Abstract
Background: Leadership is valued as a critical approach to inspire and drive new changes within integrated care contexts. Health and social care systems are extremely complex with multiple organisations structures, care pathways, financial models, cultures, professional groups, and legal responsibilities. Traditional leadership models often struggle to address the complexities and unpredictability inherent in healthcare settings. Complexity theory offers a novel approach for understanding leadership in complex adaptive systems due to its emphasis on the importance of adaptability, collaboration, and emergent behaviours. The aim of this secondary analysis was to map and describe how complexity science has been applied to empirically study the concept of health and social care leadership.
Approach: A secondary analysis of the results of a scoping review of primary health and social care research using complexity-informed approaches, with a specific focus on leadership, was performed. The original review used the revised Arksey and O’Malley scoping review framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews. Databases searched included the Cochrane Database of Systematic Reviews, MEDLINE, CINAHL, EMBASE, Web of Science, PSYCHINFO and the NHS Economic Evaluations Database. Of the 61 articles included and synthesised in the original review, 9 articles were included in the secondary analysis.
Results: Identified articles included diverse categories of leaders including management within multidisciplinary care teams, nurses and parents. Methods varied in their approach, including qualitative, quantitative and case study design, as well as the degree to which the key principles of complexity theory were engaged and applied within the research. Complexity theory was commonly applied as an underlying theoretical framework to examine change implementation or organisational settings. The common outcome of applying complexity theory was the lived experiences of leaders during a time of implementing or navigating change. There was an evident lack of innovative use of complexity theory in the creation of health and social care solutions or interventions.
Implications: This review addresses a novel gap in evidence synthesis knowledge and highlights the limited evidence regarding how complexity has been applied in health and social care leadership research. Complexity theory provides a valuable framework for understanding the dynamics and behaviour of healthcare systems, particularly in the context of integrated care. Acknowledging the limited number of identified studies, further research is essential which explores how complexity theory can inform leadership practices in healthcare organisations. The authors recommend transparency and rigour regarding leadership-specific research that includes clear definitions of leadership, framework or style employed and its context within the research. Further evidence may support leaders in navigating uncertainty, promoting innovation and fostering resilience, which are central to the pillars and provision of integrated care services.