Abstract
Purpose
Given the complex nature of integrated care systems (ICSs), the geographical spread and the large number of organisations involved in partnership delivery, the importance of leadership cannot be overstated. This paper aims to present novel findings from a rapid realist review of ICS leadership in England. The overall review question was: how does leadership in ICSs work, for whom and in what circumstances?
Design/methodology/approach
Development of initial programme theories and associated context–mechanism–outcome configurations (CMOCs) were supported by the theory-gleaning activities of a review of ICS strategies and guidance documents, a scoping review of the literature and interviews with key informants. A refined programme theory was then developed by testing these CMOCs against empirical data published in academic literature. Following screening and testing, six CMOCs were extracted from 18 documents. The study design, conduct and reporting were informed by the Realist And Metanarrative Evidence Syntheses: Evolving Standards (RAMESES) training materials (Wong et al., 2013).
Findings
The review informed four programme theories explaining that leadership in ICSs works when ICS leaders hold themselves and others to account for improving population health, a sense of purpose is fostered through a clear vision, partners across the system are engaged in problem ownership and relationships are built at all levels of the system.
Research limitations/implications
Despite being a rigorous and comprehensive investigation, stakeholder input was limited to one ICS, potentially restricting insights from varied geographical contexts. In addition, the recent establishment of ICSs meant limited literature availability, with few empirical studies conducted. Although this emphasises the importance and originality of the research, this scarcity posed challenges in extracting and applying certain programme theory elements, particularly context.
Originality/value
This review will be of relevance to academics and health-care leaders within ICSs in England, offering critical insights into ICS leadership, integrating diverse evidence to develop new evidence-based recommendations, filling a gap in the current literature and informing leadership practice and health-care systems.
Keywords
Citation
Knight, L., Neiva Ganga, R. and Tucker, M. (2024), "Integrated care system leadership: a rapid realist review", Leadership in Health Services, Vol. 37 No. 3, pp. 327-341. https://doi.org/10.1108/LHS-12-2023-0092
Publisher
:Emerald Publishing Limited
Copyright © 2024, Emerald Publishing Limited
Background
By 2035, the number of people with four or more diseases is expected to double, with a third also having mental health conditions (NHS England, 2019, p. 2). The population is aging and becoming medically complex (Charlesworth and Johnson, 2018, p. 97). This demographic shift poses challenges for health and social care, traditionally designed for acute illnesses, not chronic conditions. Integrated care has emerged as a response, driven by financial and policy factors (Ling et al., 2012, p. 2). In England, health and social care services have adopted partnership working through integrated care systems (ICSs), which became statutory bodies in July 2022, encompassing all NHS Provider Trusts (hospital, community and mental health trusts) and primary care services, including GP practices, local authorities, care providers and voluntary, community and social enterprise organisations that are involved in the provision of health and social care.
ICSs, as complex systems spanning vast areas, rely on senior leaders to improve population health, reduce inequities and maximise value. Leadership is crucial in these partnerships, often being the primary driver of large-scale change and ICS development (Bhat et al., 2022).
The International Conference on Integrated Care (Stein et al., 2023) emphasised the need for effective leadership in integrated care. However, in a recent review of system leadership in health care, Kaehne et al. (2022) found no empirical studies that examined the value of different approaches to leadership. Literature suggests that successful integration hinges on robust leadership and governance at the system level across health and social care (Asthana et al., 2020; Dickson and Tholl, 2020; Erens et al., 2016; Evans et al., 2016; González-Ortiz et al., 2018; Goodwin and Smith, 2011; Ham et al., 2011; Maruthappu et al., 2015). In Scotland, leadership qualities were deemed critical for integrating health and care services (Hutchison, 2015). Leadership ability, alongside organisational culture, workforce management and inter-organisational collaboration, is pivotal in integrated health systems (Bhat et al., 2022).
A leader’s ability to transition from organisation-centred to a broader, multi-organisational focus is vital for ICS operation and sustainability (Charles et al., 2018; Deffenbaugh, 2018; Tweed et al., 2018; Wistow et al., 2016), including developing partnerships across system members (Paice and Hasan, 2013; Social Care Institute for Excellence, 2018; Tweed et al., 2018). The NHS Confederation advocates a “collective” leadership approach for ICSs (Ham, 2022), with a consensus on the necessity of a “systems leadership” style. Effective integrated care leaders are expected to communicate a shared vision, foster trust and manage the workforce effectively (Charles et al., 2018; González-Ortiz et al., 2018; Thakrar and Bell, 2017).
Despite the recognised importance of leadership in ICS implementation and operation, research often focuses more on the identity of leaders rather than their actions (Sims et al., 2021, p. 13), hindering the understanding and application of effective leadership practices. In addition, there is an assumption that senior leaders can adapt their existing leadership styles to the new ICS structures (Chambers et al., 2020), but a clear definition of “systems leadership” and evidence for the necessary skills and attributes are lacking (Kaehne et al., 2022, p. 7).
In summary, although the significance of leadership in implementing, developing and sustaining integrated care is widely recognised, empirical studies in this area are scarce (Evans et al., 2016). Research has often focused on the attributes and skills of leaders, rather than their actions and behaviours. Notably, empirical evidence on the leadership of ICSs in England is particularly limited, despite their widespread adoption.
This rapid review aims to enrich both theoretical and practical understanding of leadership in ICSs. It seeks to elucidate how and why leadership works within these systems, aiding those involved in ICSs to better comprehend and foster leadership development. The review used a realist method, focusing on context, mechanisms and outcomes (Booth et al., 2018). It involved reviewing ICS strategies and guidance, a scoping review of literature and interviews with key informants knowledgeable about ICS leadership. These steps helped in formulating and refining programme theories about the functioning of leadership in ICSs, its effective contexts and the reasons behind its success.
Accordingly, the objectives of this study are:
to create an initial rough programme theory (IRPT) based on a scoping review of strategies and guidance relating to the implementation and purpose of ICSs and initial stakeholder interviews with key informants; and
to develop the IRPT into a refined programme theory based on empirical data published in the academic literature.
Methods
This study uses realist approaches to formulate theories for effective leadership in ICSs, focusing on desired outcomes (Pawson and Tilley, 1997; Wong et al., 2017). Theories, termed IRPTs, were developed using diverse sources, aligning with Realist And Metanarrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines (Wong, Greenhalgh, et al., 2013; Wong, Westhorp, et al., 2013). The research process used the context + mechanism = outcome heuristic (Wong et al., 2017), analysing literature, ICS strategies, and conducting interviews. Ethical review and approval were obtained via the authors’ own institutional protocols. These theories were then empirically tested, refining the IRPTs as shown in Figure 1.
This study built IRPTs by analysing ICSs policy documents, guidance and key informant interviews, drawing on Pawson and Tilley’s (1997) concept that policymakers’ expectations offer a basis for testable theory. Thirteen policy and guidance documents, along with five semi-structured interviews with ICS senior leaders, were analysed to identify contexts, mechanisms and outcomes of leadership in ICSs, leading to four programme theories and nine context–mechanism–outcome configurations (CMOCs).
Search
Adhering to RAMESES standards for transparency, this review targets literature post-2017, coinciding with the inception of England’s ICSs. This timeframe aligns with the historical evolution of ICSs and the pilot phase resulting in a rapid realist review, that uses realist processes within a limited literature set (Wong, Westhorp, et al., 2013, p. 18). Search strategy is available as Supplementary File 3.
Selection and appraisal
In Phase 1b, two reviewers (LK and RG) screened studies by title, abstract and full text for relevance, addressing any conflicts. They evaluated studies’ potential to affect leadership theories in ICSs, focusing on “conceptual richness” and “thickness” for meaningful contributions (Booth et al., 2013; Dada et al., 2023; Pawson, 2006a; Wong, 2018). The rigour of each study was assessed based on trustworthiness and relevance to testing IRPTs, including robust data points from methodologically weaker studies as per realist methodology (Pawson, 2006b).
Data extraction
Each paper’s characteristics, including objectives, study location, design and participants, were extracted. Focus was on identifying CMOCs and refining programme theory. Dalkin et al.’s (2015) formula: M (resource) + C → M (reasoning) = O, and operational definitions of context, mechanism and outcome, as shown in Table 1, guided mechanism-context delineation.
Data synthesis
Data extracts, including interview quotes, observation notes and study excerpts, were compiled to detail contexts, mechanisms and outcomes, forming CMOCs. Thematic organisation mirrored thematic analysis (Gilmore et al., 2019), with the realist review approach aiding in discerning relationships between elements (Rycroft-Malone et al., 2012). This involved juxtaposing and reconciling evidence to refine theories and develop comprehensive CMOCs, integrating data to clarify the interaction between context, mechanism and outcome (Pawson, 2006c).
Programme theory development
Search results
After screening the initial 5,716 records by title and abstract, 99 records were screened by full text. In total, 22 records were evaluated for relevance (Alonso and Andrews, 2022; Aufegger et al., 2020; Aunger et al., 2022b; Bell et al., 2022; Chang, 2021; Elliott et al., 2020; Embuldeniya et al., 2018; Gordon et al., 2020; Harlock et al., 2020; Kozlowska et al., 2020; MacLeod et al., 2019; Martin, 2021; Martin and Knowles, 2019; Miller and Stein, 2020; Mitchell et al., 2020; Nicholson et al., 2018; Pearson and Watson, 2018; Robert et al., 2022; Round et al., 2018; Shand and Turner, 2019; Sims et al., 2021; Urtaran-Laresgoiti et al., 2018) and 1 was excluded (Alonso and Andrews, 2022) resulting in 21 being included for richness assessment. Three studies were excluded following a review of richness (Elliott et al., 2020; Martin and Knowles, 2019; Robert et al., 2022), the remaining 18 papers were reviewed for rigour, considered trustworthy and therefore included in the review. Contributions of included papers to final CMOCs is included in Supplementary File 1.
Phase 1a: Literature scoping
The initial literature search aimed at theory building and understanding the scope of literature on leadership in ICSs (Booth et al., 2018, p. 154). This scoping review provided a contextual overview, contributing to the IRPT, later tested against empirical evidence in Phase 1b.
Integrated care systems guidance and policy.
ICS policy and guidance documents informed the development of IRPT (RAMESES II, 2017). These documents often mirror the social, economic, historical and political contexts of their creation, providing insights into the complex systems where programmes are developed and implemented (Miller and Alvarado, 2005). Thirteen documents were selected and analysed (Department of Health and Social Care, 2021; Department of Health and Social Care, 2022a, 2022b; National Audit Office, 2022; NHS Employers, 2022; NHS England and NHS Improvement, 2021a, 2021b, 2021c, 2022, 2021d, 2021e).
The scoping exercise highlighted essential elements for effective leadership in integrated health and social care, encompassing individual leader traits and structural considerations, detailed in Figure 2.
Individual reflection.
Leaders need to reflect and develop their thoughts and feelings, changing as necessary (Baylis and Trimble, 2018; Sullivan-Taylor et al., 2022). This involves continuous learning and fostering an adaptive learning culture (Charles et al., 2018; Hendry et al., 2021; Miller and Stein, 2020), underpinned by emotional intelligence and self-understanding (Good Governance Institute and Coventry University, 2022; King and Mendez-Sawyer, 2021).
Working together.
Integrated care leadership involves tackling complex “wicked” problems and managing conflicts (Hulks et al., 2017; Social Care Institute for Excellence, 2018). Leaders must collaborate, share powe, and use distributed leadership approaches (Aunger et al., 2022b; Baylis and Trimble, 2018; Harris et al., 2022; Miller and Stein, 2020). Clear governance structures and data sharing are crucial for managing risk and decision-making (Booth-Smith, 2017; Cheng and Catallo, 2019; Harris et al., 2022).
Relationships and trust.
Building trust within systems relies on strong relationships, effective communication and managing power dynamics (Aunger et al., 2022a, 2022b; Baylis and Trimble, 2018; Hulks et al., 2017). Trust fosters collaboration and understanding of partners’ motivations (Deffenbaugh, 2018; Ham, 2022; Harris et al., 2022).
Culture.
A shared culture is essential for collaborative working, facilitating common goals and a unified narrative (Bell et al., 2022; Harris et al., 2022; Urtaran-Laresgoiti et al., 2018). Cultural alignment reduces conflict and supports shared values and vision (Cheng and Catallo, 2020; Nicholson et al., 2018).
Engagement.
Engaging with patients, communities and the public involves cocreation and ensuring genuine influence in service design (Charles et al., 2018; Ham, 2022; Sullivan-Taylor et al., 2022). Leaders should partner with a range of organisations, including the voluntary sector, for a population-based approach (Alderwick et al., 2021; Hendry et al., 2021).
System understanding.
Leaders must understand the health and social care sectors and manage conflicts between organisational and system priorities (Deffenbaugh, 2018; Harris et al., 2022; Miller and Stein, 2020).
Progress monitoring.
Monitoring performance through agreed indicators is vital for evaluating progress and demonstrating impact (Department of Health and Social Care, 2022a; Martin, 2021; Round et al., 2018).
Quality improvement and innovation.
Leaders should foster a culture of improvement and innovation, empowering the workforce and developing quality improvement capabilities (Gordon et al., 2020; NHS Confederation, 2018; Turner et al., 2018).
Substantive theory
The Phase 1a scoping exercise identified strategies and practices for effective ICS leadership, needing further organisation and coherence. Literature informed the use of substantive theories for programme theories, providing a bridge to existing research (Marchal et al., 2018; Papoutsi et al., 2018). Systems leadership theory aligned best with the findings.
Systems leadership in health care.
Systems leadership focuses on understanding and addressing interdependencies in health-care systems (NHS Leadership Academy, 2013; NHS North West Leadership Academy, 2021). It involves engaging a wide range of stakeholders and navigating complex environments, though empirical research in this area is limited (Kaehne et al., 2022). While there are many types of “systems” within health-care and leadership contexts, in this paper the term “system” is used to refer to ICSs.
NHS North West Leadership Academy Doing Things Differently system leadership behaviour framework.
The framework identifies key behaviours for effective system leadership, developed through collaborative projects with various sector leaders (NHS North West Leadership Academy, 2018). Four overarching themes of “Being,” “Relating and Communicating,” “Leading and Visioning” and “Delivering” structure the findings, exploring what works in different contexts to support effective ICS leadership.
Initial rough programme theories
An IRPT is foundational for a realist review, providing structure for analysis (Shearn et al., 2017). Developed using the “Doing Things Differently” framework, IRPTs in this study offer a narrative on leadership effectiveness in ICSs integrating programme strategies, NHS guidance and key informant interviews. IRPTs for this study are provided in Supplementary File 2 and summarise the interplay of context, mechanism and outcomes, exemplified through quotations supporting the programme theories (Rycroft-Malone et al., 2012).
Phase 1b: empirical testing of context–mechanism–outcome configurations
The original nine CMOCs supporting programme theories, with two each for Being, Leading and Visioning, Relating and Communicating and three for Delivering, were validated against 18 empirical papers, synthesising contexts, mechanisms and outcomes. Evidence for contexts, mechanisms and outcomes were gleaned from these papers and compared with the original nine CMOCs. Four CMOCs (1, 6, 7 and 8) had empirical support with refinements, one (3) lacked evidence and four (2, 9, 4 and 5) were merged because of insufficient distinct evidence, resulting in the following six CMOCs.
Initial programme theory (IPT): Being
CMOC 1: In the context of ICS formation and development (C) leaders with a clear and sustained vision communicate clarity of intent (M – Res), which fosters a sense of purpose in stakeholders (M- Rea) and helps to focus on the achievement of ICSs’ objectives (O).
Empirical studies emphasise the need for ICS leaders to consistently commit to a clear vision, facilitating supportive actions aligned with ICS goals by partners collaboratively and independently, while minimising miscommunications. The lack of this clear vision contributes to management challenges (Aufegger et al., 2020; Aunger et al., 2022b; Harlock et al., 2020; Kozlowska et al., 2020; MacLeod et al., 2019; Martin, 2021; Miller and Stein, 2020; Round et al., 2018; Sims et al., 2021; Urtaran-Laresgoiti et al., 2018).
IPT: Leading and visioning.
CMOC 2: In the context of determining and measuring ICS priorities (C), the transparent and democratic engagement of clinical and care professionals, non-health partners and local communities (M-Res) promotes a sense of mutual accountability (M-Rea) and a focus on population health and well-being, reducing the impact of health and social inequalities (O).
CMOC 1 emphasises a clear, sustained vision for ICS objectives, mandating partner action, whereas CMOC 2 focuses on mutual accountability through partner engagement in developing and measuring ICS priorities (Sims et al., 2021). Empirical literature underscores involving all stakeholders, including the public, in setting local ICS priorities, especially in early integration stages (Bell et al., 2022; Gordon et al., 2020; Harlock et al., 2020; MacLeod et al., 2019; Martin, 2021; Miller and Stein, 2020; Mitchell et al., 2020; Nicholson et al., 2018; Round et al., 2018; Urtaran-Laresgoiti et al., 2018). This involvement aims to address broader ICS goals like population health, illness prevention and reducing health inequalities.
IPT: Relating and communicating.
CMOC 3: In the context of bringing together health and social care organisations with different histories, funding mechanisms and governance (C) and developing strong relationships through shared goals and frequent face-to-face interactions (M-Res) nurture trust and understanding (M-Rea), which support collaborative decision-making and the resolution of tensions (O).
The literature underscores recognising historical power and resource imbalances between health, social care and the voluntary sector as crucial for developing collaborative relationships (Chang, 2021; Gordon et al., 2020; Martin, 2021; Sims et al., 2021). Trust, fostered through frequent interactions and face-to-face meetings, is vital, as is resolving tensions to maintain trust and collaboration (Aunger et al., 2022b; Bell et al., 2022; Embuldeniya et al., 2018; Harlock et al., 2020; MacLeod et al., 2019; Miller and Stein, 2020; Nicholson et al., 2018; Shand and Turner, 2019).
IPT: Delivering.
CMOC 4: In the context of a shared culture of learning (C), system partners facilitating and supporting each other to innovate and identify learning from successes and failures (M-Res) supports psychological safety and encourages creativity and innovative thinking (M-Rea), leading to effective service redesign and continuous improvement (O).
ICSs require a novel approach to health and social care, fostering learning and innovation (Sims et al., 2021). Empirical studies emphasise developing processes that support innovation (Gordon et al., 2020) and encourage experimentation while managing risks (MacLeod et al., 2019). Leaders should create conditions for innovation by mobilising resources and allowing for risk-taking and learning from mistakes, crucial for inventive service delivery (Martin, 2021; Miller and Stein, 2020; Mitchell et al., 2020; Round et al., 2018; Urtaran-Laresgoiti et al., 2018):
CMOC 5: In the context of population health management and digitalisation (C), the use of shared digital intelligence (M-Res) supports leaders to better understand local population needs (M-Rea), which leads to improved targeting or prioritisation of local communities so they can access services (O).
There was empirical evidence of the need for real-time data sharing across partners and an acknowledgement that this was limited by a lack of shared systems or information governance requirements (Embuldeniya et al., 2018; Pearson and Watson, 2018). The development of shared data systems, or intelligence dashboards, which can be used at all levels to support delivery to local communities (Bell et al., 2022; Gordon et al., 2020; Mitchell et al., 2020; Nicholson et al., 2018), was therefore seen of importance to support leaders in using intelligence to target interventions. (Bell et al., 2022; Gordon et al., 2020; Mitchell et al., 2020; Nicholson et al., 2018):
CMOC 6: In the context of developing a culture of accountability (C), clear governance structures and transparent decision-making, with a robust process for monitoring and evaluation (M-Res), ensure partners accountability for quality, value for money and effective service provision (M-Rea), which leads to the achievement of system outcomes (O).
Empirical evidence indicates that clear, collaborative governance and engagement processes, like regular action-focused meetings, enhance system accountability and progress monitoring (Bell et al., 2022; Gordon et al., 2020; Sims et al., 2021). However, historical health and social care sector differences can impede this approach (Pearson and Watson, 2018). Leaders who challenge the status quo in a transparent environment facilitate goal achievement (MacLeod et al., 2019; Miller and Stein, 2020; Nicholson et al., 2018), with progress monitoring against meaningful measures bolstering accountability and outcome achievement (Aunger et al., 2022b; Mitchell et al., 2020; Urtaran-Laresgoiti et al., 2018).
Discussion
Our findings build on previous studies by suggesting key mechanisms for effective leadership and identifying that leadership in ICSs work when ICS leaders hold themselves and others to account for improving population health, a sense of purpose is fostered through a clear vision, partners across the system are engaged in problem ownership and relationships are built at all levels of the system. Whilst these findings were derived from, and therefore relate to, executive level leaders within an ICS the findings may be of relevance differing leadership levels within an ICS context.
Many of the CMOC elements identified in this review are similar to those identified by other, non-realist studies, such as the challenges arising from health and social care organisations with different histories, funding mechanisms and governance functions collaborating in partnership (Barker, 2014; Exworthy et al., 2017; Miller et al., 2021; Miller and Glasby, 2016; Parkin, 2019), increasing the validity of our findings. However, we build on these elements by making connections between the resources (mechanism) offered in contexts and the reasoning of those involved in leadership of ICSs; for example, the development of trust and understanding. The refined theories corroborate existing ICS leadership guidance, emphasising relationship development and maintenance across health and social care systems for sustained partnership and collaboration.
This aligns with previous realist reviews on integrated care leadership (Aunger et al., 2022b; Harris et al., 2022), explaining how relationships bolster effective ICS leadership. Aunger et al. (2021a) have previously noted the complexity involved in health and social care partnerships, like ICSs, due to the large number of organisations coming together across sectors; impacting not only effective communication but hindering the development of trust due to previously established competitive approaches. This resonates with our findings; we argue that historical imbalances in cross-sector organisational partnerships impact collaborative working and the development of trust. Aunger et al. (2021a) suggest a clear patient focus from all parties across the system as a means to overcome these pre-existing differences and conflicts; this is linked to our notion of a “shared sense of purpose”.
Our research builds on existing realist-informed studies of health-care partnerships or collaboration (Aunger et al., 2021a; Aunger et al., 2021b, 2021c; Aunger et al., 2022a, 2022b), and in particular recent realist reviews focused on leading in integrated care (Harris et al., 2022; Sims et al., 2021) by providing a specific focus on ICS leadership and offering Programme Theories as guidelines for ICS leadership development.
This rapid realist review was based on leadership within ICSs and informed, in part, by key informant interviews with leaders from a regional ICS. However, the results can be applied to ICSs across England, with the potential to inform learning within other nations that implement integrated health and social systems. Key learning identified from the review could support the development of effective leadership within an ICS, but given the inherent complexity within such systems, composed of leaders as individuals with relationships, this will influence the context and mechanisms and hence the outcomes each ICS demonstrates. Moreover, whilst the CMOCs are presented here positively, in most cases the opposite is likely to apply; for example, a lack of clear governance structures and transparent decision-making, within the context of developing a culture of accountability can reduce partner accountability for quality, value for money, and effective service provision, limiting the achievement of system outcomes. Table 2 offers Programme Theories as guidelines for ICS leadership development.
Further research is required to further build, test, and refine these theories. We suggest this can be achieved through a case study of ICS leadership to test these Programme Theories and CMOCs in a larger real-world case study. Therefore, the next stage of this research will entail further testing and refining these theories through a realist evaluation.
Strengths and limitations
This rapid realist review, adhering to RAMESES guidelines, offers a detailed and transparent process report. Key stakeholder engagement, a recommended aspect in realist reviews (Wong, Greenhalgh, et al., 2013; Wong, Westhorp, et al., 2013), informed the development and refinement of findings. Despite being a rigorous and comprehensive investigation, stakeholder input was limited to one ICS, potentially restricting insights from varied geographical contexts. Additionally, the recent establishment of ICSs has meant limited literature availability, with few empirical studies conducted. Although this emphasises the importance and originality of the research, this scarcity posed challenges in extracting and applying certain programme theory elements, particularly context. Finally, whilst the focus of this review was ICSs within the English NHS, findings may be relevant to integrated health and care systems within other geographical contexts.
Figures
Operational definitions of context, mechanisms and outcomes
| Operational description | |
|---|---|
| Context | A situation or condition that existed before the formation of ICS, or a situation or condition outside of the control of ICS that is relevant to the leadership of ICS and may change over time |
| Mechanism | Activities, processes and actions related to ICS leadership (resources) and the responses or reactions of leaders, or other members of the system, that follow (reasoning) |
| Outcome | Result or consequence of ICS leadership (intended or unintended) |
Source: Authors’ own work
Theories of effective ICS leadership using doing things differently: rethinking leadership behaviours as an organising framework (NHS North West Leadership Academy, 2021)
| Delivering | Effective ICS leaders hold themselves and others to account for improving outcomes for the local population. They use available intelligence to take actions that support targeting and prioritisation of local communities. Effective ICS leaders support and encourage learning, curiosity and calculated risk-taking enabling innovative approaches that lead to service improvements |
| Being | Effective ICS leaders communicate a clear vision, fostering a sense of purpose across the system regarding the achievement of agreed ICS outcomes |
| Leading and visioning | Effective ICS leaders have a clear vision that promotes a sense of mutual accountability, providing opportunities for others to develop, make decisions and take ownership of problem-solving through the engagement of all partners in the reduction of health and social care inequalities |
| Relating and communicating | Effective ICS leaders build relationships at all levels of the system; they promote partnership and collaboration. Leaders encourage a collective agreement about what needs to be achieved and communicate openly about how and why decisions are made |
Source: Authors’ own work
Supplementary material
The supplementary material for this article can be found online.
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Further reading
Care Act 2014 (2014), “Queen’s printer of acts of parliament”.