Impact case study database

A&E waiting times in the UK have increased substantially over recent years and have become a major policy issue. This led to a waiting time standard that states that 95% of patients should be assessed, treated, then either admitted or discharged within four hours of presentation at an A&E or an UCC/MIU. The Kings Fund, 2020Footnote:

The King's Fund (2020). What’s going on with A&E waiting times? https://www.kingsfund.org.uk/topics/emergency\-care (last accessed Sept' 2020). claimed that since July 2013, A&Es have not met this standard.

In 2015, the Exeter team worked with the Health & Care IMPACT Network to implement the NHSquicker app so that patients can choose the appropriate type of treatment facility for their condition. The work demonstrated that while patients do not have a direct role in scheduling operations of an urgent care facility, the decisions they take have a bearing on its performance. The work showed that real-time data on A&E/MIU wait times influenced destination choices made by patients. These results benefited the NHS trusts in the South West in two ways. First, by improving the appropriateness of the choice of an urgent care centre, and second, by smoothing demand over inevitably stretched facilities, particularly those offering emergency treatment.

The importance of the app is reflected in the following statement by Associate Director of Delivery South West Academic Health Science Network: “ *Professor Mustafee has developed new analytic models (which integrated a ‘nudge’ algorithm) based on business intelligence and real-time data and applied that to the development of a real-world innovation which empowers patients to make better, more efficient decisions. The positive impact of his work involves not only the patients who use the app, but also non-users of the app (e.g., they could experience lower wait time as those using the app may have visited an alternative urgent care centre), the NHS staff, and the entire system […] Professor Mustafee’s work has shown real time NHS benefits in Devon.*” [5.1].

The impacts ascribed to the work are described below.

1. App available to 1.7million patients, with over 40,000 patients directly using it Better information has led to shorter waiting times and improved patient experience. Large numbers of patients are also accessing the service via GP and Trust websites. An in-app questionnaire integrated with NHSquicker received 543 responses between 24/03/2020 and 10/09/2020: 82% of users agreed that NHSquicker helped them at the point of need, whilst 78% responded that it helped them decide where to go. As patients have come to know of the app and download it, the analytics data showed that the vast majority (approx. 87%) retained the app on their mobile devices having found it very useful. One patient commented: “Used NHSquicker this morning .... went to Newton as there was only two people waiting ... booked in ... had consultation ... had three X-rays ... got treatment plan and crutches ... out in less than an hour ...”. Another said: “My GP used Quicker to tell me where I could go to a local MIU, which was 15 minutes’ drive past the ED. I was seen so much quicker despite the drive”.

2. Impact on A&E services in reducing pressure on A&E services with more patients choosing to go to MIUs in the trusts which first adopted NHSquicker.

A data summary facility developed by the research team is embedded within the app and is used to access summary patterns of patient movements. The evidence from this data from two early adopters of NHSquicker (TSDFT and North Devon Healthcare Trust) show that the app made an impact in directing patients away from busy A&E department at peak times. For example, for the period 2017- Feb 2019 for TSDFT, an analysis of data showed that there was a significant shift in peak time patterns of attendances (that is, between 11.00-16.00). First there was a reduction in A&E attendances, and second, an increase in MIU attendances compared to the same period in the previous year. The overall impact of the app was to reduce attendance in A&E and increase MIU attendance. The significance of the changes in patient patterns of behaviour is reflected in the following comments:

The Chief Executive of TSDFT said, “Quarterly changes in Minor Injury Units and A&E (MIU/A&E) presentations during busy hours (11am-6pm) for ages 18-50 years has shown that there is a significant shift from the start of 2018 in the pattern of attendances, with a reduction in A&E attendances and an increase in MIU attendances. The work of Professor Mustafee has had a significant impact on shaping demand for urgent care. The success of this intervention has impacted significantly upon the pressures faced within the Torbay A&E department and led to new uses of the app. An example that comes to mind is the use of NHSquicker by frontline staff to monitor our four urgent care facilities; the application was originally developed for patients but has now found another use!” [5.2]. The 2018 Care Quality Commission (CQC) report on Torbay and South Devon NHS Foundation Trust reported NHSquicker as a University-Trust Quality Improvement initiative, "The trust had a number of innovative programmes designed to improve services. Quality improvement methodologies were being used to support a number of improvement projects, including the NHS Quicker smartphone application." [5.3]

The Executive Medical Director and Deputy Chief Executive at RD&E Trust and Medical Director at North Devon Healthcare NHS Trust said, “The success of this intervention (NHSquicker) has impacted significantly upon the pressures faced by the A&E departments at both the RD&E and the North Devon Hospital. There has been a significant shift from the start of 2018 in the pattern of attendances, with a reduction in Emergency Department attendances and an increase in Minor Injury Unit attendances, which has led to better services for the patient and led to reduction of overcrowding in the Emergency Department” [5.4].

A senior member of NHS Horizons, which is a specialist team within the Improvement Directorate of NHS England and supports “leaders of change, teams, organisations and systems to think differently about large-scale change, improve collaboration, and accelerate change”, says: “ *From the outset, I believed Professor Mustafee’s work to be an exemplar of how innovative research can shape practice and have a significant impact on the lives of patients and staff. The success of this intervention has benefitted the entire system greatly and helped ease the pressures faced by many A&E Departments in the South West.... I believe the NHSquicker app has the potential to be developed on a national scale, in order to expand the positive impact of this work to the wider NHS network.*” [5.5]

3. Shaping practices in multiple Trusts, and the subsequent adoption of the technology by the NHS

To date, NHSquicker receives data from all acute Trusts in Devon, Cornwall plus one Trust in Somerset, and one in Bristol. In June 2019, following requests from TSDFT, the research team collaborated with NHS Digital to develop a new version of NHSquicker, which provides on-demand information on GPs, pharmacies and sexual health clinics by directly using the NHS Directory of Services (DOS) database.

NHSquicker v2 was launched in February 2020. The NHS Director from Torbay described how the app was having an impact across the Trust and led to better decision-making. He said: “It’s fantastic – I use this every day to see what is happening in my organisation and the status of the adjoining trusts. Seeing data in real time allows us all to plan ahead. This is a first nationally!” A Senior Manager (Digital Transformation) spoke of the use of real-time data for empowering patients “… what the Trust wants to use it for, is a tool to drive patient behaviour” and the advantages of a system-wide view where data is pulled-in from multiple Trusts, “It’s creating value from a wider point of view. So, it would be value for patients, but it will also be value for the system because it’s about allocating people into a more efficient place to be” [5.6].

The Executive Medical Director and Deputy Chief Executive of RD&E Trust and the Medical Director of Northern Devon NHS Trust, said, “Professor Mustafee’s intervention has been so positive that we will be happy to integrate our new single electronic patient record system (EPR), which will be rolled out later this year, to send data feeds to the NHSquicker app. This demonstrates our recognition that they have created something which is both valued and has the potential to improve the service the NHS offers” [5.4].

NHSquicker was featured in BBC (Spotlight) and ITV news (South West) and other media channels [5.7] and was also a finalist in the Health Service Journal HSJ2018 award in the category “Enhancing Care by Sharing Data and Information” [5.8].

4. Shaping future adoption

The ongoing pandemic has negatively affected some activities planned during the REF impact period. The next phase of the work is to develop and evaluate the future version of the app taking into account the research results from the behavioural economics research [3.6].

Future work will be focused on scaling up the use of the app from a regional to a national setting. Another stream of work is to improve the performance of services like Pathway (used by the NHS 111 service to triage) by utilising the data collected by NHSquicker [5.5].

The Innovation Fitness Toolkit (IFT) has built repeatable organisational capability to capture the value from innovative ideas and to ensure that even if firms do not land their first innovation, they are able to continue to create a portfolio of high value innovations. The successful roll out of this tool has led to a diverse range of public and private organisations driving innovation, improving products and services and increasing efficiency and growth. This has been achieved during a period of global austerity and rapidly emerging digital disruptions. The impact of the IFT has been seen in global organizations (e.g., Bott Ltd and Hydro International); in the South West with 260 businesses and micro-organisations through Devon County Council’s economic development programmes; in public sector organisations such as Cornwall Council and Cornwall Marine Network; and across the world via the International Society of Professional Innovation Management (ISPIM).

Examples of IFT impact on new product and service development in organizationsThe IFT approach has resulted in two Knowledge Transfer Partnerships (KTP), a part funded government programme which helps UK businesses to innovate and grow by linking them with an academic and a graduate.

Bott Ltd

In 2015, a KTP was developed with Bott Ltd, a leading international manufacturer of vehicle and workshop equipment, which employs over 950 people in the UK and Germany. The aims of the partnership were to develop, build and embed an effective innovation process to deliver a new product and service offering through the company’s two UK sites. The Innovation Management Capability (IMC) approach incorporating the IFT was conducted as part of the KTP [3.2]. It enabled Bott Ltd to embed new project management structures and an ‘Innovation group’ that led to the development of new products. One of the innovations directly attributed to the KTP was the ‘Smartvan offer’, which saw an immediate £600,000 increase in annual sales turnover and a predicted £3,000,000 change in annual sales turnover in three years [5.1]. Another innovation, Tilt Box, resulted in the company investing £100,000,000 in plant and machinery [5.1]. The KTP enabled Bott Ltd to diversify its offering with 90% of the profit increase attributed to the KTP, related to new products for new markets in both their UK and German operations [5.1]. The KTP Associate was tasked with interpreting the IMC approach to fit the company’s strategic aims. According to the Head of Marketing & Development at Bott Ltd “[the approach has] strengthened our internal processes and has resulted in positive improvements to the ways in which we manage our organisational systems as well as developing a better awareness of how to embed and harness innovation as part of a structured process” [5.2]. The KTP resulted in Bott Ltd taking a “ far more strategic approach to innovation and product development. This in turn has driven the firm to adopt an evidence-based decision-making process, enabling the company to allocate development resource to the activities offering the greatest growth opportunities” [5.1, p.10]. The IFT has also led to a far-reaching international network exercising the team’s IMC approach.

Hydro International

In 2014, Dr Alexander was approached by Hydro International Ltd to lead a KTP to assess the organisation’s innovation strategy and identify potential gaps. Hydro International are a global company with a turnover in excess of $250M, who provide advanced products, services and expertise in water management. The IMC approach incorporating the IFT was implemented to identify and develop processes and behaviours that could be translated into positive changes in Hydro’s management practices for new product development, in their offices in Bristol and Cambridge (UK) and Portland, Oregan and Portland, Maine, USA [3.2]. The Director of Group Product Development for Hydro International Ltd stated that, due to the KTP, Hydro has a “better framework for assessing market opportunities and a better awareness of how to optimise resources and go to market faster for Product Development Initiatives” [5.3]. Furthermore, the KTP has “strengthen(ed) Hydro International’s reputation as an innovation leader in the water sector” and that by implementing IMC, Hydro “ can now do early market research which was not possible before (…) that staff have benefitted from being fully engaged in the product development cycle” [5.3] . A standardised, faster and more efficient process is now in place which means Hydro are able to provide solutions to clients faster [5.3].

Impact of IFT on innovation leading to efficiency and growth in the South West region

In 2015, Devon and Cornwall had the third and eighth lowest labour productivity levels nationally (Source: ONS). Dr Alexander has been instrumental in equipping public and private sector organisations in the South West with tools such as the IFT to drive innovation within their organisations.

Devon County Council (DCC)

IFT has been implemented in 260 private businesses in Devon through the Rural Growth Network Business Support Programme delivered by DCC throughout 2014-2015 [5.4]. Businesses involved received a package of support, based on the IMC approach, which was designed to enable rural enterprises to engage with innovation at a level best suited to their organisation. The DCC’s 2017 evaluation report [5.4] stated that the result of this programme for businesses involved has included significant impact, with 55% of those surveyed stating they felt the programme had resulted in ‘running the business more efficiently/effectively’ and 33% believed it had supported them in ‘identifying new markets’. In addition, 74% stated that they anticipated future benefits in terms of ‘the further growth of the business’ [5.4].

Cornwall Marine Network / Cornwall Council In 2017, a socio-economic and innovation analysis of the Marine industry in Cornwall was conducted by the Exeter team, in partnership with Cornwall Council and Cornwall Marine Network (CMN) using the IMC approach which incorporated the IFT. The project investigated how innovation can inform policy (Cornwall Maritime Strategy 2012-30) and associated macro-level interventions (e.g. Marine Strategy Action Plan). An Economic Development Officer at Cornwall Council described this work as ‘providing vital intelligence which in a rural, micro economy is extremely difficult to otherwise quantify’ [5.5] . Thirty SME businesses attended Masterclasses on Innovation Management Capability, which included the IFT, run by Dr Alexander, Professor Bessant, and Dr Pye (ESRC IAA Knowledge Exchange Fellow), in 2018 and 2019 [3.4]. In addition, other SMEs signed up for direct innovation support under the Marine-I programme, run by the University of Exeter. Cornwall Council have stated that the IMC approach helped “ Cornwall Council hone its review of the [Marine and Maritime] strategy and (more importantly) both better understand (a) supply chain issues and (b) workspace needs and demands” [5.5], creating a plan for inward investment in the key maritime regions in Cornwall. Operations Director, Cornwall Marine Network [5.6] states that the engaged research gave CMN a “new and improved understanding of business functionality in this sector”, and of “the impact of CMN itself on the marine economy in both Cornwall and the Isles of Scilly and in Europe”. This, she said will enable “a better targeted approach for CMN to identify and deliver its current and future services”, providing information “to inform and influence public sector support”. The IFT final report [5.7] demonstrates the benefits that a number of Marine Network members saw from the IFT: for example, one participant (case study C) was able to achieve a major step-change in its activities during the five months in between its IFT self-assessments as a result of taking full advantage of the project’s services and support. This led to the company being selected from over 1200 applicants to attract international interest and investment by prestigious global organisations.

Global Impact of IFT through the International Society for Professional Innovation Management (ISPIM) ISPIM is a community of 600 members from research, industry, consulting and the public sector across 60 countries. ISPIM have worked with the innovation management capability (IMC) model through a series of initiatives since 2010. As part of these, a Special Interest Group (SIG) on Teaching and Coaching Innovation for industry and academia was developed (2015-2020) and through this group ‘ Professors Alexander and Bessant have changed the way innovation and entrepreneurship is taught and coached in upwards of 500 organisations, mostly throughout the EU’, states - Operations Director, ISPIM, in 2018 [5.8]. Feedback to ISPIM from member organisations on the IMC model has highlighted its effectiveness at all sizes of corporate organisation. The Operations Director of ISPIM concludes that “The impact that Prof Alexander and Prof Bessant have had on the field of innovation management is a significant one. Without their actions through the University of Exeter as an ISPIM Member, our members, and the field in general would be significantly poorer” [5.8].

Between 2014 and 2020, The IMC has impacted innovation and entrepreneurial activity across 60 countries through the coaching of 600 global businesses at ISPIM together with creating substantial change to innovation and entrepreneurship thinking and practice to the SW region. Within the SW, Alexander has influenced at policy level by designing innovation processes with Cornwall and Devon local authorities and then at business level implementing the IMC and IFT through local business networks to reach 290 businesses. In addition, businesses Bott Ltd, Hydro International and Marine-I programme participants have been able to make substantial improvements to their innovation management processes through long term involvement of Alexander. As a result, these businesses have adapted their innovation strategies enabling the design and delivery of new products and services, bringing demonstrable business growth.

Professor Harris’ research has directly informed Bank of England approaches to understanding future risks of shocks within the UK banking sector. Results obtained from Harris’ analytical framework, described above, have been used to improve the formulation and calibration of the annual stress testing exercise undertaken by the Bank of England. In addition, they have improved macro-economic forecasting for the Monetary Policy Committee, allowing the Bank to better gauge the vulnerability of the UK banking system to possible future shocks, and the channels through which these shocks are transmitted. The analysis has also allowed policy makers at the Bank to evaluate feedback mechanisms, which are believed to play an important role during periods of economic turbulence, thus helping to fine-tune the Bank’s policy decisions.

Improved formulation and calibration of the annual stress-test exercise:

Following a recommendation by the Financial Policy Committee (FPC), the Bank of England initiated a programme of annual stress testing in 2014 in order to assess the capital adequacy of the UK banking sector, and its resilience to a range of possible future shocks. The stress testing exercise involves the formulation of a hypothetical scenario, representing a deterioration in global economic conditions that would adversely affect UK banks and building societies. The results of this scenario are compared with those from a baseline scenario that is based on the Bank of England’s forecasts of future macroeconomic conditions. A key issue that emerged from the early stress tests was the need for a better understanding of the linkages between financial market volatility, market sentiment and the ‘real’ economy. This is cited as “a key area for the Bank in terms of ensuring financial stability and a resilient financial system” by the Head of the Bank of England’s Stress Testing Strategy Division, which is mandated with monitoring systemic risk in the UK financial system [5.1].

This issue was addressed by Professor Harris whilst working on secondment at the Bank of England. Based on his underpinning research [3.1] and working together with Dr Evarist Stoja from the University of Bristol, Dr Jeremy Chiu of the Bank’s Stress Testing Strategy Division and Dr Michael Chin of the Bank’s Macro-Financial Analysis Division, Professor Harris developed an analytical framework, distinguishing between the different effects of core and transient financial volatility on the macroeconomic environment, that has influenced policymaking at senior levels within the Bank.

Professor Harris published his findings in Bank of England Working Papers no. 608 and no. 792 [5.2; 5.3] and produced an associated confidential policy note (drawing out and emphasising policy implications and recommendations) that was circulated to senior management within the Bank, including members of the Monetary Policy Committee and Financial Policy Committee. While the outcomes of these discussions and meetings remain confidential, the Head of the Stress Testing Strategy Division has provided a testimonial that confirms that Professor Harris’s work had “ important policy implications, especially for the Bank's annual stress testing exercise and, more generally, for macro-financial analysis. In particular, since the core volatility is related to macroeconomic fundamentals while transitory volatility is associated with investor sentiment, policy makers are better served by using core volatility rather than total volatility in calibrating the adverse scenarios” [5.1].

The Senior Economist at the Bank’s Stress Testing Strategy Division, and Professor Harris’s co-author, confirms the policy impact of the BoE Working paper [5.2], stating that their findings have been “discussed in important policy-making meetings, with the attendance of the Head of the Research Hub, the Head of Stress Testing Strategy Division, and the Head of the Macro-Finance Analysis Division during the summer of 2016. The responses were immensely positive, and our results were recognized as making a material impact regarding macro-prudential policies and annual stress-testing exercise” [5.4].

Improved macro-economic forecasting for the Monetary Policy Committee and broader aspects of financial stability policy-making:

Professor Harris’ analysis is also directly supporting improved macro-economic forecasting at the Bank. The Senior Economist [5.4], now working in the Forecasting Division at the BoE, and in charge of improving in-house modelling, confirms that the Working Paper findings on financial volatility [5.2] have been used to develop a new macro-economic forecasting model that is being used every quarter by the Monetary Policy Committee to inform its decision-making [5.4].

Professor Harris’ work has clearly made an important contribution to the development of effective stress-testing approaches at the Bank of England, enabling the Bank to refine its response to market volatility and thereby playing a critical role in safeguarding the stability of the UK financial system and the wider economy. The significance of Professor Harris’ impact can be viewed in terms of the importance of stress-testing to the UK economy. On its website [5.5], the Bank of England explains the need to ensure that banks and insurance companies are strong enough to withstand another financial crisis: “Banking stress tests assess how banks can cope with severe economic scenarios. We look at banks’ resilience, making sure they have enough capital to withstand extreme shocks and are able to support the economy.” In its latest Financial Stability Report (FSR), the Bank notes a substantial increase in banks’ resilience since the 2007/8 financial crisis: “The FPC judges that the UK banking system remains resilient to a wide range of possible economic outcomes. It has the capacity to continue to support households and businesses even if outcomes are considerably worse than expected. This reflects the build-up of substantial buffers of capital since the global financial crisis” [5.6].

Within changes to the broader policy landscape, stress tests enable the BoE to refine its response to market volatility and thereby play a critical role in safeguarding the stability of the UK financial system and the wider economy.

In addition, the Senior Economist in the Macroprudential Strategy and Support Division of the BoE, and co-author, said in August 2019, of the Working Paper 792 [5.3], that the study “is important and timely and fills a glaring gap in the literature of particular importance to the bank of England” [5.7]. She describes the impact of the work as providing BoE with an improved understanding of the challenges it faces with its communications such as the FSR, delivering “the concrete steps necessary to address those challenges which the bank has accepted and has started to implement and will continue to do so in the medium to long term as it pursues its core objective of financial stability and ultimately a healthy British economy” [5.7].

Finally, Professor Harris’ research has also supported the Bank of England’s efforts to engage with the wider public on its policy decisions. The non-confidential aspects of the analysis work formed the basis of an article for ‘Bank Underground’, the Bank of England’s blog [5.8]. The blog serves to demystify the work of the Bank for journalists and the wider public. The analysis was also summarised in the Wall Street Journal [5.9].

Sealy’s research has impacted national policy, strategy and local workplace practices across the NHS, leading to increased diversity in board composition. In the private sector Sealy’s research changed regulatory guidelines and provided data on regulatory adherence, impacting how key groups, responsible for the governance of FTSE 350 listed companies, respond to diversity (e.g. Financial Reporting Council, institutional investors).

NHS: National level changes of policy and practice

Sealy’s long-standing work on boardroom diversity led to her being commissioned in 2016 to advise on how this could be improved across the NHS. The 2017 Women on Boards report’s sample of over 6,000 board directors [3.3] provided national-level board data for the first time, revealing an additional 500 female directors were required to achieve gender balance. This became the national target, formally adopted by NHS leadership, including the Secretary of State for Health and Social Care, Matt Hancock in 2018 [5.1]. The Chair of NHS Improvement (the regulator) said: “I am very grateful to … Professor Ruth Sealy… who has carried out much of the work and written her report based on her research and experience of working with Lord Davies” [3.3].

In 2019, the CEO of NHS Employers, turned to Sealy again to commission an update on the national data and previous recommendations. Scheduled for spring 2020, the launch was delayed by COVID-19 until September 2020 [5.2; 5.3]. Both the 2017 and 2020 Women on Boards reports highlight the need for the NHS to develop continuous capture of board data, allowing evidence-based initiatives for problem areas. This was acknowledged by multiple NHS board Chairs and various NHS leaders [5.2] and is now in development [5.3; 5.5].

The 2020 data identified the 20 most diverse Trust boards, in terms of gender and ethnicity, and as Chairs are responsible for changing board composition [3.1], Sealy interviewed 13 of those Chairs regarding how they had successfully diversified their boards since 2017 [5.2]. Compiling best practice and case studies, the report provides all 213 NHS Trusts in England with guidance on this. Key changes included stopping ‘rolling appointments’, recruitment training for governors, outreach to communities, using proven head-hunters, gender-balanced panels, and purposeful short-lists. Findings were discussed in a 13-minute interview on BBC Radio 4’s Women’s Hour in September 2020 [5.4]. The report made 16 “very practical actionable recommendations” [5.3] to further embed the changes to leadership diversity. The CEO of NHS Confederation sent the report to all Trust Chairs and organised round-table discussions, in November 2020, on how to implement the recommendations. Unfortunately, these were cancelled due to the second lockdown, but will be rescheduled spring 2021 [5.3].

Following the 2017 Women on Boards report, new leadership programmes were set up across the NHS. The NExt Director Scheme encourages more inclusive board appointment processes for NHS Trusts, providing development opportunities for women and BAME candidates. Several of the Chairs interviewed in 2019/20 had used the programme to engage diverse non-executive director (NED) candidates [5.2, pages 12, 36, 37].

The NHS Leadership Academy runs courses aimed at senior roles, but previously not for Chief Medical Director (MD) - identified as having low female representation in 2017 [3.3]. Following report recommendations, the Aspirant Medical Director programme was launched in 2018. Current MDs (75% male) were asked to nominate potential candidates. As a result, only 25% of candidates were female. In 2019, based on research recommendations [3.2], the programme was advertised more widely using social media, resulting in 45% of the 100 candidates being female.

Based on 2017 report recommendations [3.3], in 2019, NHSC launched a taskforce, partnering with a major search firm, to increase NED diversity. The Director of Partnerships and Equality at NHSC and Chair of the taskforce confirms Sealy’s recommendations “helped us to think about how to move forward with a framework (code of conduct) to work purposefully and effectively with search firms” In addition, the taskforce is “pushing forward the recommendation for [national] data set … to better self-monitor…and improve NED diversity” [5.5].

NHS: Trust level changes of policy and practice

Between 2017 and 2020 , the percentage of women on NHS trust boards increased by 5% to 44.7% [5.2], reaching parity (as defined by the European Commission). Sealy’s research has been cited by NHS Trust Chairs across the country as galvanising them to make changes to board composition [5.2; 5.6]. For example:

Doncaster and Bassetlaw Trust:

When Sealy’s 2017 report was released, the Trust had all-male NED membership. The Chair used the report to persuade the Board and Governors to change their practices: “Using your report…Governors agreed to an open and fair [appointment] process…[Now] we not only have a much more ethnically diverse board but a true gender balance with a high level of skill and experience which is making a difference for our Trust in what are difficult times.” The Chair states these actions led directly to the trust’s CQC rating moving from 'requires improvement’ to ‘good’, with improvements in the contribution of the board to decision-making and greater wellbeing of staff at all levels [5.2, p.33; 5.3 & 5.6].

Lincolnshire Partnership NHS Trust:

The Chair tweeted in November 2018, that after “re-reading @RuthSealy’s NHS Women on Boards report”, Lincolnshire had “3 NED posts and the MD role out for recruitment & I’d welcome applications from women who are under-represented on our board.” In 2020, the board has 42% women and 25% BAME. The Chair described how, in response to the 2017 report, he had completely transformed the appointment process, resulting in many more applications from strong diverse applicants: [5.2, p.12].

East London NHS Foundation Trust:

The Chair states “the research you’ve done leads to better decisions, financial viability and better quality. The changes we’ve made in the past couple of years have increased gender and ethnic diversity. My evidence is a diverse board makes better decisions” [5.2, p.26].

The Chairs interviewed also articulated three important benefits of board diversity for the hospitals, experienced since the 2017 report:

1. Representation of Staff leading to greater staff satisfaction: “Most of us [Chairs] are leading organisations with 2-4,000 staff. They need to feel that their board understands them and part of that is about being able to see both cognitive and physical diversity around the table. We have that now” [5.2, p.24]

2. Representation of Service-Users leading to greater legitimacy: “ the more representative of the community, the better we will be at acknowledging the particular needs of the particular communities within our region.” [5.2, p.23]

3. Board Processes leading to better decision-making and effectiveness: “[with diversity] you get much better quality discussions, much better decisions and better outcomes. And it’s based on experience, it’s not based on reading other people’s experience or research, but my own personal experience” [5.2, p.22]

Regulatory & Policy Impact (Private sector):

Sealy’s 2017 Board Evaluators (BE) research [3.4] was launched at KPMG’s HQ in London, with Secretary of State & Business Minister Penny Mordaunt, MP, to an audience of 150+ FTSE Chairs, CEOs, senior business people, policy-makers, regulators and politicians. Recognising her expertise, Sealy was then asked to present evidence to the parliamentary Women & Equalities Committee on evaluation and boardroom diversity [5.7], and invited by the FRC Director Corporate Governance & Stewardship to discuss the research findings with the FRC (November 2017).

The relationship with the FRC resulted in Sealy and Tilbury being invited to add their recommendations from the BE research to the FRC’s Corporate Governance Code consultation [5.8]. Their recommendations were fully adopted into the new Code (published July 2018, effective 2020), including that organisations must now provide detailed information about their board evaluation, and the actions taken as a result [5.9; 3.5]. This is the first time that board evaluation has been so prominently featured within the Code and mandates BE’s focus on diversity. This provides more information for institutional investors allowing them to question the Board on their actions and progress.

The 2018 Board Diversity Reporting research for the FRC [3.6] evidenced the success of transparency, public statements and measurable targets in subsequent increases in board and senior management diversity. In February 2019, The Economic Secretary to the Treasury, John Glen MP, citing the report at the Wealth of Diversity Conference, explained a target for women in the Senior Civil Service of 50% by 2020: “ This has now risen to 48.2%, and we are committed to building on this progress”. Findings from the Board Diversity Reporting study and the BE research adopted in the changed Code, are evidenced multiple times in the government’s Annual Review of Corporate Governance 2019 [5.10, pages 28, 37].

Following the FRC report launch, Co-Chairs of the prestigious 30% Institutional Investor Group (responsible for £11trillion of investments), invited Sealy to present her research on the importance of post-evaluation data for voting activity, in January 2019 ahead of the AGM season. The Head of Corporate Governance, Legal & General Investment Management (LGIM) said: “the research for diverse boards and leadership teams was compelling…and there continues to be growing evidence that investors are taking action on diversity through their voting.” On 10^th March 2019, a Financial Times article stated that some of the largest investors, such as Columbia Threadneedle, LGIM, Aviva, and AXA started voting against non-diverse boards. On 2^nd October 2019 the 30% Club announced they had achieved their goal of 30% female directors of FTSE 350 and tweeted citing “@RuthSealy’s relentless efforts” to collect data as instrumental in setting the baseline measures against which they set and tracked their targets.

Through influencing improvements in the governance requirements around board evaluations and diversity reporting in the private sector, and at the level of both national policy and workplace practice across the NHS [5.3], Sealy’s work has impacted the understanding of, and practices to improve boardroom diversity.

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Adarves-Yorno’s and colleagues research into mindfulness and social identity underpins the Mindful Leaders Programme - a major prisoner rehabilitation programme, now embedded in 18 high-security prisons across Kenya. Since its start in 2015, the Programme has positively impacted prisoners, prison staff, and the wider community.

In 2015, the Director of African Prisons Project invited Adarves-Yorno to deliver mindfulness training to the Director of Rehabilitation of Kenya and five Prison Governors, in London and Devon on a Commonwealth Scholarship. Adarves-Yorno was then invited to Kenya and she worked in several prisons including Navaisha, the largest maximum-security prison in Kenya, where inmates and staff were trained. From there, the programme expanded across prisons in two ways: through the training of welfare officers who became mindful trainers themselves, and through inmates who, after becoming mindful leaders, shared mindfulness techniques and helped their fellow prisoners to improve their lives. As prisoners were transferred to other institutions, they shared the Programme further [5.1]. Two Welfare Officers trained by Adarves-Yorno have gone on to implement the Mindful Leaders Programme in 17 other Kenyan prisons, inspiring and supporting peers and prisoners [5.2]. Over a three-year period Adarves-Yorno trained a further 18 Prison Governors and 25 Welfare Officers in Nairobi. To date, a total of 2,100 prisoners across Kenya have participated in the Mindful Leaders Programme [5.3].

Core to the success of the Programme is the research finding that for change to happen, new norms need to be established. This requires a social identity shift that will allow for novel and creative thinking [3.4, 3.6]. In some settings, mindfulness training will only lead to long term transformation if it is tied with a strong sense of common identity. Thus, inmates from Naivasha prison, who were part of the Programme, exchanged their prisoner identity for one of a “Mindful Leader”. Though still incarcerated in a maximum-security prison, prisoners claim to be “internally free” [5.2] and have a purpose. The training provides them with the tools to build a cohesive and harmonious community within Naivasha prison.

Impacts on Policy and Practice in the Kenyan Prison Service

The Mindful Leaders Programme has directly benefited the prison governance and staff by significantly reducing the incidences of violence and drug use [5.2]. Prison staff attribute this change directly to Adarves-Yorno’s Programme. As a result of the Programme, prison governors report that the prisons have become more settled institutions , “inmates have developed self-awareness, hence self-acceptance” [5.4]. *“There have been less violent incidents which has made work easier for prison officers…those in the Programme have reduced their consumption of drugs abuse and trafficking.*” [5.1] In addition, a BBC World Service article reports the relationships between inmates and guards have improved drastically, with “fewer riots and attempted escapes” [5.2]. At the institutional level, new initiatives are being developed and working groups within the prison have been established. Project Co-ordinator at Kitengala Prison testifies to the beginnings of working to zero recidivism “since we started the mindfulness Programme, no prisoner released within the last three years has ever come back to prison.” [5.5]. Furthermore, the Director of Rehabilitation across Kenya would like the programme to reach “our 100 prisons, where we currently have more than 55,000 prisoners”. [5.6]

Impact on the Prisoners:

An independent evaluation report [5.7] of the Programme evidenced benefits at the individual level (e.g., inmates reduced drug use, reflect before acting, have become more resilient, and mentor and support others). At the intragroup level there was less conflict and more encouragement and collaboration among inmates. Prisoners in Naivasha adjusted and developed their own mindfulness materials, including translating key teaching resources from English into Kiswahili and finding ways to reach those who are not literate. A further ESRC-IAA evaluation report conducted in Naivasha 2017 [5.8], showed 84% of participants declared that were better able to manage their emotions; 84% of participants reported a reduced number of aggressive incidents with others; and 85% of participants had reduced the amount of drugs they were consuming compared with before their participation in the Programme. 90% of participants “can forgive themselves more” and 91% of participants “forgive others more” [5.8]. In addition, 86% of participants reported that the programme has also improved the relationship between participants and the Prison Officers and 64% of participants have improved communication with families [5.8]. Since the Programme in Navaisha started in 2015, there have been no suicide attempts.

Naivasha Officer in Charge says: “The impact that Mindful Leadership is having in Naivasha is a force to be reckoned with. Most prisoners are now directing their energies towards positive activities like educational activities, and they have positive attitude(s) towards rehabilitation programmes within the prison.” [5.2] For example, a BBC video article covering the Programme, featured a prisoner, serving a life sentence, who now leads mindfulness sessions for other inmates, who has shown such a change that prison authorities believe he may qualify for parole soon. Not only has he become the Chairman of the Mindful Leader Programme, he has completed his Bachelor of Law from the University of Law in London through the African Prison Project [5.2].

Impacts on the wider community

Reported gains from the Programme ripple beyond the prison, benefiting prisoners’ families and their home villages [5.3] as mindful leaders took their teachings home with them and shared with their families and community. One example of this is The Mindfulness Programme is now being delivered by a former Mindful Leader inmate in collaboration with a community-based organisation in Nairobi/Kisimu, working with schools, youth groups, women’s groups, teachers and engaging children with mindfulness through storytelling. [5.9] Another example is a Welfare Officer who has founded a charity, Ladhayamtaa, using mindfulness to reintegrate inmates back into the community after they have left prison, and whose work has been commended by regional authorities. Ladhayamtaa is working alongside Open Minds a non- profit located in the USA, who state they “have been bringing the work of Dr Adarves-Yorno into all teachings online and in person during the last year. Even with the challenges of COVID, mindfulness is one of the most needed practices during these unprecedented times”. [5.3]

Thus all levels of the Kenyan Prison Service became part of the Programme which has been referred to as a “mindfulness revolution” [5.8]. In a BBC news video, a Welfare Officer states that “Adarves-Yorno’s Mindfulness Programme has impacted deeply into all of those who took part in it… the Programme has spread far within prisons and beyond. Its reach has gone beyond our wildest dreams” [5.2]. The long-term sustainability of this project is ensured, as Adarves-Yorno worked with Nafisika Trust, a Kenyan charity working in prisons, who have now embedded it as part of their programmes [5.10]. Open Minds charity are taking over running the second phase of the Programme, as Open Minds Director, declares that “2100 people have directly benefited from the programme and the indirect reach in the families and communities is much larger and continues to grow” [5.3].

4.1 Transforming WAGGGS Leadership Development Programme:

In 2015/16 Jeanes reviewed WAGGGS’ leadership development materials and interviews with previous participants. Based on her expertise, Jeanes identified several challenges in their current model, including: a) cultural bias in their teaching materials, b) lack of reference to gender, and c) their training model - based on extensive training manuals - prevented them reaching many of their potential 10 million girl guides and scouts, as only a few were trained to deliver the material.

Instead of refreshing their current offering, Jeanes proposed a more fundamental rethink of their programme based on her mindset analysis. Jeanes secured ESRC funding to run workshops based on a process of co-creation with WAGGGS, in which she presented and explained the mindset approach and its value as a flexible training tool that a) can be adapted for culturally diverse contexts and, b) facilitates an easily shared training framework. In these workshops she worked with WAGGGS’ senior leadership (board members and leadership development staff) to hone the cascade model to be suitable for their purposes. The outcome was the creation of the six core mindsets (Reflective, Worldly, Collaborative, Creative and Critical Thinking, Responsible Action and Gender Equality) [3.1; 5.1]. These mindsets are relevant to the experiences of the young women participants, enabling a culturally appropriate leadership development programme, which can be adopted in any MO [5.2].

Empirically, these ideas were then tested in Oct-Dec 2016 in an ESRC Economic Development & Welfare Scheme (EDWAS)-funded study working with Girl Guides in India, at SOS Villages, Delhi. This study demonstrated that the conceptual idea [3.1; 5.1] could be translated into a ‘cascade’ training model, readily adopted by trainers, and that it was suitable for young girls.

4.2 Reaching young women with leadership development training

Through the cascade model, a core ambition of Jeanes’ mindset framework, WAGGGS has dramatically increased the number of young women involved in the programme through a) the ‘train the trainers’ method, which has extended the number of qualified trainers delivering the programme in MOs worldwide, and b) the expectation that each participant then works with 100 girls in their own MO.

The impact of this model is demonstrated by the Juliette Low Seminar (JLS) run in 2019. It was the first major event utilising the new leadership development programme [5.3]. WAGGGS members from 107 countries took part across 18 hubs [5.3] (compared to 30 in one hub prior to the new model). The event had 469 young women participants and over 100 facilitators.

A survey of participants [5.4] across all of their leadership events found that 7/10 participants who had completed their training programme project had already reached more than 10 additional young women and had given mindset training to an average of 7 girls already, to extend its reach. An evaluation of the seminar suggests that, based on current ‘100 girls’ projects underway [5.3], WAGGGS predicted over 80,000 ‘train the trainers’ beneficiaries worldwide supporting the 10million girl guides and scouts [5.5]. The process of roll-out started in 2019 but was halted by the coronavirus pandemic in early 2020 [5.5], and final numbers were not able to be collected.

4.3. Impact on facilitators

Resonance of the model with facilitators

According to WAGGGS’ evaluations, the evidence suggests that the global body of facilitators find resonance with the model (e .g. “practising the leadership model has helped me reflect on how my leadership journey is shaped by my past experiences, shaped by new and diverse perspectives” - (Facilitator, Grenada) [5.6]. Interviews with facilitators stressed the value of the mindsets. For example, one used the Worldly and Reflective mindsets to educate girls and women in Ugandan tribes about gender equality. Another talked about how the Responsible Action mindset gave her the motivation and confidence to tackle a problem at her new workplace [5.4].

Cultural applicability

WAGGGS found it appropriate for young girls and different cultures (e.g. “girls need to be highly adaptable and agile to deal with diverse cultures, needs and challenges. The WAGGGS leadership model allows leaders to broaden their leadership styles and be highly adaptable, being better role models for girls” – (Facilitator, Singapore) [5.6]. Interviews with facilitators revealed the model builds cultural understanding [see also a facilitator blog: 5.3; 5.7], giving “space in your mind to be open and receptive to different cultures” [5.4].

4.4 Impact on Young Women – Empowerment and understanding

An account from a JLS facilitator states: “It was incredibly rewarding to see the women grow in confidence and feel empowered over the course of the training” [5.7]. A facilitator from Rwanda explained how more proposals were submitted by participants to an entrepreneurship programme and more applied for leaderships positions after the training [5.4]. Participants themselves stated “I hope that every girl just like me will be able to get this chance because it is definitely life changing” [5.3]. Participants were impacted in many different ways.

Leadership understanding.

WAGGGS new mindsets made girls view leadership as a more inclusive, accessible notion. For example, the model “ brought it out as anyone can be a leader; you don’t have to be in a leadership position” [5.4]. This laid the foundation for changes in belief and confidence that underpinned their subsequent actions: “The WAGGGS leadership mindsets have helped me feel more confident as a leader because I can identify what is lacking in my leadership style and be reflective using the leadership mindsets” (participant, 2018) [5.1].

Model Relevance

WAGGGS report that 72% of JLS participants found it highly relevant to their everyday lives [5.5]. Interviews found similar effects, for example: “The bottom line is you don’t have to have certain skills; it’s having a way of thinking which you can develop from a very young age”. And “ Creating new tools, new ways of thinking, new ways of seeing the world, and be enabled and that was really amazing...because I think that was the first time that I was seeing these creative and critical aspects in a leadership program.” [5.4].

Changes in behaviour

Jeanes’ evaluation found that it encouraged changes in behaviour: e.g. “They have pushed me forward to do things” [5.4]. Participants also reported changes in their working lives from utilising the mindsets: “Others are more excited to work with me” [5.4]. There was evidence that new-found confidence enabled them to take action. For example, one participant talked about how the mindsets helped her challenge the throwing rubbish culture in her town [5.4].

Evidence of leadership

WAGGGS’ JLS report states that 76% strongly identify as a changemaker who knows they’ll make the world a better place (30% increase from before JLS) [5.5]. In the team’s interviews one participant stated she had “got a lot of self-confidence to bring back to my own leadership.” She subsequently applied for and became “a policy advisor for the New Zealand government.” [5.4]. A survey of participants across all the leadership events found that nearly 8/10 participants reported having applied for formal leadership roles because of the mindset training. At the start only around half saw themselves as potential leaders [5.4].

Gender equality

WAGGGS report that of their 2019 JLS participants, 63% felt confident to talk about gender equality in their community, 68% in their professional lives and 89% in the guiding movement (an average increase of 22% in each area). Furthermore, 92% would prioritise putting time into taking action to tackle gender equality after the JLS [5.7]. This was reflected in interviews. For example, one participant talked about setting up a network/group at her university to help challenge issues of gender equality and advocate for women studying STEM subjects. She credited the gender equality mindset with “really push[ing] me to set it up” [5.4].

4.5 Transforming WAGGGS’ strategic plans, policies and practices.

Organisational leadership

WAGGGS ambition was to ensure the mindsets operated at multiple levels, namely: for leaders of the WAGGGS movement, leaders of member organisations, leaders of girls, as well as the girl guides and scouts [5.8]. Nominations for their World Board and CEO positions now evaluate candidates through their engagement with Jeanes’ model, requiring them to ‘be able to demonstrate that they are able to work in a way which reflects these leadership qualities’ [5.9].

Policies and practices

An unexpected impact of Jeanes’ research was that resulting from their positive reception, the mindsets have been mainstreamed into the organisation more widely, and embedded into policies of many MOs : “As we review and refresh our policies, we are incorporating the mindsets” (MO leader) [5.4].

Opportunity

WAGGGs report that the leadership model has also attracted interest from other organisations who want to fund their new leadership work. As one senior leader notes “it has given donors something tangible to support”. A few new funding sources have been secured as an outcome of adopting Jeanes’ mindset approach [5.10].

In addition to adopting it internally, WAGGGS believe their new leadership development model to be impactful, culturally applicable, promoting gender equality and reaching significantly more of their members in a sustainable format.

At a time of great transition for public libraries in England, our activities have stimulated and informed public policy on mutualisation in the cultural sector as a sustainable, alternative delivery model; improved capacity for innovation and leadership among PSM management; led to commercial and economic impacts for library PSMs; and sustained accessibility to local public library services by developing PSMs. These impacts burgeoned from our initial project with Libraries Unlimited (LU) which spun-out into a programme of sustained engagement with newly-commissioned library PSMs and associated policy professionals. As a whole, this work has secured accessibility to viable key local public services and ensured that communities continue to benefit from their public libraries.

1. Stimulating and Informing public policy development in England for Public Service Mutuals

This programme of work directly influenced how DDCMS (Department of Digital, Culture, Media and Sport) supported government’s commitment of a ‘right to mutualize’ in the public sector [5.1]. Learnings from the LU-UEBS partnership demonstrated the role of leadership in driving the success and resilience of PSMs as a valid, innovative business model [3.3; 3.4]. In 2018 DDCMS published a practical guide for leadership development for PSMs written by the UEBS team. The team also assisted the DDCMS Mutuals Team in drafting a public consultation on the emerging needs of PSMs (November 2018) [3.6], and by responding to this, presented a strong case for the importance of building future leadership capacity in emerging PSMs [5.1; 5.2; 3.4]. Engaging with the research was a ‘ good check and balance for [D]DCMS...that helped to line up policy’ with ’the...practical application of what was happening to people in their day job [within] PSMs’ [5.1] said the Head of Mutuals at DCMS. She also commented that Hawkins’ input into the consultation helped them to ‘really get to grips with what it means to be a mutual’ [5.1].

To strengthen the delivery of public policy, the UEBS team contributed directly to the design of the DDCMS Leadership Development Programme (LDP) as a ‘really important layer’ in its support programme for mutuals (October 2018-March 2019) [5.1]. Nine organizations enrolled in the first cohort, there was outstanding participant feedback [5.3], and the UEBS team's assessment of the nature and level of demand for leadership development was a major factor in the decision to continue resourcing the provision in 2019/20 [5.1]. Feedback from DDCMS staff confirmed that the programme ‘ strengthened the professional profile’ of PSMs as credible business models that ‘ support...vulnerable people’ across England [5.1]. Senior leaders in the 2018/19 cohort have since confirmed that their participation has led to direct changes in practice in emerging mutuals (such as mentoring and action learning to promote innovation). For example, as a result of attending the LDP, Hertfordshire Libraries introduced its own scheme to enrich understanding about mutualisation in the service. All 52 of its libraries developed an action plan (December 2018), and in April 2020 a further new PSM, Libraries for Life, spun out saving the county council £500k per year [5.3].

1. Improved capacity for innovation and leadership amongst PSM management

The principal community of practice for our activity was all of the library-only PSMs in England. For most of the period covered by this case-study, there were four such PSMs (covering Devon, Nottinghamshire, Suffolk and York). All were impacted by our work and are now considered to be thought leaders in the sector [5.4; 5.5; 5.6].

As early as 2015, the Department for Culture, Media and Sport had been actively promoting the PSM model for libraries, not only as a means of taking services out of public control but also to stimulate new operating cultures and practices (e.g. a more entrepreneurial mindset) for those remaining in it [5.1]. We worked intensively with the library PSMs, starting with Libraries Unlimited (LU) in Devon, as the first-established of these. From 2016 to 2018, with £200,000 funding from the Arts Council England (ACE) we developed an action learning leadership development programme which enabled LU’s employees and senior leadership to balance increased commercialism with maintaining the social value of libraries within local communities [5.6; 3.1; 3.2]. A principal benefit was increased leadership capacity, entrepreneurialism and resilience throughout the organisation [3.3, 3.4]. Its CEO noted that this ‘ enabled 15 staff from all levels to share and develop their understandings of the challenges of, and opportunities from, the new operating model’, becoming ‘ active “agents of change” within LU in ways that would not have happened without the research’ [5.6]. This new entrepreneurial culture contributed to keeping ‘ *all 50 libraries open in Devon and all run by paid and trained members of staff, despite a 50% reduction in funding [compared to before commissioning]*’ [5.6]. Organization-wide buy-in to entrepreneurial activity also directly contributed to Libraries Unlimited becoming an ACE National Portfolio Organization (NPO) in 2017; that is, a leader in its area and responsible for developing national arts and cultural provision [5.2].

For LU’s CEO, working with UEBS had developed the organisation’s ability to act in a more agile, entrepreneurial and competitive manner [5.6]. The ACE Director of Libraries recorded that Libraries Unlimited is ‘ an exemplary service with a high level of support….The partnership between Beverley Hawkins and her team and Libraries Unlimited has been a beacon of excellence from which we have gained a sharper and clearer picture of the capability of public libraries’ [5.5]. ACE consequently enhanced the strategic role of libraries in arts/culture provision and announced further investment in the cultural offer of public libraries [5.5].

These striking successes enhanced LU’s reputation [3.5] across the libraries sector and among government, policy makers (e.g. DDCMS) and key public bodies (i.e. ACE and the Libraries Taskforce established by DDCMS). The UEBS team facilitated the establishment of a new knowledge sharing network for the four pioneer library PSMs in England: Optimo seeks to support the mutual model and better understand the shared challenges it presents [5.4].

1. Commercial and economic impacts for library PSMs via new contracts worth over £30m

The partnership between LU and UEBS was cited by Torbay Council [5.7] in its 2018 decision to award Libraries Unlimited a contract worth £900,000 annually to deliver its services. In fact, LU was the first PSM in the sector to expand geographically by extending its regional reach [5.7; 5.9]. Savings to Torbay Council were around £800,000 [5.8], while Libraries Unlimited’s portfolio was increased by four libraries and 135,000 potential users [5.7], who now benefit from access to a wider array of services and facilities than before. Subsequently, LU won additional ACE funding of £600,000 [5.8] for further business model innovation, to diversify its portfolio into new areas not previously offered (for instance performances, hackathons and other cultural events) to communities (often 'hard-to-reach') in a rural region where access to such activities had been limited [3.2]. The UEBS team provided key insights on how to structure and approach the contract to enhance the competitiveness of Explore York’s tender in 2018 to provide local services [5.10]. York won a further 15-year, £32-million commission –unprecedented in any public service mutual library. Engaging with the research team was ‘absolutely crucial’ to this success which sustained Explore York’s business model without any potential library closures or redundancies, according to its CEO (Feb 2018) [5.10]

1. Sustaining accessibility to local public library services by developing Public Service Mutuals across England

These successes have validated the PSM as a model for library services provision, enhancing the resilience of other library mutuals and giving confidence to other commissioning LAs that PSMs’ innovations and differing value propositions improve cost effectiveness and offer benefits to millions of users [5.4]. At Inspire Culture (Nottingham Library Services), the programme generated ‘ a shift in thinking’ towards wider entrepreneurial activity and funding, including a ‘ virtual think tank’ during the Coronavirus lockdown [3.2; 3.3; 3.4], and was the precursor to more collaboration with the DDCMS [5.4]. In Suffolk Libraries, the activity generated a new strategy for rural provision and mobile libraries and resulted in improved evidencing of social value. The use of case studies and story-telling techniques stemming from the UEBS approach demonstrated that communities continue to benefit from library services [5.4]. All four PSMs attribute more collaborative, agile and responsive working cultures to engagement with the UEBS research [5.4; 5.6]. More recently, this enabled a quicker response to the Coronavirus pandemic than would otherwise have been possible, for example by identifying and applying for additional funding sources [5.4].