one actor’s option to play two or more others against each other for his or her own benefit [22, 23]. Müller-Seitz G. Leadership in interorganizational networks: A literature review and suggestions for future research. 2011). 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]. The triple aim: Care, health, and cost. Studies over the past decades have provided important information on the structures and processes making things happen in integrated care networks, with a particular focus on leadership and outcomes at the network level of analysis. Cham: Springer. Milbank Quarterly, 2018; 96(4): 782–813. This is surprising, as the leadership challenge is greater in networks for integrated care than in typical organizations (Sydow et al. Nobody in charge: Distributed change agency in healthcare. Journal of Health Services Research & Policy, 2011; 16(s1): 14–21. The methodology used in this paper is informed by guidelines for the conduct of reviews [32, 33, 34, 35] and similar review articles [36, 37]. In a next step, the 73 articles were analysed and coded according to 11 different criteria, which were derived both deductively (e.g. What remains less clear, however, is how these actors assume their role. 2020;20(3):6. Social Networks, 1995; 17(3-4): 319–340. ), Handbook integrated care, 2017; 3–23. argue that networks seem to struggle with tensions resulting from conflicting public governance regimes, whereby these tensions are context-specific and tied to the mix of public governance in each place [9]. They note that integration is challenged by a complex context including weak inter-organisational ties, financial dis-incentives and a bureaucratic command-and-control environment. DOI:, Lukeman S, Davies B, McPherson C, Etowa J. Moreover, it draws attention to the mediating role of organisational priorities and resources [43, 45]. DOI:, Bistaraki A, McKeown E, Kyratsis, Y. Moreover, they have shed light on multiple tensions challenging leadership in integrated care networks, often drawing on integrated care, organisation and social network theory. 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]. To consider these studies, a third category called “leadership practices” was developed, a term signifying a recursive relationship between social structure and action [31]. Taking stock of networks and organizations: A multilevel perspective. 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]. In terms of methods, most studies are qualitative (41). The 2 nd National Summit on Integrated Care is the first and only event dedicated to advancing the knowledge of integrated and bundled care for healthcare leaders and practitioners. Journal of Public Administration Research and Theory, 2009; 19(4): 769–794. Social Science & Medicine, 1998; 46(9): 1137–1149. Find out what works well at Integrated Care Management from the people who know best. This definition has several implications. Integrated Primary and Community Care Implementation Leadership Committee Integrated Primary and Community Care Steering Committee General Practice Services Committee . London: Sage; 2009. pp. As one of the few studies adopting this perspective, Tsasis et al. London: Sage, 2006; 446–468. Effectiveness of a systematic approach to promote intersectoral collaboration in comprehensive school health promotion: A multiple-case study using quantitative and qualitative data. Journal of Management, 2007; 33(3): 479–516. They also suggest that leadership in integrated care networks faces multiple tensions. Furthermore, 6 articles recommended by topic experts in the field were added. DOI:, 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. Against this background, the literature argues that the formation of integrated care networks needs to be accompanied by considerable investment in supporting the change of professional work practices within network member organisations [48, 53]. In view of their global importance, it is surprising how little we know how these networks are led. Most studies target the network level, analysing how leadership affects network structures and the coordination of network activities. Others point to potential drawbacks of this governance mode, showing how it may lower network members’ citizenship and behavioural commitment [63]. DOI:, Muller J, Kunisch S. Central perspectives and debates in strategic change research. Provan KG, Fish A, Sydow J. Interorganizational networks at the network level: A review of the empirical literature on whole networks. Reviewing these findings, this section highlights gaps in the literature demanding attention in the future (see Table 2 for a summary). Post conventional leaders Current global trends call for leaders who can demonstrate a high level of maturity in dealing creatively with increasing complexity, uncertainty, diversity, and numbers of paradoxes @HelenBevan . Swensen, S. J., Dilling, J. DOI:, Morgan S, Pullon S, Garrett S, McKinlay E. Interagency collaborative care for young people with complex needs: Front-line staff perspectives. For example, it would be important to know how they stabilise and change public governance structures, enact new legislation, provide funding and deal with providers to form networks and control their performance. Legislation has a particular impact by providing funding and creating financial incentives [11, 14, 41, 48, 49, 50, 51, 52, 53]. (2008). These keywords were added by machine and not by the authors. It describes, with concrete examples, the three elements of integrated service: primary community care, agency integration, and core services. To ensure reliability, all steps were performed independently by the author and a research associate. Like traditional organisations, networks require leadership to function effectively. Structuration means that practitioners deliberately refer to emerging tensions in their leadership practices and thereby reproduce and transform them over time. In these sectors, service provision involves the coordination of activities among multiple, highly specialised expert organisations operating at different levels of the system [15]. Med Care, 2001; 39(7 Suppl 1): I30–I45. These findings raise interesting new questions about the extent to which distributed leadership is organised. Synonyms for the terms leadership, networks and integrated care were matched. Journal of Biomedical Informatics, 2007; 40(4): 429–437. 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]. DOI:, Fleishman JA, Mor V, Piette JD, Allen SM. Learn more about the Oaks Integrated Care senior leadership team led by Chief Executive Officer, Derry Holland. 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. DOI:, Van Haute D, Roets G, Alasuutari M, Vandenbroeck M. Managing the flow of private information on children and parents in poverty situations: Creating a panoptic eye in interorganizational networks? Cross-sector collaboration in the high-poverty setting: Qualitative results from a community-based diabetes intervention. Continuity in health care: Lessons from supply chain management. DOI:, Carter P, Ozieranski P, McNicol S, Power M, Dixon-Woods M. How collaborative are quality improvement collaboratives: A qualitative study in stroke care. Systems analysis of collaboration in 5 national tobacco control networks. Torn by several contradictions between opposite elements across levels, leadership appears to be less orderly than perhaps expected. Second, the leadership challenge is greater in inter-organisational networks than in traditional organisations due to a lack of hierarchical influence. DOI:, Fuller J, Oster C, Cochrane EM, Dawson S, Lawn S, Henderson J, et al. International Journal of Integrated Care, 2010; 101–14. DOI: Health and Social Care in the Community, 2019; 27: 1019–1030. DOI:, Kodner DL, Spreeuwenberg, C. Integrated care: Meaning, logic, applications, and implications. DOI:, 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. Coordinating nonprofit children’s behavioral health services: Clique composition and relationships. DOI:, Mitterlechner, M.. “Leadership in Integrated Care Networks: A Literature Review and Opportunities for Future Research”. To promote collaboration, they create formal and informal inter-organisational linkages [96], gather stakeholders to problem solve issues [51], facilitate the involvement of relevant parties [94], keep network development on the top of the political agenda [95] and invest in good personal connections among network members [41, 97]. in the areas of distributed and complexity leadership theory. Managing professionals – Führung im Krankenhaus. On the one hand, it provides practitioners with a conceptual map for navigating the different levels, media, practices and activities that need to be considered when exerting influence to create, develop and sustain integrated care networks. DOI:, Greenhalgh T, Jackson C, Shaw S, Janamian T. Achieving research impact through co-creation in community-based health services: Literature review and case study. Organization Studies, 2008; 29(3): 393–413. Social capital and transaction cost on co-creating IT value towards inter-organizational EMR exchange. It systematises the debate and outlines avenues for future research in this important and previously neglected sub-field of integrated care theory. The review started with the access to scientific databases. Time for interactive control systems in the public sector? They show that by acting multilaterally, i.e. 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. Third, the leadership challenge is exacerbated by the way health and social care services are provided. Appendix 1 provides an overview of the search strings used. The Integrated Care Management Program (iCMP) began at Massachusetts General Hospital in 2006 to support our primary care patients with complex health issues. First, leadership can make a difference. International Journal of Health Planning and Management, 2002; 17(4): 315–332. Sample sizes in empirical papers range from single case studies to 104 networks. International Journal of Medical Informatics, 2011; 80(8): 178–188. It thereby adds to the literature on integrated care and, more narrowly, the debate on leadership in integrated care networks. Leadership in organizations. Get the inside scoop on jobs, salaries, top office locations, and CEO insights. Future research could explore how actors proceed to create and re-create leadership media enabling and/or constraining the emergence and development of integrated care networks. International Journal of Integrated Care, 20(3), 6. DOI:, Lyngso AM, Godtfredsen NS, Frolich A. Interorganisational integration: Healthcare professionals’ perspectives on barriers and facilitators within the Danish healthcare system. Moreover, chronic disease accounts for 86 percent of our nation’s healthcare costs.An integrated delivery system and an accountable care organization with two large academic medical centers and six commu… Compare pay for popular roles and read about the team’s work-life balance. Information Systems Research, 2018; 29(2): 341–361. Syntranet™ Core Platform . 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]. This service is more advanced with JavaScript available, Handbook Integrated Care Specifying the integration of mental-health and primary health-care services for persons with HIV AIDS: The Indiana integration of care project. Although care integration can be accomplished by means of several governance modes like markets and hierarchies, elderly patients with chronic conditions often require a web of services delivered by multiple legally independent providers collaborating in inter-organisational networks [3, 4]. Greenwich, CT: JAI Press. Oakland, CA: Berrett-Koehler; 2017. 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]. DOI:, 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? 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. At the same time, it is rather silent on how actors implement and change these media. At the policy level, several studies emphasise that integrated care networks are mediated by in part conflicting public governance structures, government legislation, funding and performance control structures. These decisions restrict the scope of evidence reported in this review at the expense of relevant research published in other journals, monographs, edited books and languages. Exertion of influence by governments and health departments [, Using dialogue vs. the shadow of hierarchy [, Aligning goals and creating shared understandings [, Organisational priorities and resources [. Similar to distributed leadership theory, it assumes that networks are not designed through central control, but emerge from formal and informal combinations of multiple individual and situated actions [109]. Further positions will be announced in due course. DOI:, Huxham C, Vangen, S. Leadership in the shaping and implementation of collaboration agendas: How things happen in a (not quite) joined-up world. The generation of integration: The early experience of implementing bundled care in Ontario, Canada. 2020;20(3):6. Implications of network structure on public health collaboratives. In: Staw BM, Cummings LL (eds. For example, observing how persistent organisational work routines constrain service integration, Glendinning suggests relinquishing traditional professional domains without explicating how this happens in practice [48]. On this basis, the paper suggests opportunities for future research and closes with summarising considerations. Moreover, research shows that successful networks are not static but evolve dynamically, which requires ongoing leadership attention over time [18]. They also show that networks are affected by motivations and practices of network members’ senior leaders and boundary spanners. The field tends to focus on the network level of analysis. frame integrated care networks as complex adaptive systems [58]. network member organisations and third parties, do to move a network forward. We need to know who these boundary spanners are, what they do and which skills they need to fulfil their role [101]. In V. E. Amelung, J. Sydow, & A. 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