Integrating intent with mindset, systems and culture

29 July 2021

Integrating intent with mindset, systems and culture

How we integrate intent with mindset, culture and systems will be crucial to realising the aims of the integrated care systems.

With the announcement, yesterday, that Amanda Pritchard will succeed Sir Simon Stevens as the next chief executive of NHS England, the last big bit of the jigsaw is now in place. The appointment concludes a busy few weeks, in which the NHSI/E’s design and system oversight frameworks were published, Sajid Javid was announced as the new Secretary of State for Health and Care and the health and care bill was introduced to parliament. The groundwork for the healthcare reform we’ve been building towards is now well and truly in place; change is a constant but right now we are truly flipping the script.

This is the penultimate Illumination. In the previous 98 bulletins, we have explored the development of this change, providing thought, analysis, ideas and practical advice. Some of our pieces have focused more on intent, others on mindset, some on systems and a number on culture. Any change hinges on these four important elements, delivering effective change hinges on creating and maintaining the right dynamic between them.

Intent, mindset, culture and systems are all intrinsic to good governance. Without good governance, we can’t create truly integrated caring systems.

Creating systems that care

Achieving almost anything relies on good intent. But wanting is one thing; to achieve our goals, aims and ambitions, we must also have the right mindset. The health and care bill sets the intent for this generational reform, the design and system oversight frameworks give it direction but it will be on mindset that successful implementation hinges.

As progress in the development of integrated care systems speeds up and we move further from competition towards collaboration, from health maintenance to health improvement, and from activity-based performance to outcome-based performance, leaders and partners at national policy and political level, system-level and provider and partner level must align their intent and adopt a shared, positive, impact-focused mindset based on continuous learning and improvement. A change in mindset will make the difference between creating systems that look after people and systems that care for people.

Good governance is about more than just about compliance, it is about outcomes, purpose, ethical leadership, values, legitimacy, transparency. It is about what an organisation exists to do and for whom and how best to understand, express, realise and deliver on that. A broader acknowledgement and understanding of good governance will be key in ensuring effective system design. Governance that is just a static structure, considered as a safety net or obligation and orientated around policy and regulatory compliance, cannot deliver real benefit.

If the right systems are put in place with the right mindset, the right culture will follow; people will understand the purpose, align on values and feel they have the right conditions and tools to do their job. Good governance should make it easy for everyone in the organisation to do the right thing and really difficult to do the wrong thing. But for this to happen we need to be clear on intent, have our mindset aligned with the systems to facilitate a culture of good governance. The four elements are co-dependent, they are all part of a continually improving change ecosystem.

Flipping the script

At the Good Governance Institute, we believe that by turning thoughts and ideas on their heads and by thinking about, talking about, and seeing them differently, we can flip the script on what have become some very ingrained and steadfast positions. That is what we have done throughout the Illuminations series and will continue to do at this year’s Festival of Governance.

We have held a Festival of Governance every year since 2015. Each year we look at good governance over the last year and consider what we can learn from it. The festival brings together leaders from across the public, third and private sectors. This year our programme of free, in-person and virtual events throughout September will explore the integration and relationship between intent, mindset system, and culture.

The centrepiece of the festival is our annual lecture. This year Professor Jaideep Prabhu, senior lecturer at Cambridge Business School and author of How should a government be and Jugaad and Frugal Innovation, will be our keynote speaker at the event on 22 September. Previous keynote speakers include Professor Mervyn King, Rob Whiteman CBE and Lord Patel.

It is at the annual lecture that we will be presenting the annual good governance award to Sir Michael Marmot, to pay tribute to his significant lifetime of work to provide evidence-based decision-making in the public sector and his excellent work on the good governance principle of fairness through addressing inequalities in society.

As part of this year’s festival, we have designed a board game called Flip the Script. The point of the game is to help leaders collaborate on problem-solving and see challenges and solutions from different perspectives. During the festival members of the public, surrounded by Tim Nathan’s photographic exhibition, at Bermondsey Project Space, will be able to play the game live in the Bermondsey Project Space. For the week of 1 September, every day for an hour, participants will role-play different points of view based on intent, mindset, system and culture. Only once players have flipped the script on one or a combination of positions, will the group be able to agree on a favourable resolution to the game.

We will be publishing more information about year’s Festival of Governance on our social media feeds in the coming weeks. Follow #FestofGov and #flipthescript to stay up to date.


  • Good governance, and the understanding of what that is and what it means, is as important as ever if we truly want to deliver on the promise of the health and care reform.

  • How we integrate intent with mindset, systems and culture will play a vital role in the change to come, which we will be exploring at this year’s Festival of Governance in September.

  • Good governance should make it easy for everyone in the organisation to do the right thing and really difficult to do the wrong thing.

If you would like support with anything mentioned in the article or want to know more about this year's Festival of Governance, please call us on 07732 681120 or email

Meet the author: Daniel Taylor

Engagement Consultant

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Prepared by GGI Development and Research LLP for the Good Governance Institute.

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