ICS Exemplar Hub

Building on the recommendations from the Nottingham and Nottinghamshire ICS (Integrated Care System) and the University of West of England (UWE) Diagnostic Report 2021, we explored ways to:

Implement an asset-based approach by shifting the culture through climate. This approach recognises that the ICS’s work, and its vision, is based on transitioning from treating illness to promoting wellness.

A climate approach requires staff to work differently, and this change should be reflected in the organisation’s culture, leadership, and approaches to improvement and innovation. UWE’s three key recommendations to support this are:

  • Promoting a climate for creativity and innovation
  • Fostering inclusive and compassionate leadership
  • Focusing on wellbeing and resilience

What is the Exemplar hub:

The Exemplar Hub allows us to accelerate promising initiatives with system oversight and evaluation. “Exemplar” in its simplest form means something to point at’. We may either showcase existing initiatives or collaborate to create or adapt solutions for system-wide implementation. The overarching goal is to identify the best of our system assets, initiatives, and talents, and join forces. This is a concept innovated in our Community of Practice and developed and applied by Sarah Phillips, ICS Talent and Leadership Subject Matter Expert in 2024 . The exemplar hub works on the premise that ‘the integrated care system is an innovation in itself.’ UWE, 2021. In addition it creates a space that allows for oversight during early stage initiatives and during their evolvement. In effect we are enabling the most powerful way to bring about change in complexity – A complex adaptive space: Listen here to Mary Uhl-Bien about the power of these spaces. Many have seen this in action during Covid-19 and by creating an environment conducive to working with complexity we can see dramatic and rapid change across entire systems. In system spaces (ICS groups and initiatives) Sarah Phillips observed that people are able to disentangle from their own organisations, specialisms and roles in the hierarchy and utilise what Sarah has called ‘System Stretch’ becoming system first while also anchored in their own organisations and roles. To do this continues to require support from leaders and facilitators as people learn how to collaborate to innovate together and avoid the pitfalls such as collaboration lab and initiative overload all leading to lack of coherence and use of joint energy, resulting in inaction, or in the worse case organisational (system) inertia.

Culture Leadership Programme/ 4 images revealing magnifying glass, compass, jigsaw and leaf
Culture Leadership Programme 4 Phase Cycle

We create a test-and-learn spaces to apply the accelerated design approach during the early stages of design and discovery. During delivery, we evaluate and make necessary adjustments for the next phase of system implementation. During evaluation and implementation we adopt improvement methodology -You can read about his here PDSA. (Plan-Do-Study-Act) At Nottingham and Nottinghamshire we applied the Culture Leadership Programme cycle aligns well with PDSA and design thinking double diamond click link for explainer video about the Double Diamond. Systems thinking, this enabled us to easily measure impact against the people promise has been part of 2024 evaluation and it has proven helpful at system level to keep a broad approach that aligns many types of methodology. You can read about what this looked like in our presentation and view our summary impact report here as a simple snapshot around April 2024. Learn about our ICS Innovation Challenge Approach here, with practical examples to apply a dialogic approach to systems innovation.

Systems Thinking and Design Methodology in Practice

Recognising the importance of inclusive conversations, especially in complex systems undergoing transformational change, we adopted an accelerated design approach for key initiatives. Facilitators, OD Leads, Improvement Leads and change agents can do this for all organisational design and development initiatives. Once you have progressed further take it to the systems via the architecture and infrastructure – It may be a simple (Complicate domain) adapt to adopt at a large scale ie: Oliver McGowan Training, or Active Bystander and High Potential Scheme. Or it may be more about Bespoke Design and be an innovation challenge or a new initiative ie: Coaching, or we may be making something system fit, so custom adapt such as level 7 – Imperial College/Cordnel.

Step 1 – Identify your existing exemplars
Step 2 – Evaluate which align with our strategy and diagnostics, then proceed with the accelerated design approach and commit to an oversight workplan
Step 3 – Arrange a design meeting (2.5 hours, ideally in person or hybrid)
Step 4 – Review and test
Step 5 – Evaluate and apply design thinking

Where possible we utilise ICS spaces that are already in place, such as community transformation team events, Partners Assembly and ICS working groups and encourage and support with the event design to hold dialogue conference and place-based café conversations. Supporting facilitators to enable groups to collaborate effectively in order to not jump to the solution and explore the root causes. This can involve holding the dissonance and a supportive, safe and containing (Bion, 1961) style to to enable space for difficult conversation.

Exemplars Delivery 2024

ICS Initiative One: Level 7 Imperial  and now Project Management Diploma

ICS Initiative Two: ICS Coaching Faculty

ICS Initiative Three: Active Bystander – Adapt to Adopt

ICS Initiative Four: ICS Innovation Challenges (ie: UEC/Focus on Frailty and Systems Leadership in Action Events)

ICS Initiative under review/consideration: High Potential Scheme

ICS Supporting Architecture and Infrastructure: KUMU – our system leaders mapped!, Online Collaboration and learning spaces (Learning Management System to co-build) , System Innovation Toolkits, Talent and Leadership Open Hub (here), ICS Coaching Faculty, ICS Systems Leadership Community of Practice.

Innovation Challenges

These are the next level stage of our maturity or to accelerate progress to the next level of innovation for integrated working. You can read more about the approach here or download this toolkit to help you set up your own innovation challenges and see others in our ICS.

Much more than ‘another strategy framework’ this tool helps:

  • visualise and make sense of the multiple learning and innovation projects required across sectors that are needed to enable diverse actors to organise around directional goals and complex challenges;
  • recognise and align work across sectors and fields that will be needed to advance action towards bold goals, creating focus around high-leverage areas for intervention to address complex issues;
  • and create a sense of coherence across ecosystems, sectors and actors so that collective intelligence can be harnessed towards addressing challenges.

Our research diagnostics (UWE) also revealed a desire for more shared learning and development opportunities. We are applying the following five recommendations as follows and learning about our system as it forms:

  1. Leadership development programmes that connect people across the system – e.g., Level 7 Imperial Corndel, Coaching, and Active Bystander
  2. Crucible leadership experiences – exploring a midlands regional high-potential scheme with confidential “on the sofa” conversations
  3. Leadership exchanges – leveraging the high-potential scheme and our Coaching Faculty to advance strategically
  4. Innovation challenges based on local “wicked challenges” – External consultants meet with ICS OD lead to align with our strategic aims and UWE recommendations. One such challenge at delivery stage in August 2024 and first cohort session of 9 in September 2024. Together we are working on our most pressing issues
  5. Mentoring colleagues from other ICS sectors

Measure and assess the impact of interventions

When working at system level, compared to bounded organisations (where we can often set starting and finish points) t is helpful to see progress along the way (UWE recommendation 14) and to share what is working and not working as early as possible. This will give oversight within the governance infrastructure, build momentum and support and help others determine how they may align with your approach and projects. You can see an example in our impact report here.


UWE Recommendations

These recommendations and the supporting papers have been applied to our ICS in our exemplar hub and before in 2022 to 2024. They have proven effective and it is recommended in our Talent and Leadership Strategy that we continue to use these recommendations as a simple way of ensuring our approach is in line with current thinking and what our people have raised in the diagnostic. To help, we have some blue prints started which show how it can be done both in terms of initiatives and methodology.

Adapt to Adopt – ie Active Bystander (Regional)

Custom Adapted – Level 7

Bespoke Built – Organic ie: Coaching

Aligned and curated for our system: Innovation Challenges