Building an inclusive culture of leadership in Leicester, Leicestershire and Rutland ICS

In April 2022, NHS Arden & GEM was engaged as a strategic partner to support Leicester, Leicestershire and Rutland (LLR) ICS in its ambition to create a system-wide inclusive culture of leadership.

Following the co-design and collaborative delivery of three strategic phases of work delivered over two years, the ICS now has a roadmap in place which sets out in detail the activities needed to support this ambition, and how it can be measured and maintained.

The focus on stakeholder engagement, co-design and collective implementation has established collaborative commitment, working and accountability across the ICS, with an understanding that cultural change takes time.

The challenge

Leicester, Leicestershire and Rutland (LLR) ICB wanted to create a more compassionate and inclusive culture of leadership throughout the ICS based on shared values, vision and behaviours. Aligned to this ambition, the ICS had been selected, as one of three national pilots, to work with the national NHS England Culture Transformation team to implement their culture and leadership programme (CLP), which had been developed in partnership with The Kings Fund.

The ICB’s vision was to build an inclusive culture and leadership environment in which all staff and local people experience:

• The highest quality and safest care
• Compassionate leadership
• Attraction, development and retention of great people
• Opportunities for all to be included, to be heard and listened to, to be seen and understood, to shape, to access and to contribute.

To achieve this vision the ICS People Board established a dedicated workstream for inclusive culture and leadership within the CLP. NHS Arden & GEM was engaged as a strategic partner in April 2022 to support the programme in developing and implementing an inclusive culture and leadership roadmap.

Our approach

Having previously delivered OD and leadership programmes for LLR, the Arden & GEM team understood the ICS’s strengths and was able to build on these in the approach. Working alongside executive teams, senior managers and consultancy partners, they co-designed a collaborative, evidence-based programme, with three strategic phases of work to mirror the CLP methodology.

Strategic thinking
The first phase focused on ‘diagnostics’ – adopting a dialogic approach and investing time in ‘holding up a mirror’ to collaboratively challenge, explore and think creatively about the current impact, functions, forms and assumptions of the status quo and work. The team engaged with multiple stakeholders from across the ICS to explore lived experiences from individual, place and system-based perspectives.

Diagnostic activities, which aligned to the CLP process and adapted CLP framework tools, were undertaken with different health and care organisations across the LLR system. This incorporated individual leadership interviews and group events with over 130 people.

This process began to establish collaborative working across the entire system to define the programme’s vision and determine what future success looks like. A set of key priorities was co-established around which the work of the second phase would focus.

Strategic planning
The second co-design phase looked to collaboratively identify a collective sense of purpose including outcomes and objectives which aligned with national health and social care strategy.

The work needed to be undertaken was identified in more detail (what, where, when, how and by whom), along with the reasons why, by working closely with colleagues from across the ICS. Structures were co-designed to support the plan along with mechanisms to hold themselves and each other accountable.

Strategic implementation
The third and final implementation phase focused on collectively moving into action the work identified to date, ensuring compliance with policy and financial constraints. Governance practices were identified, designed and reviewed to ensure they were supporting the work using logic models and other evaluation criteria.

A framework was established for learning through questioning and observation including:

• Does how we are doing the work reflect the culture we are seeking to establish?
• Is the work being done having the impact, outcomes, success sought?
• Are assumptions still relevant and applicable to the context?
• Do the forms support the functions?
• How are we responding and developing our capacity?

The outcomes
By working as a strategic partner within the inclusive culture and leadership workstream, Arden & GEM has supported LLR in creating a safe and compassionate space for listening, learning, innovation and improvement.

The ICS now has a detailed roadmap which sets out the activities needed to support the programme’s ambitions including:

• the strategic pillars, priorities and approach to be taken
• their alignment to the three key elements of the NHS Long Term Workforce Plan and corresponding ADASS recommendations
• developing effective governance structures and processes to support the work being done and ensure it remains on track and continues to deliver the agreed outputs and aims
• determining collaborative capacity across the LLR system to implement, measure, maintain and ensure inclusive culture and leadership accountability across all stakeholder organisations.

The team has also built understanding among stakeholders that cultural transformation and behaviour change takes time to enact and emerge, with ongoing effort and support required from leaders.

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