System leadership for integrated care
What is it and how does it work?
System leadership is about building relationships and connectivity across organisations and sectors to drive the improvement, innovation and transformation of services.
Effective system leadership is:
- shared, participatory, diffused and co-productive
- relationship building, personal and person-centred
- place-based and community-oriented
- adaptive and solution-focused
- capable of surfacing conflicts and consensus seeking
- primarily accountable to people and communities.
Video transcript Open
In the context of integrated care, systems leadership is the practice of enabling all local partners to work towards the same goal of person-centred, coordinated care.
- Strengthening the relationships between local partners,
- Enabling changes to how services are designed and delivered,
- Connecting care professionals and organisations, and
- Removing barriers to better joined up care.
Systems leaders set the ambition and goals for local systems through a compelling vision and narrative of integrated care, establishing a culture of collaboration by working effectively in partnership.
Systems leaders champion change initiatives that will improve the standards and outcomes of care, whilst working with service users, front-line professionals and communities to co-design and co-produce solutions for better heath and care.
The skills and behaviours of successful systems leaders reflect a collaborative style of working that underpins integrated care.
Leaders must be able to influence outside of their positions of authority and across the whole system, not just within their own institutions – using persuasion and negotiation skills to seek consensus.
But equally, leaders need to operate in an environment where they are able to plan for the long term, and are given the time and space to innovate.
Where there is tolerance for things not working, including learning to ‘fail well’.
There has to be trust and delegation of autonomy from the centre, recognising that responsibility for making change happen cannot be held centrally.
Relationships need to come before structures – ideally drawing on established working relationships built over the years.
There has to be clarity about how governance and accountability work, and responsibilities of individual organisations
And ideally, stability in leadership positions across organisations.
Research evidence not just from the UK but from across the world has shown a positive relationship between strong collaborative leadership and the implementation of integrated care.
Effective systems leadership is therefore a critical enabler for success.
Explore system leadership
- Achieving integrated care: 15 best practice actions (LGA/SCIE 2019)
- How to lead and mange better care: integration guide (Better Care Fund 2019)
- Leaders equipped to develop high quality local health and care systems in partnership (NHSI 2019)
- Integrating Better: a guide (NHSE 2019)
- Leading large scale change: a practical guide (NHSE 2018)
- Leadership in integrated care systems (SCIE 2018)
- Shifting the centre of gravity (LGA 2018)
- Leading across the health and care system: lessons from experience (King's Fund 2017)
- Stepping up to the place (LGA et al. 2016)
- The practice of system leadership: being comfortable with chaos (King's Fund, 2015)
- Talent management: developing leadership not just leaders (King's Fund 2015)
- Systems Leadership: A view from the bridge (OPM 2015)
- The practice of system leadership: being comfortable with chaos (King's Fund 2015)
- Developing systems leadership: interventions, options and opportunities (NHS Leadership Academy 2015)
Practice examples Open
- Using financial reform to enable change in Bradford (NHS Confederation 2020)
- Croydon: Bringing organisations together to deliver integration (NHSE Integrating Better 2019)
- Driving improvement: case studies from nine adult social care services (CQC 2018)
- The journey to integration (LGA 2016)
Measuring success Open
- From place-based to place-led: a whole area approach to integrating care systems NHS Confederation (NHS Confederation 2020)
- System wide collaboration? Health and social care leaders’ perspectives on working across boundaries (Journal of Integrated Care 2019)
- Stepping up to the place: part A: review of the vision (IPC 2018)
- Stepping up to the place: part B: evidence review (IPC 2018)
- Leadership in interprofessional health and social care teams: a literature review (Leadership in Health Services 2018)
- A year of integrated care systems: reviewing the journey so far (King's Fund 2018)
- Beyond barriers: how older people move between health and social care in England (CQC 2018)
- A system-level evaluation of the Better Care Fund (Qoru 2018)
- What works in implementation of integrated care programs for older adults with complex needs? (IJQHC 2017)
Latest evidence Open
These are the latest resources from Social Care Online, the UK’s largest database of care knowledge and research.
System leadership and COVID – Case study of practice
- Social Care Institute for Excellence, 2021
How might leadership roles evolve in integrated health and care systems?
- Social Care Institute for Excellence, 2021
Webinar recording: Building trusted relationships in integrated care systems
- Social Care Institute for Excellence, 2020
Towards a theoretical framework for Integrated Team Leadership (IgTL)
- Taylor and Francis, 2020
Building a resilient system: reflections and insights from health and care leaders
- Carnall Farrar, 2020
Does training in co-production lead to any real change in practice? Reflections from practitioners in Northern Ireland
- Emerald, 2021
Time to be radical? The view from system leaders on the future of ‘system by default’
- NHS Confederation, 2020
Integrating care: next steps to building strong and effective integrated care systems across England
- NHS England, 2020
The future of integrated care in England: health leaders’ views on how to make system working a success
- NHS Confederation, 2020
Systems leadership: enhancing the role of social care
- Research in Practice, 2020
- System leadership and COVID – Case study of practice
How does shared system leadership support integrated care?
Integrated care is delivered through an array of emerging collaborative arrangements and local partnerships, from the Integrated Care Pioneers and the New Care Models to the Sustainability and Transformation Partnerships, Integrated Care Systems, and devolved authorities. While there is variation in depth of integration, governance structure, footprint size and scope of activities, their success depends on a strong shared system leadership, to provide and nurture a compelling vison and narrative of integration, a strong collaborative culture, and a commitment to place-based, person-centred, coordinated care.
Leading change across organisations and stakeholders, and championing the integration of health and social care but also public health, housing, children’s social care, mental health and the voluntary community sector may be effectively achieved through:
- co-designing and co-producing solutions with those who receive health, care and support, and work effectively with elected politicians
- place-shaping, understanding how strategic plans relate to very locally-based neighbourhood teams. Understanding how to commission and deliver population improved health is another important skill
- leading large-scale change, improvement, innovation and transformation
- tackling complex issues, including cross-system workforce planning; shifting care out of hospitals and into communities; and planning for the winter
- building commitment and ensuring leadership is rooted deeper within organisations, engaging middle managers and leaders of multidisciplinary teams in their thinking.
What do leaders need to succeed?
To effectively respond to the complexities of leading integrated systems and influencing and championing large-scale transformation, system leaders need to operate in an enabling environment where:
- they are able to plan for the long term, and are given the time and space to innovate
- there is tolerance for things not working, including learning to ‘fail well’
- there is trust and delegation of autonomy from the centre – a permissive, not prescriptive, approach and national guidance that provides a broad, enabling framework
- decision-making roles are distributed, and staff and service users involved; recognising that responsibility for making change happen cannot be held centrally
- relationships come before structures – ideally drawing on established working relationships built over the years
- there is clarity about how governance and accountability work, and responsibilities of individual organisations
- there is stability in senior leadership positions across organisations.
At a professional level, leaders must be able to rely on:
- communities of practice, ‘safe spaces’ where to share views and concerns and formal and informal networks
- peer support and buddying up
- leadership programmes, including using learning together approaches, bringing together professionals from different disciplines and sectors
- Support for middle managers and distributed leadership.
What is the evidence for outcomes and impact?
Findings of a realist review of the evidence show that contextual factors such as strong and supportive leadership and joint governance are critical to the successful implementation of integrated care programmes, and to fostering a culture of collaboration (Kirst M. & al., 2017). Evaluations of integrated care programmes similarly suggest that:
- ‘Strong, collective leadership is the single most important enabler for success in providing high-quality health and social care for people’ (Care Quality Commission, 2018)
- ‘Strong leadership across the area’s organisations is essential to maintain focus and mitigate against the risk of change in leadership and loss of momentum’ (LGA, 2016)
- Good leadership and project management are key in coordinating planning, and mobilising and sustaining support and engagement for BCF programmes at both strategic and operational level (Forder Julian et al., 2018).