Leading system level change in health and care: Learning from the Northern Triangle
Learn from the lived experience of system leaders and consider what it takes to deliver meaningful change at scale and across boundaries.
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Background to the project
Through our National Improvement Leaders peer spaces we have been convening leaders across the UK and Ireland over a number of years. They provide a unique opportunity to learn across regions and nations, develop system leadership capabilities, and share insights and strategies for system improvement.
In the early days of this programme, participants identified a need to the demonstrate leadership practices that can deliver meaningful change in health and care when the solutions to the most pressing challenges lie beyond any single leader or organisation.
Sparked by those conversations, three Q members came together to explore this topic further. Their project was supported by supported by The Health Foundation and Q.
‘Of Clocks and Clouds, Leading System Level Change in Health and Care’ is a summary report of their leadership journey and practical learning over the past two years.
The report asks us to consider “how can we do things better together?” and “what does it take to shift to a more relational approach that puts people at its heart?”
Approaches and systems explored
- Engineering Better Care – a four(then five)-step systems-engineering approach to bring technical rigour and multi-perspective clarity to complex clinical issues. (Pathway level, Lancashire & South Cumbria).
- A Human Learning Systems approach – to foster an inclusive learning community. (Regional level, North East & North Cumbria)
- The Scottish Approach to Change – a holistic framework with a ‘people-led’ approach to transformation. (National level, Scotland)
Q members involved
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.
Prior to becoming an independent consultant, Kathryn was Deputy Director of People, Culture, Learning and Improvement at North East North Cumbria ICB.
Download the report
Discover more
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National Improvement Leaders Peer Spaces
3 minute readThis programme of support boosts the insight and collaboration opportunities available to national leaders so they can work together on major challenges in health and care. -
Relational Services Resources
Toolkit 9 June 2026 10 minute readA collection of resources, articles, webinar recordings and ways to connect with others to support more person-centred, learning-focused approaches to care and system improvement.