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How do we intentionally develop the integrated workforce?

How do we intentionally develop the integrated workforce?

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This blog is about intentionality. We intend to improve integrated care for local people – and improvement can be anywhere on the spectrum of small local change, to radical new models of care to transform population health outcomes – and we intend to invest time, energy and resources in doing this.
But just how intentional are we about equipping our combined health and care workforce with the knowledge and skills to lead and implement transformational change? Our experience at the Advancing Quality Alliance (AQuA) is that intentionality varies across the UK, and global delegates at this year’s International Congress for Integrated Care in Barcelona had a similar view.

In Constructive Comfort The Health Foundation emphasise the importance of investment in workforce skills including leadership, change management and quality improvement in order to accelerate and build the system-wide capability to sustain large scale change. In recent years inspirational stories have illustrated intentional skill-building as part of transformation plans in NHS Highland, South Central Foundation in Alaska, Kaiser Permanente, USA and the Canterbury system in New Zealand to name just a few. So the big question is…how do you get started?

Intentionality: getting started

If you’ve asked yourself how intentional your approach is to equipping the local workforce with the capability to drive change, and the answer is ‘not very’ or ‘there’s scope to improve’, I offer five questions to help frame your discussion:

  1. What skills and knowledge do you require to implement integrated care at scale?
  2.  At what scale is the skill and knowledge needed and how can this be achieved locally?
  3. What change models and improvement methods are suitable for your complex environment?
  4. What resources are available to support implementation of the changes in the local strategic plan? This includes the role of local leadership, improvement and innovation agencies.
  5. How can multiple simultaneous priority work streams be co-ordinated and the learning spread?

Ideas on how to intentionally build workforce capability to underpin integration

AQuA recently shared its intentional approach to large-scale workforce capability building in Leading in Complex Systems: 10 learning points for developing multi-agency leadership teams. We advocate a change model (see diagram) that blends approaches to make best use of staff time and resources, and underpin this with a facilitated peer learning community and team coaching.

We condensed learning from our work with local health and care systems across the UK into ten points with the aim of helping others design programmes for system leaders:

Design and Planning

  1. Blend theory and methodology
  2. Intentionally design system leadership support into transformation programmes
  3. Model collaboration in the provision of system leadership support
  4. Teams learn to lead together
  5. Develop distributed system leadership capability
  6. Sustain support to leaders
  7. Tailor support for senior and executive leaders

Skills in the wider workforce

8.Support relationship development at all levels
9. Embed improvement expertise in leadership teams


10. Think measurement – what is feasible?
We’d really like to hear your thoughts on this topic, and invite you to share examples of how you are intentionally developing integrated workforce capability via Twitter @IFICinfo or #ICIC16.


Elizabeth Bradbury,
(board member for the International Foundation for Integrated Care from 2014-16)

For more information about AQuA and our work, please visit, or follow us on Twitter @AQuA_NHS.