Abstract
Introduction:Health and social care services in England are moving towards greater integration, yet little is known about how leadership of integrated care teams and systems can be supported and improved. This realist review explores what works about the leadership of integrated care teams and systems, for whom, in what circumstances and why.Methods:A realist synthesis approach was undertaken in 2020 to explore English language literature on the leadership of integrated care teams and systems, complemented by ongoing stakeholder consultation.Results:Evidence was identified for seven potentially important components of leadership in integrated care teams and systems: ‘inspiring intent to work together’; ‘creating the conditions’; ‘balancing multiple perspectives’; ‘working with power’; ‘taking a wider view’; ‘a commitment to learning and development’ and ‘clarifying complexity’.Discussion:Research into the leadership of integrated care teams and systems is limited, with ideas often reverting to existing framings of leadership, where teams and organisations are less complex. Research also often focuses on the importance of who the leader is rather than what they do.Conclusion:This review has generated new perspectives on the leadership of integrated care teams and systems that can be built upon, developed, and tested further.
Highlights
Health and social care services in England are moving towards greater integration, yet little is known about how leadership of integrated care teams and systems can be supported and improved
Effective leadership is claimed to be a key element of wellcoordinated and safe health and social care [8,9,10,11] and where leadership is ineffective or absent, this has been linked to reports of failures in care leading to patient/ service user harm [12]
This paper reports on the findings of this realist review, exploring what aspects of leadership of integrated care teams and systems work, for whom and in what circumstances
Summary
Health and social care services in England are moving towards greater integration, yet little is known about how leadership of integrated care teams and systems can be supported and improved. Despite the frequent rhetoric about the importance of leadership in the success of organisations, much research is based upon smallscale studies in specific contexts or grounded in the dated premise that leaders provide guidance for single or uniprofessional teams [13, 14], which overlooks the complexity and inevitable tensions of leading integrated care teams and systems These leaders do not influence just one organisation or professional group, but instead often work between several organisations, across primary and secondary care, health and social care, publicly funded services, the not-for-profit sector, and private businesses. This paper reports on the findings of this realist review, exploring what aspects of leadership of integrated care teams and systems work, for whom and in what circumstances (https://www.journalslibrary.nihr.ac.uk/programmes/ hsdr/180106/#/)
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