Supporting Leadership Capacity in an NHS Trust During Transformation 

Organisational and system change Leadership development

An NHS Trust was entering a sustained period of transformation, involving significant service redesign and organisational change. This was taking place alongside ongoing operational pressure, workforce challenges, and rising demand and increased risks.  

For the senior leadership group, this created an intense environment in which immediate service pressures often dominated. Over time, it became increasingly difficult to step back and reflect. Leaders described feeling stretched by both the complexity of the change and the emotional demands of supporting their teams. 

There was a growing recognition that the organisation’s capacity to think, individually and collectively, was under strain, at precisely the point when thoughtful leadership was most needed. As pressure increased, leaders were often drawn away from their primary task and into more reactive patterns of working. 

Situation

Within this context, leaders experienced: 

• A strong pull into operational detail and problem-solving 
• Rapidly shifting roles and unclear boundaries 
• Emotional pressure from teams seeking direction and reassurance 
• Limited opportunities for collective reflection 

As urgency increased, there was a risk that leadership would become reactive, with less space to consider how best to take up role and authority in a changing system. 

Initially, I felt guilty taking time out to focus on leadership. Day-to-day, the work can feel relentless, it sometimes feels like a warzone, with pressure from the team to step in and fix problems quickly.

Photo by Dariia Lemesheva 

Our approach 

We worked alongside the senior leadership group to create and sustain space for thinking during the transformation, drawing on a systems-psychodynamic perspective. 

The work began with an in person facilitated awayday, offering a rare opportunity to step out of day-to-day pressures and reflect on the nature of the change. This included exploring: 

• The primary task of the organisation during transformation 
• How roles, boundaries, and accountabilities were shifting 
• The impact of the wider system on organisational culture and leadership behaviour 

Attention was paid not only to what was happening structurally, but also to the underlying dynamics shaping the group’s experience, including anxiety, dependency, and the pull towards urgent action. 

This was followed by a series of monthly online action learning sets, creating a structured and consistent space where leaders could: 

• Work on live organisational challenges in real time 
• Reflect on how they were taking up role and authority 
• Explore how emotional pressures were influencing decision-making 
• Notice patterns of behaviour within and between teams 
• Support and challenge one another, while maintaining shared accountability 

These sets functioned as a contained space to reflect and think together, enabling the group to slow down, surface assumptions, and consider the wider system dynamics at play, rather than focusing solely on immediate problems. 

Impact

Over time, the leadership group developed: 

• Greater capacity to contain and think about organisational anxiety, rather than reacting to it 
• Increased clarity about roles, boundaries, and accountabilities 
• A shift from patterns of dependency and rescue towards shared responsibility 
• Stronger relationships and a more cohesive leadership system 
• Improved ability to hold both operational pressures and longer-term change in mind 

Leaders reported feeling better able to navigate complexity and to sustain their leadership through a demanding period of transformation. 

I’ve realised how quickly I’m pulled back into solving problems, and how unhelpful that can be. I need to take up a coaching approach, to support my team to think and act for themselves.

Photo by Sylvain Brison

Meeting regularly with colleagues has been invaluable, a space to reflect on real experiences, support one another, and stay accountable for the actions we’ve agreed. I feel supported, knowing I am not navigating this challenging period alone.

More broadly, the work helped the group to function more effectively as a leadership system, with increased capacity to think collectively and respond to pressure with greater deliberation. 

Reflection 

This work highlights the value of creating protected, ongoing spaces for reflection during periods of organisational transformation. By supporting leaders to think together about their role, relationships, and shared task, the Trust strengthened its ability to remain connected to its primary task, even under significant pressure. 

Conclusion 

In complex and demanding environments, leadership can easily become absorbed in immediacy. This case demonstrates that when organisations invest in structured opportunities to step back, reflect, and learn together, leaders are better able to sustain their effectiveness. Strengthening collective leadership capacity in this way not only supports individuals but enables the wider system to respond to challenge with greater coherence, resilience, and thoughtfulness.