Cultures and Leadership for Integration: A Compass for Navigating Change

Background: Integrated care offers the promise of better outcomes, but successful transformation of this complex system faces implementation challenges demanding solutions for increasingly more diverse health and care needs. Transition towards fully integrated, high quality and cost-effective care requires leaders to create inclusive cultures that empower and support the workforce to collaborate and co-produce outcomes with clients, patients and caregivers. The limited examples of inter-professional education in Scotland contrasts with the need for a confident, innovative and collaborative workforce to achieve excellent health and care outcomes.

 

Approach: To build a picture of ‘what we know now’ about cultures and leadership for integration (CLI), knowledge from a literature review was used to plan a one-day CLI Research and Practice convention to gather multiple professional and sector perspectives. Written and oral insights from research, policy or practice were sought from representatives of community health, social care, third sector, academia and people with lived experience of care in Scotland in advance of, and during, the convention. This qualitative evidence was transcribed, summarised and thematically analysed to construct a theory of change for CLI with impactful outcomes.

 

Results: A total of 35 implementation cases, submitted in advance of the convention, informed seven statements about what we know on CLI. These statements were considered by 30 people with different professional and sector backgrounds who participated in interactive plenary and facilitated small group sessions. The various contributions from diverse stakeholders included insights about the enablers and barriers of successfully steering positive change. Convention outputs informed development of a CLI Compass - a tool that offers direction when navigating change in the complex and dynamic health and social care landscape.

 

The CLI Compass describes seven dimensions important for individuals, teams and organisations seeking to transform towards an effective integrated system. These dimensions (cultures, belonging, headspace, mindsets, outcomes, leadership, learning and development) are discussed in the context of developing competences for new ways of working together in interprofessional teams that share a vision and common values, despite differences in knowledge and cultures shaped by professional boundaries and training.

 

Implications: Workforce development for successful transformation is a complex process that requires a strong vision and support. The CLI Compass offers a new tool for supporting integration efforts for individual professionals, teams, organisations, and communities. In response to an urgent need for education that develops competencies to work in an integrated context now, the CLI Compass has shaped a six-week online CPD for community health, social work, social care, third sector leaders, managers and professionals, and for integrated care policy makers and advocacy organisations.

 

Early feedback from CPD participants is positive in terms of providing valuable headspace for reflective practice, understanding of different cultures, and building capability for the leadership mind-sets and behaviours that nurture collaborative practice. The CLI Compass CPD is a scalable online educational offer with potential to bridge the implementation gap in Scotland. The CLI tools will resonate with regions aspiring to build workforce capability for transformation, and internationally in health systems facing similar workforce development needs.