Authority or Adaption? Leadership within integrated care systems

Background: The contribution of leadership to implementing integrated care has been of longstanding interest within practice and research internationally and within England in particular. What good leadership looks like in this context and how leaders work across professions and sectors is less known (Sims et al 2021 What does Success Look Like for Leaders of Integrated Health and Social Care Systems? a Realist Review ) This research explores the reality of leadership during the introduction of Integrated care Systems (ICS) in England 2022.

 

Approach: A semi-structured qualitative methodology was used for one-to-one interviews with a “cross-section” of role holders within a single region – this included those from acute health, public health, social care and the voluntary sector Three focus groups interviews were also conducted, two of which were with groups of people with lived experience. In total, 30 participants were interviewed between May 2024 – September 2024. Adaptive leadership was used as a theoretical lens for the research as a means to understand leadership within a time of change and transformation (Heifetz et al 2009).

 

Results: Overall, respondents tended to equate their experience of leading through COVID-19 with the adaptive leadership approach, recognising the need to balance taking a strategic view (on the balcony) with responding to operational concerns (being on the dancefloor). They reported that during the pandemic, higher degrees of trust were experienced between leaders in health and care. They stated that there was an implicit commitment to avoiding bureaucratic responses in daily practice.

But some resistance was experienced, too. Anxiety that “chaos” might ensue was cited as a reason to maintain some traditional ‘technical’ approaches (albeit, deployed in new ways) rather than looking for more radical ‘adaptive’ solutions which would entail changing established practices. There could also be contrasting experiences between nationally-accountable health service leaders and locally-accountable care leaders in their willingness to embrace new ways of working.

People with lived experience were thought to be the most anxious amongst all concerned in the ICS. They reported feeling less powerful and not involved from the outset. Similarly, leaders in community and voluntary sector felt like “David” to the statutory sector “Goliath” in terms of influence

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Implications: In terms of growing capacity and skills amongst the workforce, to make best use of the positive benefits which adaptive leadership brought to ICS’s, it was felt that “unlearning” of traditional methods of collaboration would be required. Opportunities for leaders across the system to reflect and learn together, and have space to challenge and create new solutions will be important enablers. However, the current context, in which ICS's are merging due to reduced funding is likely to make such collaboration more, not less challenging in the short term.