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Leadership for integrated care: a case study

Olga Kozlowska (Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK)
Gemma Seda Gombau (Autonomous University of Barcelona, Bellaterra, Spain)
Rustam Rea (Oxford University Hospitals NHS Foundation Trust, Oxford, UK and NIHR Biomedical Research Centre, Oxford, UK)

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 4 February 2020

Issue publication date: 23 April 2020




Integration of health services involves multiple interdependent leaders acting at several levels of their organisation and across organisations. This paper aims to explore the complexities of leadership in an integrated care project and aims to understand what leadership arrangements are needed to enable service transformation.


This case study analysed system and organisational leadership in a project aiming to integrate primary and specialist care. To explore the former, the national policy documents and guidelines were reviewed. To explore the latter, the official documents from the transformation team meetings and interview data from 17 health-care professionals and commissioners were analysed using thematic analysis with the coding framework derived from the comprehensive and multilevel framework for change (Ferlie and Shortell, 2001).


Although integration was supported in the narratives of the system and organisational leaders, there were multiple challenges: insufficient support by the system level leadership for the local leadership, insufficient organisational support for (clinical) leadership within the transformation team and insufficient leadership within the transformation team because of disruptions caused by personnel changes, roles ambiguity, conflicting priorities and insufficient resources.

Practical implications

This study provides insights into the interdependencies of leadership across multiple levels and proposes steps to maximise the success of complex transformational projects.


This study’s practical findings are useful for those involved in the bottom-up integrated projects, especially the transformation teams’ members. The case study highlights the need for a toolkit enabling local leaders to operate effectively within the system and organisational leadership contexts.



The authors would like to thank Mr Tony O’Malley, a patient representative on the Integrated Diabetes Care Project, for his input into conceptualising and designing this study.

At the time of data collection, Dr Olga Kozlowska was a Lord Leonard and Lady Estelle Wolfson Future Hospital Project Fellow at The Royal College of Physicians, London, UK and Dr Gemma Seda Gombau was a visiting researcher at the Saïd Business School, Oxford, UK.


Kozlowska, O., Seda Gombau, G. and Rea, R. (2020), "Leadership for integrated care: a case study", Leadership in Health Services, Vol. 33 No. 2, pp. 125-146.



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