Role of medical leaders in integrated care systems: what can be learnt from previous research?

Abstract

Integrated care systems are an example of collaborative governance, a mode of governance that brings together diverse stakeholders, both public and private, to make collective decisions.The Ansell and Gash model of collaborative governance is an evidence-based framework that sets out the critical variables that influence whether this mode of governance will produce successful collaboration.We use this model to explore the role of medical leaders in integrated care systems, the challenges they can expect to face, and the skills they will need to develop.Where there is a prehistory of conflict, medical leaders will need to invest time repairing relationships and rebuilding trust.Some stakeholders may need convincing that collaboration will be meaningful and not merely rhetoric or co-optation.For collaboration to be successful, participants need to believe that good faith bargaining for mutual gain is a good way to achieve policy objectives, and there needs to be appreciation of the perspectives and interests of other stakeholders.This will be a key challenge for medical leaders faced with policy stakeholders who continue to see integrated care systems as a way of implementing NHS priorities, and where some stakeholders may see their position in absolute terms.Leadership development should focus on diplomatic skills for bringing diverse stakeholders to the table, including and empowering less powerful actors, and sustaining collaboration across organisational boundaries.