing - was intriguing: ‘No thank you. Part of why I've been able to make a difference is because I refuse to become "a name".'

This led to a first reflection. Ambitious people enter public service wanting to make a difference. But, perhaps as our hopes and aims are frustrated, the desire to make change can easily become conflated with the appetite for power. Initially, power is the means, and change is the end, but as time passes the means become the ends. The pursuit of power is its own justification. 

To get power and to keep it, especially in hierarchies and even more in politics, often involves agreeing to questionable things, making dubious claims and fighting destructive organisational turf wars. People not willing to play such games rarely last long. Thus, the pursuit of ambition becomes a barrier to positive change. 

This is why the leader's attitude to being a ‘name' is more than modesty. It is an insightful response to the counterproductive consequences of seeking status and power. 

As I came to realise, my interlocutor had quietly contributed to some of the most impressive changes in care models I've seen in the NHS, I wanted to know how she did it. The answer, and again I paraphrase, was disarmingly simple. First create a strong provider partnership bringing together everyone needed to accomplish change. Second, use data and an understanding of good practice to identify areas where there is unarguable scope for sustainable improvement to benefit patients. Third, gain clinical and community buy-in. Fourth, move quickly and increase momentum for future change. 

Leadership involves finding the sweet spot where ambition and credibility meet. As is the nature of the leaders of large complex hierarchies, the centre finds it easier to describe problems and issue instructions than understand barriers and enable change. 

You know all this, of course, but the point can be illustrated with one of the most cited areas of necessary improvement. 

To minimise the failure journey from an elderly frail person coping at home to that same person being stuck in a hospital bed could involve at least eleven steps including: effective population health management; proactive primary care; access to non-medical services; step up provision; care-co-ordination; triage at the front door of ED; triage in ED; same day emergency care and hospital flow management; discharge processes; step down provision; and social care. 

As I travel round the country, I often see impressive work on several of these links in the chain, rarely, if ever, all of them. Yet, unless everything is covered, it is – to mix my metaphors – like trying to keep a carpet dry in a room where only some of the leaks in the roof have been repaired.  

To make progress across this pathway involves co-ordinated action by managers and clinicians in acute, community, primary and mental health care along with vital contributions from social care, the voluntary sector and other public services. History shows it is very hard for a distant centre (or even slightly closer regions) to achieve this level of local collaboration, even in good times with money to spare. 

Thus, whatever the aggregate ambitions of the centre, if change happens it will rely heavily on local initiative and shared commitment of the kind described by the leader I spoke to last week. Parts of Government realise this, including Number 10.

Yet the centre lacks a credible account of local change (indeed one national leader bafflingly once told me ‘I hate the concept of a model of change'). Despite the genuine commitment to reducing central bureaucracy, too many national names want to flex their muscles and pursue their agendas. National political priorities – however justified – can raise the barriers to local relationship-building. Most importantly of all, with ICSs facing massive disruption, far too little is being invested in local brokerage and place-based organisational development. 

The person I recently met is a hero. Someone with the discipline, which I wish I could emulate, to focus on making a difference rather than building a reputation; someone with a simple and proven way to improve outcomes for patients. 

Wouldn't it be great if the number one question for a DHSC/NHSE focused on change rather than power, was how best to support such leaders?