Leadership for integrated care: a case study

Abstract

Purpose Integration of health services involves multiple interdependent leaders acting at several levels of their organisation and across organisations. This paper aims to explore the complexities of leadership in an integrated care project and aims to understand what leadership arrangements are needed to enable service transformation. Design/methodology/approach This case study analysed system and organisational leadership in a project aiming to integrate primary and specialist care. To explore the former, the national policy documents and guidelines were reviewed. To explore the latter, the official documents from the transformation team meetings and interview data from 17 health-care professionals and commissioners were analysed using thematic analysis with the coding framework derived from the comprehensive and multilevel framework for change (Ferlie and Shortell, 2001). Findings Although integration was supported in the narratives of the system and organisational leaders, there were multiple challenges: insufficient support by the system level leadership for the local leadership, insufficient organisational support for (clinical) leadership within the transformation team and insufficient leadership within the transformation team because of disruptions caused by personnel changes, roles ambiguity, conflicting priorities and insufficient resources. Practical implications This study provides insights into the interdependencies of leadership across multiple levels and proposes steps to maximise the success of complex transformational projects. Originality/value This study’s practical findings are useful for those involved in the bottom-up integrated projects, especially the transformation teams’ members. The case study highlights the need for a toolkit enabling local leaders to operate effectively within the system and organisational leadership contexts.

Impact of the Enhanced Universal Support Offer to Care Homes during COVID‐19 in the UK: Evaluation using appreciative inquiry

“…This study re-confirms the interdependencies of leadership and working relationships across multiple systems levels and the need to focus on population health. These findings add to the literature and learning about how the care home sector might be supported to manage workforce turnover, develop new professional practices, and develop intersector and agency knowledge (Kozlowska et al, 2020). The EUSO presented an opportunity to reduce roles ambiguity, resolve conflicting priorities and enhance resources during a traumatic period for the care sector.…”

Implementation considerations for non-communicable disease-related integration in primary health care: a rapid review of qualitative evidence

“…The Asian countries studied were Cambodia [ 14 , 50 ], China [ 41 ], India [ 36 ] and Israel in the Middle East [ 34 ]. Case studies in European countries comprised three in the United Kingdom [ 34 , 42 , 43 ] and one each in five other countries (Germany, Northern Ireland, Scotland, Spain (Catalonia) and Sweden) [ 44 ]. Oceania was represented by Australia [ 45 – 47 ], New Zealand [ 39 ], and US-administered Pacific Islands [ 40 ].…”

“…Most countries were from LMIC settings, and the remaining nine were high-income countries. Most studies addressed integration of NCDs, either with other NCDs [ 37 , 39 , 40 , 43 – 45 , 47 ] or with HIV or maternal, child and reproductive health [ 14 , 33 ] or mental health [ 35 , 36 ]. Others addressed integration of HIV with other disease programmes, such as maternal, child and reproductive health and TB [ 32 , 48 – 50 ].…”

“…An enabling policy environment is one where policy support makes integration reform more politically and practically feasible (including suitable adaptation to local context), which can help to narrow the policy to implementation gap [ 32 , 36 , 38 , 43 ]. This includes having a policy environment is where there is shared expectations, staff communication and readiness to be support integration efforts, as explained: “the extent to which there is a shared perception that integrated care is expected, supported and rewarded within an organization; communication between providers or staff within an organization to support integrated care; and variation in workforce readiness to implement models of integrated care.” [ 34 ](p8).…”

“…Regulations, funding, resources, and payment mechanisms should be aligned to support implementation and improved quality of integration services; poor alignment has been implicated in impeding of integration efforts across several country settings [ 33 , 35 , 36 , 43 , 44 ]. Funds are required for structural, or ‘hardware’ resources (infrastructure, human resources, information systems, and medicine and equipment), as well as for ‘software’ resources (for leadership, supervision, and building multi-disciplinary teams) [ 33 , 38 , 41 , 46 ].…”