Supporting system improvement: lessons from a peer learning programme

Health and care systems are under significant pressure. System improvement can help deliver more holistic, place-based care that improves people’s health and expands beyond the confines of the NHS to include the voluntary sector, local government and other partners. It provides an opportunity to do things differently by working at scale, actively breaking down siloes, maximising resources and tackling issues that cannot be solved by individual organisations – harnessing improvement methodologies.

We build on our earlier research, Improving Health and Care at Scale, with the insights from the 2024 Learning and Improving Across Systems peer learning programme. The programme was delivered in partnership by the NHS Confederation, the Health Foundation and the Q Community. It brought together 168 leaders from across 38 integrated care systems, NHS trusts and health boards, local authorities and voluntary organisations across England, Scotland, Wales and Northern Ireland.

Programme participants spoke about several challenges that stifled progress in system improvement, including fragmentation and siloed working, financial constraints, and lack of senior leadership support. These challenges, alongside the reality that the complexity of system change means that progress may take time, can take its toll on the individuals leading system improvement efforts.

Peer learning supports system improvement by nurturing a sense of belonging and providing peer support, reducing the sense of isolation. It enables leaders to share experiences and challenges, facilitating knowledge sharing and benchmarking, through helping them learn from other systems. Additionally, peer learning can help support effective and trusting relationships, a crucial element of effective system improvement to improve quality of care and patient outcomes.

System leaders should consider strengthening peer learning mechanisms and enhancing leadership and governance for system improvement. Central bodies should develop and promote a shared approach to system improvement, and support peer learning programmes and networks at a national scale.