Strategy development that shifts culture
Royal Papworth Hospital is the UK's leading heart and lung hospital, with an outstanding CQC rating, world-class clinical results, and a workforce doing genuinely extraordinary work. Their challenge wasn't survival. It was to build on success while becoming a more connected, collaborative organisation. Over 15 months, we worked with over 1,100 staff, patients and partners to develop a five-year strategy that people recognised as their own — and began shifting culture before it was even published.
Introduction
Royal Papworth Hospital NHS Foundation Trust worked with Kaleidoscope for 15 months beginning in January 2025 to develop, publish and start implementing a five-year strategy for the UK’s leading specialist centre for heart and lung care. In addition to setting direction, the strategy process began to change culture before the strategy document was even launched.
The challenge
In many ways, Royal Papworth’s situation was desirable. Financially sound, CQC Outstanding, and recognised as one of the top 100 hospitals in the world, the Trust’s challenge wasn’t survival or recovery; It was to build on extraordinary success.
In the lead up to the new strategy, staff survey scores were mixed. There was pride in the clinical work, yet frustration at the organisation around it. Staff told us good ideas got lost in committees and that they felt undervalued despite doing extraordinary work. Meanwhile, the Trust’s ambitions to extend specialist expertise into local communities, to deepen partnerships and to reach patients who were not yet accessing its services were bigger than its systems to deliver them.
Royal Papworth wanted a strategy that would produce clear direction and take people with it. The goal was to build on extraordinary clinical foundations and move firmly into a new phase, becoming a more connected, collaborative organisation whose reach and impact extended well beyond its walls.
Our approach
We designed an engagement process built around a single principle: that the way you develop a strategy says as much about your organisation as what the strategy says.
Between January and November 2025, we reached over 1,100 people (staff, patients, community members and partners) through engagement approaches designed to give people real influence, not just the appearance of it.
The centrepiece was Team 2031. Inspired by citizens’ assembly models, twelve staff members were selected through an open expression of interest, from medical education fellows and healthcare scientists to critical care nurses, estates staff and occupational therapists. Over eight weeks they had more than 500 conversations with colleagues, patients and community members, supported by engagement toolkits we co-produced. They presented their findings directly to the Trust Board, a deliberate signal that shaping strategy wasn’t reserved for those at the top of the organisation.
We also ran “Pairs Discussions”, pairing Board members with staff leaders to meet jointly with 29 partner organisations and start to form more effective working relationships. A comprehensive survey gathered 467 responses from staff, patients, community members and partners. Fortnightly strategy webinars kept the whole organisation involved as thinking developed. Targeted workshops, including with the Consultants’ Forum, ensured specific and hard to reach voices were heard.
We analysed all the engagement data and distilled it into key themes, tensions and trade-offs, reviewed by the executive leads, the Board and Team 2031. This formed the backbone of the draft strategy, that people recognised as their own. “At the centre of heart and lung care” sets out six aims spanning clinical excellence, innovation and team-working, local and regional partnerships, national and international leadership, staff experience, and getting the operational basics right, all grounded in what the Trust’s own people said mattered most.
From strategy to action
Publishing the strategy was not the end of our work. With the final document in place, it was time to turn words into actions.
We worked with Royal Papworth’s leadership team to turn the strategy from theory into practice. This meant running a public and internal launch, establishing clear accountability for each of the six strategic aims, and working with executive leads to develop their implementation plans. We ran a series of sessions with the executive team on what high-performing leadership looks like during a strategy implementation. We held honest conversations about progress, barriers and collective accountability. And we supported the next round of staff involvement in carrying the strategy forward without us.
Our implementation work starts from a simple premise: a strategy only becomes real when leaders at every level feel they own it, and when there are honest systems to track progress. We worked with Royal Papworth to build both.
Results
The 2025 NHS Staff Survey, conducted as the strategy launched, showed early signs that the process had made a difference. Morale saw its strongest single-year rise since 2021, staff engagement rose above the average for Acute Specialist Trusts, and scores for teamwork and compassionate leadership improved. These are the measures you would expect to move when staff feel heard and involved in shaping their organisation’s future.
Through our engagement process, the proportion of people feeling unfamiliar with the strategy fell from one in three to just one in eight. The number of people feeling “fairly” or “very involved” in shaping the strategy almost doubled.
Beyond the numbers, partners who had been eager to work more closely with Royal Papworth came away from Pairs Discussions with the beginnings of working relationships. Staff who had never previously shaped organisational decisions had done exactly that through Team 2031. And the Board had strategic direction that they owned and a much clearer picture of what it would take to deliver it.
