This is the first empirical report comparing longitudinal and contextualised findings from a number of case studies of different organisational and management healthcare innovations. The findings made possible explanations for success factors and useful practical recommendations for conditions needed to nurture such innovation in public healthcare.

Introduction: Integrated health and social care based on formal collaboration and cooperation is essential for persons with complex needs. Increasingly complex health care routines however challenges traditional forms of leadership and often require innovative forms of leadership. Collective leadership is one form reported to benefit collaboration and joint management between sectors and providers.Aim: to better understand the functions of collective leadership and its potentials for integrated health and social care.Objectives: to explore formal leaders perceptions of helping and hindering conditions to collaborate in an integrated health and social care organisation followed by a synthesis on implications for collective leadership in complex organisations.Methods: a qualitative, explorative study research design. Study setting: a psychiatric centre with long traditions of providing integrated health and social care, characterised by co-location of interprofessional teams managed by collective leaders and a shared top management.Participants: four pairs of first line managers performing collective leadership were interviewed. Data analysis: The initial and descriptive phase of the analysis addressed the role and process of collective leadership and its prerequisites. To advance the understanding of collective leadership in complex organisations the next phase was informed by complexity theory and the theory of leadership in complex organisations. Five key dimension of complex leadership served as a framework in the final analysis. Results:Our findings provide valuable insight into advantages as well as challenges when using collective leadership as a management form in integrated care. The advantages and challenges concern both formal management tasks and tasks associated with leadership. Furthermore our findings provide insight into contextual aspects and aspects related to leader qualities and skills important to consider when implementing collective leadership as a management form in integrated care. Conclusion:Based on our findings we can provide pros and cons of collective leadership as a management form in integrated care. Moreover we can highlight some preconditions which could facilitate and hinder the collective form of management.

A European initiative to design a “medical information framework” conceptualised how multiple stakeholders join in collaborative networks to create innovations. It conveyed the ways in which value is created and captured by stakeholders. We applied those insights to analyse a multi-stakeholder initiative to promote improvement of Swedish healthcare. Our longitudinal case study covered totally fifty stakeholders involved in a national project, aiming at designing a system to support value-based evaluation and reimbursement. During the project the focus changed from reimbursement to benchmarking. Sophisticated case-mix adjusting algorithms were designed to make outcome comparisons valid and incorporated in a software platform enabling detailed analysis of eight patient groups across seven regional health authorities. Those were deliverables demonstrating value created. However, the project was unable to transfer the system into routine use in the regions, a failed value-capture. The initial success was promoted by collaborative processes in diagnosis-specific working groups of well-informed and engaged professionals. The change of focus away from reimbursement decreased the involvement among health authorities, leaving no centrally placed persons to push for implementation. It highlights the importance of health professionals as the key stakeholder, who has both the know-how instrumental to creating an innovation, and the local involvement guaranteeing its implementation.

Dynamic sustainability of integrated health and social care and the importance of adaptive strategic management