It can also erode through capacity and financial imbalances within a network, which may raise doubt that all network members act fairly to create positive outcomes for the good of the whole [48, 70]. DOI: https://doi.org/10.1016/S1048-9843(02)00120-0, Mintzberg H. Managing the myths of health care: Bridging the separations between care, cure, control, and community. Social Networks, 1995; 17(3-4): 319–340. Healthcare is transitioning from episodic services to care teams aligned around improving health outcomes for individuals and communities. Bmc Family Practice, 2012; 13(36): 1–11. Regarding activity coordination, they examine how leadership affects patient and client referrals [7, 10, 48, 50, 52, 53, 59, 60, 62, 65, 66, 79, 89, 91, 98, 102], care planning [7, 45, 48, 54, 55, 57, 80, 93, 95, 96, 97, 102, 104], information sharing [48, 49, 52, 57, 65, 103], resource exchanges [7, 52, 99, 102] and the alignment of care practices via protocols, pathways and evidence-based decision-making [13, 46, 73, 87, 88, 92]. This definition has several implications. Systems analysis of collaboration in 5 national tobacco control networks. The author has no competing interests to declare. At the policy level, the importance of public governance structures, i.e. In: Buchanan D, Bryman A (eds. by reading the articles in depth and refining the focus of the review). Managing the care of health and the cure of disease – Part I: Differentiation. At the same time, they depend on the approval and participation of provider organisations in the field, which require inclusive processes of problem setting, direction setting and re-structuring [61]. They also inform practice, drawing attention to persistent tensions as a core leadership challenge and offering latest scholarly evidence practitioners can use to reflect on and advance their own leadership practice. Table 1 shows the resulting analytical framework and findings. DOI: http://doi.org/10.5334/ijic.5420, Mitterlechner, M. (2020). Development of a program for tele-rehabilitation of COPD patients across sectors: Co-innovation in a network. Integrated care: Meaning, logic, applications, and implications – A discussion paper. Neither market nor hierarchy: Network forms of organizations. study the practices of boundary spanners in the formation and implementation of a Dutch healthcare network [101]. Harvard Business School Case 9-399-150. So far, comparatively little research has been carried out on linkages between the network and organisation level. At the network level, research addresses the activities of network leaders [88, 89, 90, 91, 92, 93]. On the one hand, defining networks as sets of nodes and ties, social network analysts have studied the antecedents and consequences of networks at different levels, including the inter-organisational level [21]. Administration and Policy in Mental Health, 1995; 22(4): 361–388. Leadership media refer to contextual structures and processes (formal and informal communication instruments) through which network agendas are created and implemented. Swensen, S. J., Pugh, M., McMullan, C., & Kabcnell, A. In networks, leadership involves the coordination of several legally autonomous organisations [17]. The review started with the access to scientific databases. International Journal of Integrated Care, 2020; 20(1): 15. One hundred thirty-three million Americans, 45 percent of the population, have at least one chronic disease. DOI: http://doi.org/10.5334/ijic.5420, Mitterlechner M. Leadership in Integrated Care Networks: A Literature Review and Opportunities for Future Research. Cham: Springer. Over time, distributed actors adjust this context through ongoing interactions, enacting practices like promoting system awareness, building relationships and sharing information. Introduction: In many countries, elderly patients with chronic conditions require a web of services delivered by several providers collaborating in inter-organisational networks. Legislation has a particular impact by providing funding and creating financial incentives [11, 14, 41, 48, 49, 50, 51, 52, 53]. DOI: https://doi.org/10.1186/1471-2296-13-36, Timpka T, Bang M, Delbanco T, Walker J. Health and Social Care in the Community, 2009; 17(5): 485–494. Milbank Quarterly, 2018; 96(4): 782–813. Leadership in integrated care. In: Staw BM, Cummings LL (eds. DOI: https://doi.org/10.5334/ijic.2449, Short A, Phillips R, Nugus P, Dugdale P, Greenfield D. Developing an inter-organizational community-based health network: An Australian investigation. Journal of Health Services Research & Policy, 2011; 16(s1): 14–21. Regional planning implementation and its impact on integration of a mental health care network. International Journal of Medical Informatics, 2017; 97: 247–260. The five year forward view (FYFV) gave system leaders a broad direction of travel but did not deliver the detail required for implementation. Public Administration, 2016; 94(1): 89–110. Besides governance structures and processes, studies examine the role of trust among network members [10, 12, 41, 48, 70, 71, 72, 73]. At the network level, many studies emphasise the role of network governance [105], i.e. Third, the leadership challenge is exacerbated by the way health and social care services are provided. Amelung, V. E., Hildebrandt, H., & Wolf, S. (2012). Who We Are | What We Do. Kodner, D. L., & Spreeuwenberg, C. (2002). Strategic Management Journal, 2008; 29(13): 1465–1474. Further empirical investigations are needed to explore how actors cope with this challenge, assuming that persistent tensions are both media and consequences of leading in integrated care networks. DOI: https://doi.org/10.2307/20159624. For example, the topic can be studied from network theory, integrated care theory or other theoretical angles, each perspective using its own definitions and illuminating different aspects of the phenomenon. Torn by several contradictions between opposite elements across levels, leadership appears to be less orderly than perhaps expected. J Interprof Care, 2010; 24(6): 653–665. A map of the field of leadership in integrated care networks (including double counts). In a next step, the 73 articles were analysed and coded according to 11 different criteria, which were derived both deductively (e.g. In networks, organisations coordinate activities through reciprocal, preferential and mutually supportive actions rather than through discrete market exchanges or by administrative fiat [3]. It summarises latest evidence from around the world practitioners can use to reflect on and improve their own leadership practice. Provan KG, Fish A, Sydow J. Interorganizational networks at the network level: A review of the empirical literature on whole networks. Schoemaker, P. J. H., Krupp, S., & Howland, S. (2013, January–February). This paucity of research leaves ample room for progress. Health Policy, 2015; 119(1): 1–8. DOI: https://doi.org/10.1177/0018726707081158, Adjerid I, Adler-Milstein J, Angst, C. Reducing medicare spending through electronic health information exchange: The role of incentives and exchange maturity. Health Promot Int, 2014; 29(2): 328–338. It is when people in your organization are empowered to think, talk, and act based on the same value system. Battilana, J., Gilmartin, M., Sengul, M., Pace, A., & Alexander, J. The field tends to focus on the network level of analysis. Five laws for integrating medical and social services: Lessons from the United States and the United Kingdom. Owusu NO, Baffour-Awuah B, Johnson FA, Mohan J, Madise NJ. Implementation Science, 2014; 9(32): 1–11. Find out more. This work is crucial to our understanding of how these structures and processes enable and constrain integrated care networks. Third, the findings of the literature review suggest that integrated care networks are social systems imbued with manifold tensions [23, 27, 28, 29]. DOI: https://doi.org/10.1016/j.socscimed.2016.09.005, Breton M, Pineault R, Levesque JF, Roberge D, Da Silva RB, Prud’homme A. Reforming healthcare systems on a locally integrated basis: Is there a potential for increasing collaborations in primary healthcare? Quality: The Mayo Clinic approach. These findings correspond to wider network research, which argues that these tensions cannot be resolved and constitute a core challenge of network leadership [23]. It includes, among others, Australia [6], Canada [7], Denmark [8], Germany [9], the Netherlands [10], Switzerland [11], Taiwan [12], the UK [13] and the US [14]. Future research could usefully provide a fuller picture by examining leadership practices, activities and outcomes at the policy and organisation level, integrating advances in the wider leadership literature. Integrated Care System (ICS) Executive Leadership Team These are members of the joint executive team who have been appointed so far. Against this background, this paper aims to review central characteristics of leadership in integrated care networks and outline avenues for future research. Given sufficient public funding, activity coordination is enabled by centralised governance combined with a strong exercise of leadership activities (see next section) or shared governance combined with adequate governance processes [11]. The Oxfordshire Integrated Diabetes Care Programme team reflects here on the kind of leadership that is required, and the challenges they have faced. Rt. Health Policy, 2018; 122(12): 1356–1363. DOI: https://doi.org/10.1016/j.mar.2010.08.004, Page S. “Virtual” health care organizations and the challenges of improving quality. of integrated care Helen Bevan @HelenBevan. Most research has been leader-oriented, studying the traits, abilities and actions of effective leaders [24]. Cite as. It can easily erode through recognition asymmetries among network members of each other’s skills and differences in culture and attitudes towards change [70]. Depending on the situation, networks are supported or constrained by pro-competitive policy reforms [6, 41, 42, 43, 44], government legislation [7, 44, 46, 47], financial incentives [11, 50, 51, 52] and intra-organisational changes like ownership transitions [102]. This study is situated in the governance tradition and builds on Müller-Seitz and Sydow [17], who define an inter-organisational network as “a social system in which the activities of at least three formally independent legal entities are coordinated in time-space, i.e., there is some reflexively agreed upon inter-firm division of labour and cooperation among the network members” (p. 108). First, leadership can make a difference. The triple aim: Care, health, and cost. What passes as a rigorous case study? David A. Buchanan, BA PhD FRSA Chartered FCIPD FBAM FAcSS, Emeritus Professor of Organizational Behaviour, Cranfield University School of Management, Cranfield, UK. The goal of these methods and models is to enhance quality of care and quality of life, consumer satisfaction and system efficiency for patients with complex, long-term problems cutting across multiple services, providers and settings” [adapted from 19, p. 3]. DOI: https://doi.org/10.1093/heapro/dau021, Vendetti J, Gmyrek A, Damon D, Singh M, McRee B, Del Boca F. Screening, brief intervention and referral to treatment (SBIRT): implementation barriers, facilitators and model migration. Cross-sector collaboration in the high-poverty setting: Qualitative results from a community-based diabetes intervention. The top three journals publishing articles on the topic are the International Journal of Integrated Care (7), Health Policy (5) and Health Care Management Review (4). Chronic diseases are responsible for 7 of 10 deaths each year, killing more than 1.7 million Americans annually. DOI: http://doi.org/10.5334/ijic.5420, Mitterlechner, M.. “Leadership in Integrated Care Networks: A Literature Review and Opportunities for Future Research”. Health Care Management Review, 2010; 35(2): 187–199. DOI: https://doi.org/10.1111/j.1365-2524.2009.00850.x, Westra D, Angeli F, Carree M, Ruwaard D. Understanding competition between healthcare providers: Introducing an intermediary inter-organizational perspective. one actor’s option to play two or more others against each other for his or her own benefit [22, 23]. Multilateral boundary spanners: Creating virtuous cycles in the development of health care networks. DOI: https://doi.org/10.1186/s12889-015-1911-2, Bazzoli GJ, Harmata R, Chan CL. Grabher G, Powell, WW. Health Education & Behavior, 2016; 43(6): 674–682. Health Policy, 2004; 69(1): 33–43. DOI: https://doi.org/10.1016/j.leaqua.2009.04.007, Mitterlechner, M., 2020. They also suggest that leadership in integrated care networks faces multiple tensions. I am also grateful to four reviewers and their helpful comments on earlier versions of the paper. DOI: https://doi.org/10.1023/A:1012915631956, Grusky O. Regarding the latter, research reveals how networks rely on the availability of communication instruments like coordinating councils [65], information technology [49, 64], regular network meetings [11, 68], cross-organisational teams [69] and board interlocks [63]. This article reviews research on leadership in integrated care networks. What kind of leadership this needs, which professionals should fulfil this role and how these leaders can be supported remains unclear. DOI: https://doi.org/10.2105/AJPH.2009.184358, Hermens N, Verkooijen KT, Koelen MA. Leadership is certainly one of the neglected topics in integrated care. 3 The constitution of society. Using this approach, 67 journal articles corresponding to the definition of leadership in integrated care networks were identified. International Journal of Integrated Care, 20(3), p.6. both within and across organisations over time, boundary spanners generate virtuous cycles in the development of network structures. Results: Findings indicate that the field has focused on leadership media and outcomes at the network level. The Integrated Care Leadership Network (ICLN) is a 501(c)(3) nonprofit funded in part by the Gordon and Betty Moore Foundation. A final avenue for future research concerns the outcomes of leadership in integrated care networks. Reinertsen, J. L., Bisognano, M., & Pugh, M. D. (2008). DOI: https://doi.org/10.1111/j.1748-8583.2010.00144.x, Dinesen B, Seeman J, Gustafsson J. 39, 40]. International Journal of Integrated Care, 2011; 11. Community-based trauma systems in the United States: An examination of structural development. American Journal of Public Health, 2010; 100(7): 1290–1297. The field focuses on important leadership media but is rather silent on how actors implement and change these media. DOI: https://doi.org/10.1111/ijmr.12141, Minkman MM, Ligthart SA, Huijsman R. Integrated dementia care in The Netherlands: A multiple case study of case management programmes. The English NHS: facts and figures • The world’s largest publically funded health system • Provides comprehensive healthcar DOI: https://doi.org/10.1016/j.healthpol.2018.09.003, Meijboom B, de Haan J, Verheyen, P. Networks for integrated care provision: An economic approach based on opportunism and trust. DOI: https://doi.org/10.5334/ijic.5499, Muller-Seitz G, Sydow J. BMC Health Serv Res, 2017; 17(149): 1–14. Paul Burstow A. 212.227.94.130. At the organisation level, the literature emphasises that integrated care networks are enabled and constrained by network members’ professional work practices [46, 48, 50, 53, 99, 100]. The organization and effectiveness of community mental health systems. This definition suits to this study because it addresses multiple levels of analysis, outcomes of care and inter-organisational collaboration. Over 10 million scientific documents at your fingertips. Academy of Management Journal, 2004; 47(6): 795–817. This paper looks at the components of effective systems leadership in the context of ICSs and STPs. The mission of the Integrated Care Management LLC is to identify & assist individuals with challenging medical or psychosocial needs to age in place for as long as safely possible in Sarasota, Bradenton, FL and neighboring areas. ), Research in organizational behavior, 1990; 295–336. The study emphasises the recursive relationship between leadership media and activities, arguing that the identified practices are “contextually and temporally contingent, with the capacity to produce new contexts, which in turn generate new sets of mechanisms” [78, p. 783]. Avoiding an overly heroic image of leadership in light of the above mentioned complexities of integrated care networks, it recognises how leadership activities are enabled and constrained by contextual structures and processes [31]. International Journal of Management Reviews, 2018; 20(2): 457–482. A few other studies focus on the policy level including citizens, patients and payers, showing how leadership influences access to care [11, 12, 42, 56, 66, 74], service quality [13, 41, 42, 43, 66, 74, 83, 85, 86], efficiency [12, 14, 42, 74, 83] and care outcomes [12, 56, 76, 83, 86]. Integrated care systems (ICS) are fragile and still developing. While all of these perspectives are legitimate, this study follows Kodner and Spreeuwenberg, who define integrated care as “a coherent set of methods and models on the funding, administrative, organisational, service delivery and clinical levels designed to create connectivity, alignment and collaboration within and between the cure and care sectors. Integrated Care Management Platform. DOI: https://doi.org/10.1186/s12913-017-2096-4, Scheele CE, Vrangbaek K. Co-location as a driver for cross-sectoral collaboration with general practitioners as coordinators: The case of a Danish municipal health centre. Addressing these gaps may help improve our currently limited understanding of leadership in integrated care networks [15]. Schmitz, C., & Berchtold, P. (2009). Information Systems Research, 2018; 29(2): 341–361. Journal of Public Administration Research and Theory, 2009; 19(4): 769–794. DOI: https://doi.org/10.1007/978-3-319-56103-5_14, Goodwin N. Inner fire: Building competence and resilience to enable the effective management of integrated care systems. Health Policy, 2003; 65(2): 139–151. Most studies target the network level, analysing how leadership affects network structures and the coordination of network activities. In V. E. Amelung, J. Sydow, & A. Windeler (Eds.). Moreover, they show that “the government” is not a unity but involves a broad range of political and administrative actors whose activities are misaligned and need to be coordinated. Den Hertog, F., Groen, M., & Weehuizen, R. (2005). DOI: https://doi.org/10.1177/0170840607088020, Tranfield D, Denyer D, Smart P. Towards a methodology for developing evidence-informed management knowledge by means of systematic review. Brass DJ, Galaskiewicz J, Greve HR, Tsai WP. Some argue that activity coordination is facilitated by proximity among provider organisations [67, 77]. Finally, while focusing on the network level, it recognises that networks are recursively situated in “neighbouring” levels including those of the institutional field (policy level) and network members (organisation level) [23]. Goodwin N, Stein V, Amelung V. What is integrated care? DOI: https://doi.org/10.1016/j.healthpol.2003.11.005, Larsson LG, Back-Pettersson S, Kylen S, Marklund B, Gellerstedt M, Carlstrom E. A national study on collaboration in care planning for patients with complex needs. Experienced Care Advocate What is a Care Manager? Studies find that they need to strike a balance between facilitating cooperation among service providers and using the “shadow of hierarchy” [62]. Understanding evidence-informed decision-making: A rural interorganizational breastfeeding network. DOI: https://doi.org/10.1111/1753-6405.12834, Kramer L, Schlossler K, Trager S, Donner-Banzhoff N. Qualitative evaluation of a local coronary heart disease treatment pathway: Practical implications and theoretical framework. It also reaches beyond leader-oriented theories emphasising individual actors’ traits, styles, behaviours or transformational skills [24]. DOI: http://doi.org/10.5334/ijic.5420, Mitterlechner M, ‘Leadership in Integrated Care Networks: A Literature Review and Opportunities for Future Research’ (2020) 20 International Journal of Integrated Care 6 DOI: http://doi.org/10.5334/ijic.5420, Mitterlechner, Matthias. Social Science & Medicine, 2016; 168: 43–52. DOI: https://doi.org/10.5334/ijic.5420.s2. Management Accounting Research, 2011; 22(4): 220–241. Future research should also expand on the role of boundary spanners, who occupy a central position in bridging the network with member organisations. At the policy level, research is concerned with the activities of governments and health departments in advancing integrated care networks [59, 60, 61, 62]. Academy of Management Journal, 2000; 43(6): 1159–1175. Denyer D, Tranfield D. Producing a systematic review. While a broad range of synonyms was used to include as many studies as possible, the search was narrowed with the term “inter-organisational” (and related synonyms) to exclude inter-personal, intra-organisational and other forms of networks. DOI: https://doi.org/10.1016/j.healthpol.2014.09.016, Cristofoli D, Markovic J. Addiction, 2017; 112: 23–33. DOI: https://doi.org/10.1002/smj.722, Muller J, Kunisch S. Central perspectives and debates in strategic change research. DOI: https://doi.org/10.1287/isre.2017.0745, Amelung V, Chase D, Reichert, A. shows how actors achieve integration by generating connectivity and consensus. As Goodwin underlines, one of the core challenges for the successful adoption of integrated care systems is leadership [16]. Uncover why Integrated Care Management … Health Services Research, 2018; 53(5): 3416–3436. The ties that bind: Interorganizational linkages and physician-system alignment. It thereby adds to the literature on integrated care and, more narrowly, the debate on leadership in integrated care networks. A., Miliner, D. S., Zimmerman, R. S., Maples, W. J., & Lindsay, M. E. (2009). Moreover, research shows that successful networks are not static but evolve dynamically, which requires ongoing leadership attention over time [18]. Public Health, 2019; 166: 19–24. Berwick, D. M., Nolan, T. W., & Whittington, J. DOI: http://doi.org/10.5334/ijic.5420. 41]. Second, similar to integrated care, research on inter-organisational networks is highly fragmented. Fourth, to increase its heuristic potential, the field could expand its theoretical base, which focuses on integrated care, organisation and social network theory. DOI: https://doi.org/10.1111/j.1541-0072.2009.00316.x, Janssen BM, Snoeren MW, Van Regenmortel T, Abma TA. DOI: https://doi.org/10.1215/03616878-23-5-771, Pucher KK, Candel M, Krumeich A, Boot N, De Vries NK. Leadership for integrated care: secured, shared and adaptable Effective leadership is crucial for successful integration. The three key terms used in this paper – integrated care, networks, and leadership – are all “polymorphous” concepts, which have been defined from various theoretical and disciplinary angles and with multiple objectives [1, p. 5]. , Buchanan DA, Addicott R, Nolte E, Müller-Seitz G. managing inter-organizational Relations: and... Key terms, PubMed, and act based on the role of governments health. Integration will be one of the joint Executive team who have been since. Breastfeeding network these media, budgeting and modernising government Prottas J, Calloway M, Marion complexity... In view of their worldwide importance, it alerts practitioners to manifold tensions constituting leadership in interorganizational networks a! 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