Background: Integrated care offers the promise of better outcomes, but successful transformation of this complex system faces implementation challenges demanding solutions for increasingly more diverse health and care needs. Transition towards fully integrated, high quality and cost-effective care requires leaders to create inclusive cultures that empower and support the workforce to collaborate and co-produce outcomes with clients, patients and caregivers. The limited examples of inter-professional education in Scotland contrasts with the need for a confident, innovative and collaborative workforce to achieve excellent health and care outcomes.
Approach: To build a picture of ‘what we know now’ about cultures and leadership for integration (CLI), knowledge from a literature review was used to plan a one-day CLI Research and Practice convention to gather multiple professional and sector perspectives. Written and oral insights from research, policy or practice were sought from representatives of community health, social care, third sector, academia and people with lived experience of care in Scotland in advance of, and during, the convention. This qualitative evidence was transcribed, summarised and thematically analysed to construct a theory of change for CLI with impactful outcomes.
Results: A total of 35 implementation cases, submitted in advance of the convention, informed seven statements about what we know on CLI. These statements were considered by 30 people with different professional and sector backgrounds who participated in interactive plenary and facilitated small group sessions. The various contributions from diverse stakeholders included insights about the enablers and barriers of successfully steering positive change. Convention outputs informed development of a CLI Compass - a tool that offers direction when navigating change in the complex and dynamic health and social care landscape. The CLI Compass describes seven dimensions important for individuals, teams and organisations seeking to transform towards an effective integrated system. These dimensions (cultures, belonging, headspace, mindsets, outcomes, leadership, learning and development) are discussed in the context of developing competences for new ways of working together in interprofessional teams that share a vision and common values, despite differences in knowledge and cultures shaped by professional boundaries and training.
Implications: Workforce development for successful transformation is a complex process that requires a strong vision and support. The CLI Compass offers a new tool for supporting integration efforts for individual professionals, teams, organisations, and communities. In response to an urgent need for education that develops competencies to work in an integrated context now, the CLI Compass has shaped a six-week online CPD for community health, social work, social care, third sector leaders, managers and professionals, and for integrated care policy makers and advocacy organisations. Early feedback from CPD participants is positive in terms of providing valuable headspace for reflective practice, understanding of different cultures, and building capability for the leadership mind-sets and behaviours that nurture collaborative practice. The CLI Compass CPD is a scalable online educational offer with potential to bridge the implementation gap in Scotland. The CLI tools will resonate with regions aspiring to build workforce capability for transformation, and internationally in health systems facing similar workforce development needs.

Background
The ability to learn is central to performance and innovation across industries, yet the upstream drivers of organizational learning remain underexplored in healthcare. Understanding how learning arises within complex systems is critical for achieving the Quadruple Aim and building Learning Health Systems (LHS) capable of continuous improvement. This study examined how and why learning occurs—or fails to occur—within a large, integrated community hospital system, to identify the structural, contextual, and leadership factors that create the conditions for learning in practice.

Approach
We used a multi-method design to assess and explore organizational learning capability (OLC) across formal leaders in a large Canadian health system with more than 17,000 staff. Phase 1 included a cross-sectional survey of 231 leaders using the 14-item OLC scale, which measures experimentation, risk-taking, dialogue, participative decision-making, and interaction with the external environment. Latent Profile Analysis (LPA) identified subgroups of learning profiles. Phase 2 included 12 realist-informed interviews with leaders from both high and moderate OLC groups to examine how contextual and leadership factors enabled or constrained learning. The study was co-designed with executives, researchers, and the organization’s LHS leadership. Interest holders validated findings through member checking and ongoing and internal knowledge translation sessions to ensure relevance and practical application.

Results
The mean OLC score was 4.74/7 (SD = 0.99), indicating moderate overall learning capability. Two learning profiles emerged: one characterized by high OLC (n = 71) and one by moderate OLC (n = 70). Dialogue had the highest mean score (5.72), while interaction with the external environment (3.82) and risk-taking (4.02) were lowest. Qualitative findings revealed that learning unfolds sequentially: dialogue creates psychological safety and shared sense-making, which in turn enable participative decision-making and external engagement, ultimately fostering experimentation and risk-taking. Four key themes emerged: (1) dialogue drives learning but must link to transparent decision-making; (2) structural and funding constraints undermine learning despite motivation; (3) leadership microclimates create localized learning cultures; and (4) over-prioritization dilutes focus and sustainability.

Implications
Learning is both a cultural and structural property: it thrives when dialogue and trust are supported by leadership, time, and systems for reflection and action. For integrated care systems internationally, three priorities emerge. First, link communication to action by embedding dialogue within governance and decision-making processes. Second, create protected time and resources for learning, rewarding experimentation and adaptive capacity alongside efficiency. Third, cultivate inclusive, inquiry-driven leadership microclimates that empower teams to test and scale solutions. By identifying the upstream drivers of learning, this study offers a roadmap for embedding continuous learning in the everyday work of integrated care—transforming how systems think, adapt, and improve for patients, staff, and communities.

Background
Health and care systems across the UK face persistent challenges of fragmentation, despite years of strong policy direction toward integration. Achieving integration clearly requires more than policy and structural reform. How do we create the conditions for systems leadership, rapidly and sustainably?
The Leading for Systems Change (L4SC) programme was designed to develop system leadership capability to support implementation of the Long-Term Conditions (LTC) strategy in Leicester, Leicestershire and Rutland ICS. Delivered between late 2024 and mid-2025, it aimed to accelerate collaboration by strengthening relationships, systems thinking, and collective action.
Audience
The programme engaged a diverse cross-section of leaders and practitioners from across the health, local authority, and community sectors. Participants ranged from senior executives and clinicians to operational managers and voluntary sector leaders. In total, well over 120 people committed to the programme.

Approach
L4SC was delivered through six whole-system workshops between November 2024 and June 2025. Each session was grounded in living systems principles, adult learning theory, and reflective practice, combining expert facilitation with real-time work on the LTC pathway. The approach was immersive, experiential and experimental.
Workshops were designed to create safe spaces for cross-sector experimentation, where leaders could explore system challenges, test collaborative approaches, and develop shared understanding. Over eight months, the programme fostered a shift from organizational identity and focus toward system-level collaboration.
The evaluation drew on Menti surveys, online questionnaires, semi-structured interviews, attendance records, and facilitator observations. Thematic analysis provided insights into participant experience, learning outcomes, and emerging system impacts.
Outcome
Key Results
• Participants valued the protected facilitated space to reflect, connect, and collaborate, citing it as “energising” and “transformative.”
• Stronger, cross-boundary relationships and trust networks developed, supporting a shared purpose around integrated care delivery.
• Leaders demonstrated a clear shift in mindset, moving from “What’s my role?” to “How do we act collectively?”
• There was increased recognition of the patient and public voice as central to system design.
Lessons and Insights
• Time and space for individual and collective reflection are essential to foster new behaviours and collaborative leadership.
• Systems leadership requires unlearning – letting go of traditional hierarchies and embracing distributed power.
• Emerging roles such as convenor, connector, and coordinator are often poorly-defined.
• Connection is both means and outcome: increasing cross-system contact builds the “weak ties” that drive innovation and adaptability.
Food, administrative support and a sense of humour are real, and under-recognised, elements of the conditions precedent for systems leadership development.
Impact and Sustainability
The L4SC programme catalysed a narrative shift in the LLR system from siloed to collaborative ways of working. Participants built shared language, trust, and systems awareness — essential preconditions for integration. Early ripple effects include strengthened cross-organisational teams, use of system tools within local teams, and new joint initiatives.
Sustaining this momentum requires continued investment in network facilitation, coaching, and reflective spaces, alongside embedding patient and citizen voices in future work. The L4SC model offers a replicable framework for developing system leadership capacity across ICSs nationally.

Background.
Wales faces familiar but deep-rooted challenges in health and social care: workforce shortages, rising demand, stretched resources, and fragmentation between services. Despite strong policy commitments and structures for integration, people still experience disjointed pathways while staff navigate processes that sometimes add work without value. To better understand these pressures from those who live and work within the system, the Bevan Commission, in partnership with Llais (the statutory voice of the Welsh public) and the Institute for Healthcare Improvement, launched ‘Silly Rules’, a national campaign to uncover the everyday barriers that get in the way of good care and improvement. By surfacing examples directly from those affected, the campaign aimed to support organisations and teams to identify opportunities to simplify processes, release time, and strengthen integration for the benefit of people, staff, and the wider system.

Approach.
A bilingual open survey invited people with lived experience (patients, carers, families, and service users) alongside the health and care workforce to share examples of ‘Silly Rules’. The central question asked: “If you could break or change any rule(s) to provide a better care experience for patients, families, or staff in Wales, what would it be?”

Participants were also asked whether they were responding as members of the public or workforce, whether their example related to health, social care, or both sectors, and for basic details such as role and location. Responses were systematically coded against ten themes (including Operations, Workforce, Clinical Services), with qualitative and computational text analyses used to identify cross-cutting and co-occurring themes.

Results.
Over 780 participants from across Wales contributed more than 800 “rules”, including members of the public, carers, and staff from all seven health boards and multiple local authorities. While most rules related to healthcare (68%) and a smaller number to social care (3%), 23% referred to “both health and social care”.
Upon closer analysis, over 30% of all responses related to some aspect of Integrated Care. These were mapped to the IFIC Pillars, with people and partnerships in care and digital solutions emerging as the most frequently raised themes. showed how small procedural changes (e.g., enabling shared digital access or reducing unnecessary referrals) could release time, capacity, and morale while improving safety, experience, and organisational efficiency.

Implications.
The findings reveal that unnecessary bureaucracy and rules are not trivial frustrations but shared challenges that can unintentionally hinder care quality and integration. For Wales and beyond, the message is clear: progress towards integrated, person-centred care will depend not only on aligning rules, processes, and accountabilities, but also on reviewing them - keeping what adds value and simplifying or removing what does not. ‘Silly Rules’ has given a voice to people and professionals who experience these barriers every day and helps organisations identify where efforts to join up care can also build trust, efficiency, and empowerment. It highlights a culture ready for improvement - one where removing waste and restoring common sense strengthen both the experience of care and the sustainability of the system.