Abstract
Background: Intersectoral models of healthcare delivery require different approaches for effective leadership and governance, and thus a different set of knowledge, skills, attributes and values, or competencies. Previous reviews of the literature have described the components, structures or mechanisms necessary for assessing and enabling health system governance or collaborative governance models, but have not explored the competencies needed for governing within these spaces.
While recent literature has synthesized competencies for leading within increasingly complex health systems and integrated care, we sought to identify and characterize the range of competencies required for governing effectively within these models by conducting a rapid review of the literature. A competency framework may be an additional outcome informed by this work.
Approach: A rapid review of the literature was undertaken to a) identify governance competencies for intersectoral, collaborative models of healthcare delivery and b) determine if there are existing frameworks that articulate these competencies.
We conducted our search in multiple health and interdisciplinary electronic databases using the key search terms ‘collaborative’, ‘intersectoral’, ‘governance’, and ‘competency’, and their synonyms. Relevant articles aligning with our study aims were included if they were peer reviewed and published in English after 2000. Following the review in Covidence, data related to competencies and any associated framework domains were extracted into a spreadsheet for a comparative analysis.
Results: From our preliminary search we identified a small number of competency frameworks for collaborative governance, and an even smaller number specific to healthcare.
Initial findings suggest that the skills and knowledge required at governing tables may evolve as collaborations mature. Competencies may also vary to some extent by role (e.g. leaders and collaborative partners) and by level of organization (e.g. for individual leaders, their organizations, and the collective).
Individual-level competency domains were frequently described within the frameworks, emphasizing the import of approaches (e.g. system thinking), attitudes (e.g. having a collaborative mindset) and relational competencies (e.g. engagement and growing shared vision). Bridging individual and collective competencies include domains related to managing organizations and networks, evaluation, communications, and knowledge related to health systems and population health.
A larger body of research describing competencies for collaboration, health system governance, and healthcare leadership may warrant further exploration. In particular, exploring an apparent overlap between leadership competencies for integrated care and those required by individuals governing within these spaces will help uncover important competencies in Indigenous health sovereignty, health equity, power imbalances, and community representation not found in existing frameworks.
Next steps may include refining our search and inclusion criteria, searching the grey literature, triangulating findings with existing interview data, and working with OHT leads and leaders to co-design a competency framework for collaborative governance.
Implications: While older competency frameworks exist, the rapidly evolving integrated care context offers opportunity to expand existing or offer new frameworks. Our findings will offer a starting place for conceptualizing a competency framework and articulating the knowledge, skills, values and behaviors needed for governing within integrated care, with applications for identifying learning needs and supporting the recruitment and onboarding of new members.