THE SURREY CASE STUDY - AN ORGANISATIONAL DEVELOPMENT INITIATIVE DELIVERING IMPACT
This blog explores an organisational development (OD) initiative which delivered significant results across all levels of a health system in Surrey. The story of a system that moved to become more collaborative and enabling. A story about a group of leaders who dared to devolve and turn rhetoric into reality. Strategy into practice. Connect people with places, taking a 360 degree approach to health.
Delivering system-wide and cultural transformation in the NHS requires a shift from a rigid, top-down structure to a collaborative and enabling model. This case study explores how Surrey transitioned from a ‘one system’ structure to a place-based, integrated care model, using OD principles to align leadership, governance, and practice. The work showcases how leaders can overcome the strategy-to-practice disconnect and deliver sustainable, community-focused change.
The Challenge: Building a Collaborative System at Place-Level
Like many healthcare systems, Surrey Heartlands ICS and Ashford and St. Peter’s Hospital faced the challenge of moving from a centralised, hierarchical system to one that enabled place-based, devolved decision-making. The core challenge was twofold:
Creating an Integrated Care System (ICS) and Integrated Care Board (ICB) that genuinely enabled place-based working.
Embedding OD principles to develop system leadership, governance, and cultural change at all levels.
The 360 Degree Approach – People and culture as the catalyst for transformation
To deliver true integration and collaboration, our team applied a 360-degree approach to OD, embedding leadership capabilities and system-wide learning. The process was rooted to the experiences and realities of people and communities at Place Level. A learning by doing approach designed to connect people at all levels of the system – from executives to frontline teams – ensuring that change was sustainable and embedded in everyday practice.
Key OD interventions:
1. Understanding the System: OD Diagnostics & Leadership Definition
We began with a comprehensive OD diagnostic, drawing insights from place-based work, cultural reviews, and the evolving policy landscape. This provided a clear picture of leadership strengths, gaps, and system tensions. Additionally, we defined the leadership capabilities required for ICS transformation, ensuring these informed executive recruitment and development. Leaders were helped to see beyond their immediate context and recognise interdependencies and encouraged to shift from transactional to visionary leadership.
2. Developing ICS Leaders: Executive Coaching & Board Development
A significant focus was placed on one-to-one coaching for ICS executives, including the CEO, alongside a CCG Board programme to support the transition. This ensured leaders were not just operationally prepared but also psychologically ready to lead through ambiguity and transformation. Additionally, place-based mentoring provided the ICS CEO with peer learning opportunities, strengthening distributed leadership across the system. Coaching created a safe space for leaders to navigate complexity, reflect on their personal leadership, and adapt to the demands of system working.
3. Building a High-Performing ICS Executive Team
A year-long team coaching programme for the ICS Executive Team & Directors of Place was critical in strengthening leadership cohesion. This programme addressed:
Trust-building & team development using the Aston Team Journey
Defining system/place culture & behaviours
Clarifying system/place roles, tensions & opportunities
Embedding design principles for the county-wide Integrated Operating Model
Without a shared leadership culture, technical governance structures alone were not enough—real transformation came from teams building trust and psychological safety together.
4. Creating Governance & an Integrated Operating Model
System leaders needed clarity on governance, delegation, and accountability, especially as CCGs transitioned into ICSs. This intervention included:
Application of system thinking to real cross-boundary challenges
Defining place/system principles to support integrated working
Design & delivery of the first county-level Integrated Operating Model in England (with NHS Transformation Unit)
Governance frameworks only worked when aligned with the lived reality of system leadership—leaders needed both structure and flexibility to succeed.
5. Action Learning & System-Wide Engagement
Traditional leadership programmes often fall short because they fail to engage the wider system. To counter this, we implemented:
System-wide action learning & leadership masterclasses
Experiential learning programmes across organisational boundaries
Directorate-specific development, including work with the Chief Medical Officers Directorate
Leaders became more effective when learning was embedded into live system challenges, rather than being confined to classroom-based development.
Reflections & Impact
The OD interventions delivered tangible improvements in system leadership, collaboration, and governance clarity. Some of the most significant shifts included:
ICS leaders moving from operational firefighting to strategic, system-wide thinking
A shift towards shared accountability & distributed leadership at place/system levels
The development of a psychologically safe leadership culture
Clearer system-wide governance & a fully operational ICS model
As OD professionals, we know that leadership development is not a one-off intervention—it requires ongoing adaptation and reinforcement. The work done through this programme laid the foundation, but continuous effort is needed to embed these behaviours and sustain system transformation.
The Results: Real impact for local communities in Surrey and a Sustainable and Scalable model for system leadership
Through our 360-degree OD approach, we enabled a fundamental shift in how leadership, governance, and cultural change were embedded in the system. Key outcomes included:
A fully integrated operating model, balancing central leadership with place-based decision-making.
Eliminating the strategy-to-practice disconnect by ensuring frontline teams were actively engaged in system design.
Cultural transformation that increased staff morale, retention, and recruitment.
Financial sustainability, enabling long-term investment in community-led health initiatives.
The Implications for System Leadership
This case study highlights the power of OD in delivering system-wide NHS transformation. The key takeaways for leaders looking to deliver cultural and system change include:
Leadership Must Be an Enabler – Move away from hierarchical control and develop a deep understanding of the realities of communities at place level to underpin the transition to collaborative, place-based leadership.
People and Culture are at the heart of change - Engaging people, even in times of uncertainty, is crucial – they often know the issues and frustrations and possess the ideas and creativity that can drive improvements for populations. You have to be brave – face up to those aspects of long standing culture and behaviors that block rather than enable the right changes to happen
Governance Should Support, Not Block Change – Develop flexible, adaptive structures that align with frontline realities.
OD Needs to be Continuous – System transformation is an ongoing process, requiring sustained leadership development. An external OD partner with the right expertise is invaluable in helping a system to co-ordinate and combine policy and structural change, place based health improvements alongside developing the people skills and leadership needed
Learning Must be Embedded in Practice – Prevent the strategy-to-practice disconnect by ensuring leadership decisions are informed by real, ground-level experiences. Recognise what happens best at system, and what happens best at place – and that this may differ from Place to Place – use date and intelligence to understand this, not history or politics
Watch Donna Bradshaw’s 5 minute film setting out our approach to systems leadership in Surrey and what we learnt from the process.