Collective leadership as a management arrangement of integrated health and social care

Abstract

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.

Understanding the dynamics of sustainable change: A 20-year case study of integrated health and social care

“…The abbreviation IC will be used, referring to integrated mental health and social care services. Based on our previous research [ 30 – 32 ], we anticipated that this case would be particularly interesting to study from a sustainability perspective. By viewing sustainability as a process in a constantly changing context, the DSF is a relevant means through which to explore the mechanisms of sustainability in this integrated mental health and social care organisation.…”

A 10 Step Framework to Implement Integrated Care for Older Persons

“…Integrating care is consequently proposed as a policy solution internationally (Hendry 2015;Berglund et al 2015;Keong et al 2013;Carswell 2015;Pike and Mongan 2014). Whilst there is growing evidence on 'what works' in improving discrete aspects of care for older persons (Davies et al 2011;Ellis et al 2011;Stokes et al 2015;Parker et al 2002;Mitchell et al 2015;Gullery and Hamilton 2015;Stewart et al 2013;Goodman et al 2012;Wodchis et al 2015;Nolte 2012;Trivedi et al 2013;Coffey et al 2015;Roland et al 2012;Davies et al 2011;Goodwin and Smith 2011;Stewart and Georgiou 2013;Bodenheimer and Berry-Millet n.d.;Boult et al 2011;Lyon et al 2007;Hutt et al 2004;Boult et al 2011;Counsell et al 2007;Naylor et al 2004) it is less clear 'how' best to implement integrated care systemically (Goodwin 2013;Valentijn 2015;Klinga et al 2016). Systemic change is typically centrally defined but implementing 'top-down' change is problematic, delivering less than anticipated (Best et al 2012;Greenhalgh et al 2009).…”

Identifying the context, mechanisms and outcomes underlying collective leadership in teams: building a realist programme theory

“…"Co-leadership exerted in an integrated and colocated centre allowed the managers to deal with service users' needs and problems in a more holistic and efficient way." [39] "They also felt that the award had helped enable each of them to develop as leaders in their own spheres, had made the team leader more willing to listen to them, and had given them the confidence to put their own ideas forward more" [26] An enhanced recognition of the skills and expertise of team members, and a sense of being valued, were triggered in contexts where collective or shared leadership was practiced included and for their expertise and judgement. This resulted in interdisciplinary collaboration in patient care.…”

“…"Being interested in and willing to invest time in collaboration and in learning about each other's responsibilities and sector-specific [health and social care] activities was crucial to understanding and managing the big picture … By the advantage of being two managers with different knowledge and responsibilities, the managers could complement each other's areas of expertise." [39] Discussion This paper describes the results of a rigorous and iterative approach to the development of an initial programme theory to evaluate the impact of a collective leadership intervention. Through realist synthesis of the extant literature on collective leadership in healthcare, interviews with individuals on teams that are leading collectively, feedback from a realist research group and expert panel input, we extracted and refined seven CMOCs that together offer an initial programme theory of how collective leadership triggers mechanisms in specific contexts that lead to patient, staff and organisational outcomes.…”