The challenges within the health and care system are felt every day by those working in improvement. Efforts to recover from the effects of COVID-19, on top of long-standing system pressures, have led to crucial improvements. But the question remains: where will transformative and enduring change come from?

We know that collaborative improvement makes a crucial difference, even in a challenging health and care context. But to have an even greater impact, we must look beyond organisational-level improvement. In integrating health and care, local systems will be looking to create radical, system-wide improvement to increase the scale of impact for the populations they serve.

For this, leaders need to work across local systems to develop shared improvement approaches. But this is hard. There is no clear recipe book for developing improvement across a large, complex system, with stakeholders from multiple sectors.

How we developed the principles

NHS Confederation and the Health Foundation are working in partnership with the Q community to support local health systems to learn and improve. Through this partnership we are exploring integrating improvement across all sectors, and how this can be brought together in local systems. In June we ran a roundtable and interviews with over 40 people who are developing shared, system-wide improvement approaches. This raised some of the challenges and enablers when engaging stakeholders in this work. We synthesized the collective experiences of our participants into five principles:

• Define scope and goals together
• Build relationships and trust
• See diverse expertise as an asset
• Develop shared system leadership
• Use an improvement mindset

Using the principles

These principles are designed to help people working at system level to engage their stakeholders, in a way that enables effective and sustainable change in practice. Whether developing an improvement strategy for your local system, considering your own leadership, or taking part in cross-system improvement work, these principles can help start conversations and guide your approach.

The principles don’t tell you what your system’s shared improvement approach should look like, but they can help guide you when the path forward feels complex and challenging. On a practical level, use them to start conversations with your stakeholders and discuss how they can help shape the culture in which this work takes place. The principles support a shared endeavour, bringing people from across your system on board.

We will continue to explore how these shared principles are applied in practice. This will be a focus of our partnership and we will keep you informed on how you can get involved.

Please read the principles and feel free to share them with your teams.

Contact us: Q@health.org.uk