System change in practice: lessons from the north of England and Scotland
How to achieve meaningful system-level change when no single leader or organisation has effective jurisdiction
On this page
About the workshop
How can we achieve meaningful system-level change when no single leader or organisation has effective jurisdiction?
For several years, system leaders across Lancashire and South Cumbria, North East and North Cumbria, and Scotland have explored this fundamental tension. Collaborating with Professor Nicola Burgess and Nick Downham, they have documented their reflections in the report: ‘Of Clocks and Clouds: Leading System Level Change in Health and Care’.
Drawing on the lived realities of healthcare leaders, this session explores three distinct approaches to system-level change. We will examine what it truly takes to enable improvement across organisational boundaries where formal mandate and jurisdiction do not exist.
Real-World Case Studies
We move beyond theoretical frameworks to examine how three systems – known collectively as the Northern Triangle – actively manage this unresolvable tension:
- Engineering Better Care (Lancashire and South Cumbria ICB): A systems-engineering approach to the frailty pathway, demonstrating that system-level change must be clinically led, operationally driven, and improvement-supported.
- Boost (North East and North Cumbria ICB): A human learning systems approach to capability-building that moves beyond traditional training to master relational leadership through communities of practice.
- Scottish Approach to Change (Healthcare Improvement Scotland): A unified national framework that democratises change by making tools and capability universal, establishing a shared language with learning at its core.
What you’ll learn
- Greater understanding of different approaches to system level improvement.
- New framing and language that will help you understand, navigate and lead improvement in complex systems.
- Improvement approaches used by the Northern Triangle case studies to apply to your own work.
Who should attend?
Leaders from across different sectors across health and care who have an interest in developing their leadership practice for systems improvement.
Speakers
Penny joined the Health Foundation in 2011, leading work on improvement capability building, patient safety and improving flow, among other things. She has led Q since its inception.
In 2022, while retaining overall responsibility for Q’s strategic direction, Penny took on interim accountability for the Foundation’s portfolio of strategic initiatives, funding programmes and analysis aiming to improve the quality of health and care in the UK.
Before joining the Health Foundation, Penny was the Director of Strategy and Service Improvement at Newham University Hospital NHS Trust. She has spent her career leading improvement work at local and national levels in the NHS, with particular expertise in process and system redesign, leading strategic change across organisations, developing networks to support improvement and collaborative design.
Ailsa is the Chief Strategy and Improvement Officer at Lancashire Teaching Hospitals with an interest in system level improvement that began over a decade ago when she was undertaking the Generation Q programme and a Masters in leading improvement at Ashridge Business School. She is an honorary clinical professor at Lancaster University and an honorary professor at the University of Lancashire. Ailsa was also the Improvement Director for NHS IMPACT and the National Improvement Board.
Diana Hekerem is Associate Director of Transformational Change at Healthcare Improvement Scotland. She is currently excited to be leading work on the Scottish Approach to Change, and Healthcare Improvement Scotland’s Mental Health, and Alcohol and Drug portfolios.
She has built and leads a team that brings together expertise in Quality Improvement, Strategic Planning, the Scottish Approach to Service Design, and Human Learning Systems. Together, they support user engagement, service design, ethical commissioning, and partnership approaches to planning, alongside work on economic approaches to inequalities, rurality, and collaborative leadership.
Previously, Diana was a senior leader for Marie Curie, overseeing divisional service development across Scotland, Wales and Northern Ireland, as well as leading on UK-wide strategic development. She has also worked in international development in Ukraine and Nigeria, and in fundraising for the Red Cross.
Diana has served as a Trustee for SCVO and the National Wallace Monument, and co-founded the Chukwu Trust with her husband, Chief Nyeche Hekerem, supporting communities in the Ogbolo Kingdom in Nigeria.
Nicola is Professor of Operations Management at the University of York. A leading author in her field, Nicola’s research on healthcare operations is published in top-tier international journals. She is a Senior Fellow at The Health Foundation, a member of the Scientific Advisory Group for the Institute for Healthcare Improvement (IHI), and a Visiting Academic at Warwick and Aston Business Schools. She is also co-author of the best-selling suite of Operations Management textbooks, now in their 11th edition (Pearson, 2026).
Nick is an independent improvement specialist and Director of Cressbrook Ltd. He supports teams and systems internationally to improve operational efficiency, safety, and health inequalities. With a background in quality engineering and two decades of experience in health and social care, Nick is the co-author of Improving Quality in Healthcare (Sage, 2024).
Overview of the workshop
In the workshop, we’ll cover:
- A presentation, with report highlights and key takeaways
- Reflection time and opportunities for discussion with other system leaders
- A Q&A
The evaluation report will be published in June, and will be shared with you before the workshop.
Accessibility
We provide captions for all our online events. If you need any other adjustments to help you to participate please let us know using the form when you register or contact Adriana Thursby Pelham at adriana.thursby-pelham@thenhsalliance.org
Book your place
Discover more
-
From framework to action: supporting Improvement across systems
Opinion piece 1 June 2026 5 minute readDiscover our new toolkit to support your conversations on system improvement -
Cross-System Improvement Framework
Framework 29 May 2026 10 minute readPlan and deliver large-scale health and care improvements across systems with this detailed framework developed in collaboration with sector leaders and aligned with NHS IMPACT.