ICB mergers: lessons for future success
Harness organisational development knowledge and experience to build a new culture
Why this matters
ICBs being brought together can have different histories, geographies and ways of working as well as variation in how closely they have worked together in the past. It’s important to start to build a shared culture and help staff feel part of a new organisation, rather than a collection of legacy bodies. While going through a restructure, staff may be overwhelmed by engaging in organisational development (OD) work with ongoing uncertainty about their roles, but focusing on culture from the outset is essential to setting the new organisation up in the right way. Building a new culture is an ongoing process, rather than a one-off event but different interventions can set the right direction of travel.
What works in practice
Developing a ‘values impact position’ proved helpful for managing these differences in one ICB, supported by plans to co-create shared values at an all-staff conference after the merger had completed. Another ICB scheduled two board development sessions within the first 60 days of the new cluster’s operation, focused on building the collective leadership team, identifying opportunities, and surfacing challenges early. This early investment was viewed as critical in setting expectations for collaboration and constructive challenge at all levels.
Advice from ICB leaders
- At a time of significant uncertainty, it’s important to counter ‘takeover’ narratives and create psychological safety.
- Harness OD expertise and experience and build it into staff engagement and design of the new operating model.
- Acknowledge cultural differences openly and establish interim behavioural expectations during the consultation and merger phase, while committing to more in-depth cultural work once the new organisation is formally established.
Work in practice
Thames Valley ICB: using OD to support transition
Learning from previous experiences of organisational change, the incoming Thames Valley ICB used its Organisational Development (OD) function to support its transition, with a focus on improving communication, building trust, engaging with staff and shaping a positive organisational culture.
How did OD support the development of the new ICB?
1. Shaping communication and narrative
OD played a central role in reframing organisational messaging to be more open and inclusive. This included challenging ‘us vs. them’ narratives between legacy organisations and promoting a shared sense of purpose and collective responsibility. Despite these efforts, perceptions persisted. For example, the composition of the executive team led some staff to view the merger as a ‘takeover,’ although leadership representation helped partially balance these views.
Design values were co-developed with trade unions and equality, diversity and inclusion (EDI) networks, emphasising outcomes (better health, care and equity), prioritising relationships and culture, and embedding inclusion from the outset. These values guided a co-creation approach, defining needs and functions before structures.
2. Building psychological safety
OD prioritised creating psychologically safe environments by:
- facilitating team away days and collaborative sessions
- creating structured opportunities for staff to share experiences and concerns.
These interventions improved openness and engagement, while recognising that cultural integration would take time.
3. Working across formal and informal systems
OD extended beyond formal structures to engage with informal networks and underlying dynamics. This involved:
- listening to unspoken concerns and informal narratives
- identifying gaps between formal messaging and lived experience
- actively addressing issues emerging on the ground.
4. Embedding OD in organisational design from day one
Rather than being brought in after structures were defined, OD was embedded in the design process from the outset. This ensured that culture, behaviours, and EDI principles were integral to organisational design. A co-creation approach replaced traditional consultation:
- Eight ‘input into design’ workshops provided safe spaces for staff to share views.
- Discussions explored purpose, enablers of effective commissioning, ways of working, and desired culture.
Outcomes
Utilising the OD function from the outset of organisational design enabled the ICB to take a more inclusive and strategic approach to the merger, resulting in stronger engagement and alignment across the system. Through the input into design workshops, over 300 staff contributed nearly 5,000 insights, which were synthesised into a core design document used to shape and test emerging organisational structures. This approach ensured that staff voice directly informed decision-making, visibly influenced final outcomes, and helped build trust and transparency throughout the process. As a result, staff felt more engaged, heard, and part of the journey, supporting smoother cultural integration and a more cohesive foundation for the newly formed ICB.