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Many health systems face challenges such as rising costs and lacking quality, both of which can be addressed by improving the integration of different health care sectors and professions. The purpose of this viewpoint is to present the German health care Innovation Fund (IF) initiated by the Federal Government to support the development and diffusion of integrated health care.

This article describes the design and rationale of the IF in detail and provides first insights into its limitations, acceptance and implementation by relevant stakeholders.

In its first period, the IF offered € 1.2 billion as start-up funding for model implementation and evaluation over a period of four years (2016–2019). This period was recently extended to a second round until 2024, offering € 200 million a year as from 2020. The IF is triggering the support of relevant insurers for the development of new integrated care models. In addition, strict evaluation requirements have led to a large number of health service research projects which assess structural and process improvements and thus enable evidence-based policy decisions.

This article is the first of its kind to present the German IF to the international readership. The IF is a political initiative through which to foster innovations and promote integrated health care.

Mergers have become an influential part of public hospital development, and the successful implementation of such mergers requires skillful management. Recent studies have pointed to the impact of the distribution of leadership tasks amongst employees for implementing planned radical changes, yet this lacks examination with regard to hospital mergers. The purpose of this paper is to investigate the emergence of distributed leadership and this leadership’s influence on the implementation of a hospital merger.

The emergence of distributed leadership is examined through a qualitative case study of two Danish hospital units in the context of a large hospital merger. The data consist of 21 interviews and documents collected over a three-year period.

The findings suggest dynamics of widened and restricted distributed leadership being influenced by and influencing the merger at hospital and local-unit levels, respectively. Importantly, the perceived purpose of widened and restricted distributed leadership mediated the actual effects of widened and restricted distributed leadership on the implementation of a merger. Moreover, the findings show that mergers on both the hospital and local level lead to variations in top-down and bottom-up distributed leadership across pre-merger organizational boundaries.

Perceived purposeful widening and restriction of distributed leadership at various hospital levels enables merger integration and collaboration across organizational boundaries and hierarchies.

The paper addresses the need to understand the complex dynamics of widened and restricted leadership distribution in a merger context.