Immersive leadership: strategic commissioning in action

Our Connected Leadership 2025 programme, funded by Boehringer Ingelheim, for chief executives and chairs of integrated care boards (ICBs), and chairs of integrated care partnerships (ICPs) used this approach to support the leadership capabilities for strategic commissioning.  

This dynamic method helps senior health and social care leaders develop critical skills in a risk-free environment. These transformative experiences provide leaders with the tools and insights to navigate complex decision-making processes, equipping them to lead with agility and confidence in the face of ongoing change. 

Our approach  

A key component of this session was the introduction of an innovative strategic commissioning return on investment (ROI) tool, developed in collaboration with our partners Boehringer Ingelheim and Carnall Farrar. 

Our ROI tool enabled the cohort to run a decision-making ‘simulation’ of the allocation of public funds across various healthcare sectors, allowing the leaders to visualise the consequences of their decisions. This created a real-world context for their decision-making, pushing leaders to consider the broader impact of their choices and the trade-offs involved in balancing competing priorities. 

Dynamic decision-making 

The immersive experience itself was transformative in several ways. By engaging in the simulation, leaders were not simply learning theoretical concepts, they were actively practicing and refining their decision-making skills in a realistic and dynamic environment. 

The immersive nature of the activity allowed them to experience the pressure of making high-stakes decisions, which enhanced their ability to think critically, act decisively, and lead with confidence in situations that mirror the complexities of real-world healthcare systems. 

This hands-on approach at NHS Confederation accelerates learning, as it allows leaders to test their decisions, experience the immediate impact of those decisions, and reflect on the lessons learned, all in a safe, risk-free space. 

Leadership behaviours 

The immersive learning activity also provided a unique opportunity for leaders to analyse their leadership behaviours during the decision-making process, especially at the ICB board level. It encouraged participants to reflect on how they handle pressure, manage disagreements, and prioritise resources in a complex environment. 

By engaging in the exercise, leaders gained insights into how they approach decision-making, and the tool helped them see where they might need to adjust their strategies to ensure more balanced and effective commissioning decisions. 

Real-world context 

In addition to testing their strategic decision-making, the immersive experience provided valuable insights into the consequences of investing in certain areas over others, particularly in shifting from treatment to prevention-focused approaches. 

Leaders were able to see first-hand the ROI for different services, helping them understand the long-term impact of their decisions. This was a key learning point, as it highlighted how difficult it can be to allocate investment, especially when considering the unintended consequences and long-term implications of decisions, alongside the public reaction. 

A reflection session followed the immersive exercise, allowing leaders to debrief on the experience and enhance their sense-making of the decision-making process. The activity also helped sharpen their understanding of the leadership behaviours required under pressure and provided insights into how they can improve their leadership style in future decision-making scenarios. 

Strategic alignment  

Through working together on the immersion activity, it became clear that even when time is short, it pays to spend time upfront aligning on the basics. Questions like: What’s the overall goal? What’s the basis upon which we’ll make decisions? What’s our approach to discussion? - were crucial to making effective decisions. This insight proved to be invaluable, reinforcing the importance of strategic alignment before diving into decision-making processes. 

Furthermore, the exercise demonstrated the importance of considering where services should be commissioned, and importantly, the impact of the investment, is truly felt. 

An awareness of this is required for measuring the effect of commissioning on the three big shifts in healthcare. The ROI tool enabled leaders to reconsider how and where investment was made, particularly in terms of ensuring the community shift was being considered, in terms of neighbourhood working and prevention versus treatment. This was important in critically evaluating their previous assumptions and avoiding the ‘right-drift’.  

“It’s striking how often we cling to our preferred way of doing things because that’s what we’ve always invested in.”  

The tool highlighted the importance of challenging the status quo and using data to guide decisions, rather than relying solely on ingrained habits. 

The immersive experience also shed light on how leaders tend to revert to their ‘defaults’ in decision-making, especially under pressure. Whether it's responding to stress or relying on expertise to make quick judgments, these default responses can sometimes prevent leaders from seeing new possibilities. 

The best leaders, however, are aware of their own biases and seek out alternative perspectives. They recognise the gaps in their own thinking and actively look for people around the table who will challenge their assumptions. 

Diverse perspectives 

Feedback from participants confirmed the value of the exercise, with many noting how it helped them collectively think about prioritisation and the importance of diverse perspectives. Comments such as, “This was really useful, especially with local authority colleagues, exploring a range of perspectives,” underscored the collaborative value of the experience.