Participative organisational re-design and target operating model development

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The challenge

In March 2023, NHS England announced that the running cost allowance (RCA) for ICBs would be reduced by 30% in real terms from April 2025. Bristol, North Somerset & South Gloucestershire Integrated Care Board (BNSSG ICB) aimed to reduce its operating costs starting from 2024/25 by creating and implementing a new operating model. In June 2023, we were commissioned to support the ICB’s ‘Shaping the Future’ program. We provided our services in two phases: engagement and design, and implementation.

Our response

Engagement stage: We co-designed and facilitated a mass participation event for over 200 ICB staff. Using Fisher’s Transition Curve (2012), we helped colleagues identify and understand their position within the change process, which allowed them to accept their vulnerability in facing the challenges and uncertainty through the work. This helped to create a supportive environment that acknowledged the emotional impact of change. During design sessions with each team, staff had the chance to prototype solutions using lean methodology, reviewing each function of their team. The outputs informed the design stage.

Design team stage: We provided a bespoke design pack for each directorate and supported the directorate design leads in drafting initial designs for their service’s functional delivery. This focused on vertical slices of the organisation at directorate level. An asset-based approach was used, recasting roles within design principles and aligned to the BNSSG strategy.

Horizontal design with executive team: Facilitated sessions with the ICB executive team informed further analysis on horizontal efficiencies across the directorates and explored wider system working. Three potential operating models were developed. The preferred model was approved by the ICB Board, enabling the organisation to enter consultation on the executive structure. Recommendations were made to inform the implementation stage.

Implementation stage: We worked closely with the new executive team to develop detailed organograms for each directorate, reflecting the new operating model. We conducted a comprehensive review of job descriptions, developing new ones where required, in preparation for consultation with ICB staff.

Operating model multi-coloured word cloud


Staff felt engaged: We fostered a climate of engagement and collaboration. All staff had the opportunity to be involved in the change process. Design leads ensured the employee voice was heard throughout the design phase. The mass participation event and contributions from the directorates, Design Leads and the Executive team were critical to the success of the programme.

Budget target achieved: During the design phase, three potential new models were developed to achieve a cost saving of 30%. These models were also designed to support the delivery of the system strategy and reflect the ICB responsibilities set out within the new NHSE National Operating Framework. BNSSG ICB  selected their preferred operating model, which involved moving from nine directorates to seven. Consultation with the executive layer was completed within one month and staff consultation started on time in December 2023 to enable people change to be completed by Spring 2024.

Fit for purpose target operating model: Our strong relationships, developed through engagement and design stages, enabled us to provide a high-quality end-to-end service, from design to launch of staff consultation. We worked collaboratively with the ICB throughout the process to ensure that the model was aligned with and incorporated the ICB’s vision, purpose statement, objectives and the NHSE Operating Framework


From the initial design stage through to consultation you have provided both expertise and an external critical friend role that has kept us on track and enabled us to get to this crucial point. It has been a pleasure working with you all and has felt like a huge team effort from day one.”

Jo Hicks

Chief People Officer, Bristol, North Somerset & South Gloucestershire Integrated Care Board (BNSSG ICB)