Sciana Fellow Markus Ries on building resilient health systems through interdisciplinary leadership
Markus Ries is a paediatrician, crisis leader, public health professional, and resilience researcher at Heidelberg University Hospital. His work focuses on understanding and strengthening resilience across individuals, organizations, and systems in the face of increasingly complex global challenges. He developed a universal crisis-resilience model that integrates interdisciplinarity, methodological diversity, and transferability to address uncertainty in today’s rapidly changing world. Markus also serves as a Colonel in the German Army Medical Reserve Corps, where he has contributed to national crisis preparedness and response efforts, including during the COVID-19 pandemic. In addition, he led a Marsilius project on disaster resilience in children and adolescents, bringing together expertise from multiple disciplines to explore how systems can better support vulnerable populations during times of crisis. He is a member of Sciana’s eighth cohort.
This interview has been edited for brevity and clarity.
Sciana Network: The Sciana Network places a strong emphasis on health systems leadership. What does systems leadership mean to you in practice?
Markus Ries: […] For me, systems leadership means helping people and organisations work across the boundaries that usually separate them. In practice, this involves bringing together different perspectives, making interdependencies visible, and creating the relationships and shared understanding that allow coordinated action when conditions are uncertain.
What I value about Sciana is its programme: it provides methods, questions, and structures that challenge my assumptions and help me think more clearly about complex problems. When you face wicked problems that are extremely complex and have no easy answers, Sciana provides a good platform for approaching them. It does so through leadership training and by bringing in experts who can exchange best practices. Its international network and the diversity of the group bring different perspectives. If you have only copy-and-paste people in your team, you get copy-and-paste answers, but no diversity of ideas, and you tend to miss blind-spots. The network is strong internationally and culturally. The opportunity to meet in one place for an off-site meeting is also important. You step away from the daily hamster wheel and have time for reflection and exchange. That is very important.
SN: How can health leaders move beyond reacting to crises and instead build systems that are truly resilient?
MR: I am not going to change the world on my own. That is a hard reality I have come to understand over the years. Change happens at different levels: the individual level, which is me; the micro level, which includes my close relationships, such as family and colleagues; the meso level, which includes the organisations and communities in which I work; and the macro level, which is society and its wider institutions.
I feel more comfortable working where I can have a direct influence, because then I can see the impact. I need to prepare myself and learn about emerging issues. In a period of exponential change, you need a sense of what will be required in five or ten years. You prepare by developing the necessary skills and building a network of people with whom you can face these issues. Then you are prepared to face them.
At the micro level, within my immediate relationships, people often turn to me in times of crisis, looking for guidance. Sense-making is key: I try to explain transparently what emerging issues may mean, but also what they may not mean, and help friends, family, and colleagues consider how they can prepare and respond. Empowering people to become more self-sufficient is an important way of countering fear. It also builds trust through a personal expert voice that may be more influential than information found online. Wicked, complex problems have no easy answers, but it is important that people recognise them and begin to think them through together.
At the meso level, within organisations and communities, an understanding of how complex adaptive systems work needs to be translated into collective action. This means bringing people together, building networks, creating opportunities for learning, and ensuring that preparedness becomes part of trusted everyday structures, responsibilities, and decision-making. In this way, organisations do not simply react when a crisis occurs; they gradually develop the relationships, capabilities, and adaptability needed to deal with uncertainty ahead of the curve. Living at the “edge of chaos” creates considerable potential for innovation, and this should not be overlooked. In a crisis, leadership is tested not by how well any single organisation performs, but by whether multiple organisations can work together to create fairness, trust, and continuity among themselves, especially when no single actor controls the entire system.
At the societal level, you can contribute by generating knowledge, publishing, sharing ideas through social networks, speaking at meetings, and influencing policy through a network like this. I think Sciana is an excellent network for spreading important ideas.
SN: What role can the exchanges and conversations held through Sciana play in shifting health leadership towards more shared, systems-based approaches to global challenges?
MR: To take a systems-based approach to tackling wicked issues, you need broad perspectives and insights. We all work in different systems, often separated by distinct cultures and language barriers, but we are often challenged by the same overarching questions. Each system has advantages and can empower you, but it also has limits. We should connect these bubbles because global challenges are unfolding, and we need to face them together. One benefit of bringing together people from three different countries and healthcare systems at Sciana is that it gives me broader perspectives from which to learn and an opportunity to influence my peers, colleagues, and friends. You need to help provide answers, empower people, and give them confidence and hope. That sense of confidence and hope is the most important part of the Sciana Network.
SN: Can you explain the importance of peer learning and network building when leading complex systems change?
MR: What matters is lifelong learning, remaining curious and open, and exchanging ideas with peers. Connection and a sense of community are important, so that you are not alone when facing wicked problems. Healthcare is a complex system. In uncertain situations marked by considerable ambiguity, you need to work collaboratively, bring others with you, and build alliances.
When you look at the countries represented in the Sciana Network, such as Switzerland, Germany, and the UK, you see health systems that are similar in some respects and different in others. It is interesting to understand how each one works. This helps you step outside your own bubble and reduce blind spots that are difficult to recognise on your own. These exchanges are therefore extremely valuable.
SN: As their Sciana Challenge, Cohort 8 is exploring “systems leadership for ageing in good health.” As populations age across Europe, what do you think healthcare systems must rethink most urgently? How can health leaders help make this change a reality?
MR: Health systems are highly fragmented and often operate in silos or bubbles that do not necessarily communicate with one another, even though they face many of the same questions and problems. I hope the Sciana Challenge can help open channels between these bubbles. A holistic view that brings together different perspectives from an early stage is important.
As a paediatrician and from a public health perspective, I would add that if people choose to adopt a healthy lifestyle from a young age, many problems later in life can be avoided. Otherwise, these problems may eventually require major repairs, sophisticated technology, considerable effort, and high costs. Good preventive measures can avoid much of this burden.
We need stronger dialogue and greater determination. In many areas, we do not have a lack of knowledge; we have an implementation crisis. We already know a great deal about what needs to be done, but we need to become better at translating this knowledge into practice and reaching the last mile. Some of this is already happening, but it remains fragmented.
