Coaching for System Improvement - Learning from an Innovative Leadership Programme Supporting the Collaborative Development of Integrated Care

Background: Delivering high-quality integrated care requires leaders to step outside silos, collaborate across organisational boundaries, and engage the collective intelligence of diverse teams and communities. Yet, few have received training in cross-system improvement. Drawing on the Health Foundation’s Improving Across Health and Care Systems work—developed with national improvement leaders from the UK and Ireland—we designed a leadership course to address this gap, aiming to be the first in the UK to offer training based on its recommendations.

 

Approach:The Coaching for System Improvement programme was co-designed by system improvement leaders at One Gloucestershire ICS and Rubis QI, Northumbria Health and Care Trust.It equips senior leaders with coaching skills to enhance collaborative leadership and accelerate transformational change. Drawing on improvement science, coaching theory, co-production principles, and frameworks such as the Health Foundation’s Improving Across Systems, the curriculum blends theory with practical application.

 

It follows the lifecycle of a system improvement project, with sessions on diagnosing needs, building conditions for change, designing aims and measures, managing change, and sustaining improvement. Peer-to-peer learning and safe spaces for reflection are central, facilitated by a teaching faculty with expertise in quality improvement, coaching, and systems thinking. Case studies and live system challenges help develop practical coaching skills.

 

The target audience includes senior leaders navigating complex system change, from diverse professional backgrounds across health and care organisations in Gloucestershire. The initial cohort included six participants, with later cohorts expanding to thirteen. Sessions were delivered as full or half days, spaced to allow integration of learning into practice.

Our ambition is to build a cohort of leaders who appreciate the relational aspects of transformation, think systemically, support each other, and spread this approach. A community of practice was established to consolidate skills and foster networks.

Evaluation and reflection were embedded, with structured reviews after each session and at programme end to support iterative improvement.

 

Results:We have trained 21 leaders (rising to 34 by end of 2025), with bi-monthly community of practice meetings. Satisfaction surveys showed an average rating of 9.14, with 93% recommending the programme.

 

Evaluation used mixed methods across two cohorts. Findings show increased confidence in relational leadership, psychological safety, and use of improvement tools. Participants valued the cross-organisational cohort, which fostered stronger relationships, broader perspectives, and a shared language of improvement. Protected time for reflection was highly valued, and many reported sustained engagement with coaching practices. Embedding these approaches within organisational cultures remains challenging. Executive sponsorship and strategies for sustaining behavioural change were identified as essential for long-term impact.

 

Implications: Following two successful cohorts, we are confident the programme meets the needs of health and care leaders seeking to enable collaborative system improvement. Case studies show encouraging changes in practice. Our third cohort is oversubscribed, and we plan to embed a local ongoing programme while exploring regional and national expansion.

The approach is being applied across initiatives including virtual wards, neighbourhood-based falls prevention, and weight management services. In Gloucestershire, it will underpin leadership capability for the continued development of Neighbourhood Health.