Day 3 has been spent with Helen and the NHS Leadership Academy of the East of England. A room full of the change agents in the Integrated Care Systems (ICS's) and STP's. These are the folks who will ultimately bring partners together to realize the potential of integrated care. Integrated care is close to my heart. I believe it's one of the greatest opportunities for improvement in health and social care. The thing about integration is, it's about something bigger, to realize its potential, it's about shared purpose,

Today's session was focused on finding shared purpose, Then, once you have found it, how you go about achieving it, using the most emergent improvement and implementation science approaches: including interdependency, scaling up and scaling down and the importance of theories of change.

Large scale change is about a shift in mindset towards shared purpose with the people who are part of the improvement effort.

Workshops like today, with 150+ change agents/transformation leads are so important because people are on a journey in developing a large scale change mindset and the skills that go with it. Few come by it naturally and even fewer are trained or have the experience with the level of transformative change this conversation speaks about. Taking the time to discuss and further develop these skills is critical. The workshop was convened for that reason, to bring people together so that they can continuously grow their ability to be in service of large-scale change.

Today's session was convened by Karen Bloomfield of the East of England NHS Leadership Academy. Karen really gets the importance of bringing change leaders together. It's an act of bravery to acknowledge that you cannot do radical transformation and change in the same way we do regular work. Radical transformation requires sharing and learning together as a pre-requisite. It was a privilege for me to see Karen’s act of leadership in brining this group together in this way.

I love being with people who want to realize the potential of integrated care and who come with an open mind and heart to contribute and learn. I saw this from each person at the NHS Leadership Academy today. I genuinely did see this in each person. People worked hard together to work the 'mindset muscle' to facilitate large scale change.

Helen's main messages from the day:

- OUR (Who are the people that will be impacted by the change? Who will need to be part of the change) SHARED (What unites us) PURPOSE (Why are we taking action? How does it connect with the things that really matter to us?). Don't confuse shared purpose with an AIM.

- We need to move from independent quality improvement initiatives (within a clear boundary) to inter-dependent quality improvement (collaborative, built on shared purpose, multiple methods).

- We need to both scale up and scale down. Personalized care (what matters to me) for each person AND at a scale that impacts hundreds of thousands of people.

- Theories of change are important because they help describe what success looks like and how to get there. The Change Foundation team has developed a theory of change that serves as a guide for how our multiple change efforts are interdependent and together demonstrate our intention for improvement at both the system and individual level. I was excited to tell The Change Foundation story today, for people to get to know us and to share our theory of change.

What else did people leaves today’s session with?:

In addition to the process people went through to build their 'transformative change muscles', people walked away completing their partnerships templates which they will be using to guide their approach to their work with the ICS's and STP's. People spent time meticulously rolling up and packaging their completed work as they knew it would serve as a guide to them for how they will move forward next. Talk about delivering value for everyone who attended. Follow the tweet discussion at #eoefuturelead.

One of the disciplines Helen does and which I really value:

Before the start of the workshop she brings the organizers (Today it was NHS Leadership Academy) and her team together for a pre day debrief. We discuss what success would look like and how we will go about the day. At the end of the day, we huddle again and go around and share our perspectives, what was strong and what could have been done differently. It creates a sense of shared purpose and solidarity amongst us and it allowed us to close off the day with individual and collective insight. When Helen came to Toronto, Ontario, Canada last November we ran a few virtual discussions with hundreds of people, and we did the same thing. I believe this is a disciplined practice for quality improvement and one I plan to take with me. The gifts that keep on giving....

Thank you, East of England NHS Leadership Academy

A special thank you for having me play such an active role today, facilitating, listening, contributing and presenting. I felt right at home. Thank you for the sketch note, I love it. I have it folded perfectly to bring home to Ontario, Canada to frame.

Reflecting on the International Foundation for Integrated Care (IFIC)

Today reminded me of how proud I am to be part of the global movement on integrated care and large-scale radical change focused on what's most important to people and their families and to spend time with others who have the same shared passions.

A special shout out to my close colleagues at the International Foundation for Integrated Care (IFIC), with whom I also collaborate, along with the 60 countries they have brought together to accelerate the learning and adoption of integrated care around the world. After my few weeks with Helen and the Horizons team, I will be heading to IFIC's international conference where 1200 people from 60 countries will come to connect and learn from each other. I plan to build my learnings from this time into my presentations. I'm looking forward to sharing … for those who aren't attending the conference, live webinars have been enabled so please join and the link above.

Day 4

I am off to the global conference for Ambulance Services joined by Ian Baines of the NHS Horizons team. I'm looking forward to another great day.