Aims The ‘Fellows Unit’ was set up at NHS England & Improvement during COVID-19’s first wave, consisting of over 20 Clinical Leadership fellows (doctors, dentists and pharmacists) from the Faculty of Medical Leadership & Management. It aimed to become a novel, cohesive, productive team working on clinical and operational policy in a context of high pace, crisis and uncertainty.

Methods Foundational workshops were held to review progress, to identify the group’s unique skill set and professional ethos, to assess challenges and opportunities, and to agree structures and strategies promoting productive working. Bespoke team activities were developed iteratively based on Agile techniques and clinical environment-derived ways-of-working including:

• Morning stand-up – 20-min digital board round with physical and virtual attendees leading updates on progress, priorities and blockers, based on the Daily Scrum model and clinical board rounds

• MDT allocation meeting – using clinical, behavioural science, project- and knowledge management skillsets to screen a high volume and variety of requests

• Afternoon ABC huddle – well-being and team-building intervention to Appreciate positives, offer suggestions where things might Be Better If…, and share Creativity – ideas for improvement or new projects.

Results The unit completed more than 50 projects over 4.5 months. Strong team identity and cohesion were developed, with a clear sense of role, ethos and core areas of work. In a high-stress environment, group activities cost little time overall, but were vital to rapid improvement of team cohesion and productivity.

Conclusions Clinical practices blended with project management techniques can create a powerful environment for cohesive team development and productive working in a healthcare crisis. A supportive environment, where positive values and behaviours are promoted, and where active, continuous improvement is valued, is vital to meet uncertain, shifting challenges.