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The purpose of this paper is to provide an overview of a structured improvement process that is used in all programmes of work of the NHS Institute for Innovation and Improvement (NHS Institute).

This paper outlines the background to the development of the improvement process, specifically how learning from the domains of new product development, user centred design and innovation and creativity have been incorporated into the process.

There are key elements of evidence and experience that can be taken from other domains and incorporated into a structured approach to healthcare improvement.

An improvement process is outlined that could be used as a basis for any healthcare improvement effort, and will help to ensure the development of better solutions more quickly.

This paper introduces a process that will help anyone interested in improving healthcare create better solutions to the challenges they face in shorter timescales.

There is little published research on the role of middle managers in the delivery of health and social care integration. Middle managers are critical to change management and require the skills to do this effectively. This study aims to explore what middle managers perceived as helping and hindering them in the delivery of change in one high‐profile integration project.

The study involved semi‐structured interviews of eight middle managers across health and social care organisations using a grounded theory approach.

Middle managers possessed good project management and staff engagement skills and understood the challenges of integration. Time and capacity, changes in senior leadership and lack of role clarity were significant hindrances. There were indications that informal networks had allowed them to progress the project.

This is a small‐scale study limited to one project. Although findings are supported by other published evidence, they may not be transferable to other settings.

Middle managers appear to possess change skills but lack understanding of how to apply them in complex environments. Dedicated time and awareness of complexity and leadership models may help middle managers to lead change within integration projects.

This study provides rich information about how middle managers perceive their roles as change agents within integrated working.