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Article
Publication date: 24 December 2020

Steve Willcocks and Tony Conway

The purpose of this paper is to explore leadership in the context of the policy shift to collaborative working and integration currently being pursued in the UK NHS. As…

Abstract

Purpose

The purpose of this paper is to explore leadership in the context of the policy shift to collaborative working and integration currently being pursued in the UK NHS. As ways of integrating care are being explored in other countries it can be argued that this topic may have wider policy significance. This paper is particularly concerned with leadership in Primary Care Networks in the English NHS.

Design/methodology/approach

This paper is a conceptual paper using literature relating to the antecedents of shared leadership and relevant policy documents pertaining to the English NHS. The paper is informed, theoretically by the conceptual lens of shared leadership. A conceptual framework is developed identifying the antecedents of shared leadership that help to explain how shared leadership may be developed.

Findings

The paper identifies the challenges that may be faced by policymakers and those involved in Primary Care Networks in developing shared leadership. It also reveals the implications for policymakers in developing shared leadership.

Research limitations/implications

The paper is conceptual. It is acknowledged that this is a preliminary study and further work will be required to test the conceptual framework empirically.

Practical implications

The paper discusses the policy implications of developing leadership in primary care networks. This has relevance to both the NHS and other countries.

Originality/value

There is limited research on the antecedents of shared leadership. In addition, the conceptual framework is applied to a new policy initiative.

Details

Journal of Integrated Care, vol. 30 no. 1
Type: Research Article
ISSN: 1476-9018

Keywords

Open Access
Article
Publication date: 27 July 2022

Maria Mathews, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily Gard Marshall, Judith Belle Brown, Paul S. Gill, Madeleine McKay, Eric Wong, Stephen J. Wetmore, Richard Buote, Leslie Meredith, Lauren Moritz, Sarah Spencer, Maria Alexiadis, Thomas R. Freeman, Aimee Letto, Bridget L. Ryan, Shannon L. Sibbald and Amanda Lee Terry

Strong leadership in primary care is necessary to coordinate an effective pandemic response; however, descriptions of leadership roles for family physicians are absent…

Abstract

Purpose

Strong leadership in primary care is necessary to coordinate an effective pandemic response; however, descriptions of leadership roles for family physicians are absent from previous pandemic plans. This study aims to describe the leadership roles and functions family physicians played during the COVID-19 pandemic in Canada and identify supports and barriers to formalizing these roles in future pandemic plans.

Design/methodology/approach

This study conducted semi-structured qualitative interviews with family physicians across four regions in Canada as part of a multiple case study. During the interviews, participants were asked about their roles during each pandemic stage and the facilitators and barriers they experienced. Interviews were transcribed and a thematic analysis approach was used to identify recurring themes.

Findings

Sixty-eight family physicians completed interviews. Three key functions of family physician leadership during the pandemic were identified: conveying knowledge, developing and adapting protocols for primary care practices and advocacy. Each function involved curating and synthesizing information, tailoring communications based on individual needs and building upon established relationships.

Practical implications

Findings demonstrate the need for future pandemic plans to incorporate formal family physician leadership appointments, as well as supports such as training, communication aides and compensation to allow family physicians to enact these key roles.

Originality/value

The COVID-19 pandemic presents a unique opportunity to examine the leadership roles of family physicians, which have been largely overlooked in past pandemic plans. This study’s findings highlight the importance of these roles toward delivering an effective and coordinated pandemic response with uninterrupted and safe access to primary care.

Details

Leadership in Health Services, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 17 August 2021

Carolyn Jackson, Kim Manley and Mayur Vibhuti

This paper aims to present the impact evaluation findings from a multiprofessional leadership programme commissioned in the South East of England to support primary care

Abstract

Purpose

This paper aims to present the impact evaluation findings from a multiprofessional leadership programme commissioned in the South East of England to support primary care networks (PCNs) to lead system improvement together. It identifies programme impact at micro and meso system levels; a leadership impact continuum that can be used by individuals and teams to evidence impact of improvements in PCN practices; the learning and development strategies that were effective and proposes implications for other networks.

Design/methodology/approach

Mixed methods underpinned by practice development methodology were used to explore the impact of the programme on two practitioner cohorts across 16 PCNs. Data were collected at the start, mid-point and end of the eight-month programme.

Findings

Results illustrate an innovative approach to collective leadership development. A continuum of impact created with participants offers insight into the journey of transformation, recognising that “change starts with me”. The impact framework identifies enablers, attributes and consequences for measuring and leading change at micro, meso and macro levels of the health-care system. Participants learned how to facilitate change and collaboratively solve problems through peer consulting which created a safe space for individuals to discuss workplace issues and receive multiprofessional views through action learning. These activities enabled teams to present innovative projects to commissioners for service redesign, enabling their PCN to be more effective in meeting population health needs. The authors believe that this programme may provide a model for other PCNs England and other place-based care systems internationally.

Originality/value

This study offers insight into how to enable a journey of transformation for individuals and PCN teams to enhance team effectiveness and collective leadership for system-wide transformation required by the National Health Service Long Term Plan (2019).

Contribution to Impact

Details

Leadership in Health Services, vol. 35 no. 3
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 4 June 2018

Richard Q. Lewis and Nav Chana

The purpose of this paper is to consider how the evolving concept of the “primary care home” (PCH) that is developing in England might be an effective vehicle for the…

Abstract

Purpose

The purpose of this paper is to consider how the evolving concept of the “primary care home” (PCH) that is developing in England might be an effective vehicle for the delivery of the goals of “population health”. The authors examine evidence from earlier initiatives to achieve similar objectives of primary care-led health system planning and care integration to understand relevant lessons for the PCH.

Design/methodology/approach

This paper is based on a descriptive review of the PCH using documentary sources and a non-systematic review of literature relating to primary care commissioning initiatives and recent initiatives to deliver general practice services on a larger scale.

Findings

The PCH is likely to bring forth relatively high engagement from general practitioners due to its neighbourhood scale, voluntary nature and its focus on professional partnership, personalisation of care and outcomes. It is important that participants have sufficient autonomy to act and that financial incentives are aligned with the goals of population health. It is also important that, unlike some earlier primary care initiatives, the PCH is given time to develop to maturity.

Originality/value

The PCH is a recent phenomenon that is developing in England and elsewhere. This paper locates the PCH within a historical context and draws conclusions from a relevant evidence base.

Details

Journal of Integrated Care, vol. 26 no. 3
Type: Research Article
ISSN: 1476-9018

Keywords

Open Access
Article
Publication date: 29 June 2018

Thomas Round, Mark Ashworth, Tessa Crilly, Ewan Ferlie and Charles Wolfe

A well-funded, four-year integrated care programme was implemented in south London. The programme attempted to integrate care across primary, acute, community, mental…

2413

Abstract

Purpose

A well-funded, four-year integrated care programme was implemented in south London. The programme attempted to integrate care across primary, acute, community, mental health and social care. The purpose of this paper is to reduce hospital admissions and nursing home placements. Programme evaluation aimed to identify what worked well and what did not; lessons learnt; the value of integrated care investment.

Design/methodology/approach

Qualitative data were obtained from documentary analysis, stakeholder interviews, focus groups and observational data from programme meetings. Framework analysis was applied to stakeholder interview and focus group data in order to generate themes.

Findings

The integrated care project had not delivered expected radical reductions in hospital or nursing home utilisation. In response, the scheme was reformulated to focus on feasible service integration. Other benefits emerged, particularly system transformation. Nine themes emerged: shared vision/case for change; interventions; leadership; relationships; organisational structures and governance; citizens and patients; evaluation and monitoring; macro level. Each theme was interpreted in terms of “successes”, “challenges” and “lessons learnt”.

Research limitations/implications

Evaluation was hampered by lack of a clear evaluation strategy from programme inception to conclusion, and of the evidence required to corroborate claims of benefit.

Practical implications

Key lessons learnt included: importance of strong clinical leadership, shared ownership and inbuilt evaluation.

Originality/value

Primary care was a key player in the integrated care programme. Initial resistance delayed implementation and related to concerns about vertical integration and scepticism about unrealistic goals. A focus on clinical care and shared ownership contributed to eventual system transformation.

Details

Journal of Integrated Care, vol. 26 no. 4
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 19 August 2022

Anna Coleman, Julie D. MacInnes, Rasa Mikelyte, Sarah Croke, Pauline W. Allen and Kath Checkland

The article aims to argue that the concept of “distributed leadership” lacks the specificity required to allow a full understanding of how change happens. The authors…

Abstract

Purpose

The article aims to argue that the concept of “distributed leadership” lacks the specificity required to allow a full understanding of how change happens. The authors therefore utilise the “Strategic Action Field Framework” (SAF) (Moulton and Sandfort, 2017) as a more sensitive framework for understanding leadership in complex systems. The authors use the New Care Models (Vanguard) Programme as an exemplar.

Design/methodology/approach

Using the SAF framework, the authors explored factors affecting whether and how local Vanguard initiatives were implemented in response to national policy, using a qualitative case study approach. The authors apply this to data from the focus groups and interviews with a variety of respondents in six case study sites, covering different Vanguard types between October 2018 and July 2019.

Findings

While literature already acknowledges that leadership is not simply about individual leaders, but about leading together, this paper emphasises that a further interdependence exists between leaders and their organisational/system context. This requires actors to use their skills and knowledge within the fixed and changing attributes of their local context, to perform the roles (boundary spanning, interpretation and mobilisation) necessary to allow the practical implementation of complex change across a healthcare setting.

Originality/value

The SAF framework was a useful framework within which to interrogate the data, but the authors found that the category of “social skills” required further elucidation. By recognising the importance of an intersection between position, personal characteristics/behaviours, fixed personal attributes and local context, the work is novel.

Details

Journal of Health Organization and Management, vol. 36 no. 7
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 4 October 2011

Luís Velez Lapão and Gilles Dussault

This paper aims to describe the training strategy developed to provide the leadership of a new coordination structure of health centers in Portugal, with managerial…

395

Abstract

Purpose

This paper aims to describe the training strategy developed to provide the leadership of a new coordination structure of health centers in Portugal, with managerial competencies adapted to the requirements of their function, in support of primary care reform.

Design/methodology/approach

Pre and post‐program questionnaires were exploited. These focused on the perceptions of the new managers of their needs and of the benefits derived from their participation in learning activities during 2008 and 2009.

Findings

The findings outline that although the program created opportunities for executive directors to identify and analyze planning and management problems and to share potential solutions with colleagues, a training program is not sufficient to create the conditions that facilitate change.

Research limitations/implications

More research is required to better understand the impact of the program on executive directors' attitudes and behaviors. More research on measuring the impact of leadership training is needed to provide policy‐makers with strategies to support their reforms.

Practical implications

The PACES training program was designed to develop and strengthen the managerial capacities of a group of managers of a new administrative structure in the health sector; it could be also applicable to other sectors like education, environment, etc.

Social implications

If a reform process is to be effective, policy‐makers need to address, in addition to building individual capacities, organizational and institutional capacity needs, and design mechanisms to support managers on a continuing basis.

Originality/value

This paper describes the development of a new program focused on management and leadership to fit the needs of a reform in primarycare.

Details

Leadership in Health Services, vol. 24 no. 4
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 15 August 2011

Akwatu Khenti, Jaime C. Sapag, Consuelo Garcia‐Andrade, Fernando Poblete, Ana Raquel Santiago de Lima, Andres Herrera, Pablo Diaz, Henok Amare, Avra Selick and Sandra Reid

Since 2002, the Centre for Addiction and Mental Health in Ontario, Canada, has been working closely with partners in Latin America and the Caribbean (LAC) to implement…

302

Abstract

Purpose

Since 2002, the Centre for Addiction and Mental Health in Ontario, Canada, has been working closely with partners in Latin America and the Caribbean (LAC) to implement mental health capacity‐building focused on primary health care. From an equity perspective, this article seeks to critically analyze the process and key results of this capacity‐building effort and to identify various implications for the future.

Design/methodology/approach

This analysis of capacity‐building approaches is based on a critical review of existing documents such as needs assessments and evaluation reports, as well as reflective discussion. Previous health equity literature is used as a framework for analysis.

Findings

More than 1,000 professionals have been engaged in various kinds of training in Chile, Peru, Brazil, Nicaragua, Mexico, and Trinidad and Tobago. These capacity‐building initiatives have had an impact on primary health care from both an equity and systems perspective because participants were engaged at all stages of the process and implementation lessons incorporated into the final efforts. Stigma was also reduced through the collaborations.

Originality/value

Using concrete examples of capacity‐building in mental primary healthcare in LAC, as well as evidence gathered from the literature, this article demonstrates how primary healthcare can play a strong role in addressing health equity and human rights protection for people with mental health and/or substance abuse problems.

Details

Ethnicity and Inequalities in Health and Social Care, vol. 4 no. 3
Type: Research Article
ISSN: 1757-0980

Keywords

Article
Publication date: 8 November 2021

Mari Kiljunen, Elina Laukka, Tarja K. Koskela and Outi Ilona Kanste

The degree of remote working has increased in the health-care sector, but remote leadership in health-care contexts has not been systematically studied. Thus, the purpose…

Abstract

Purpose

The degree of remote working has increased in the health-care sector, but remote leadership in health-care contexts has not been systematically studied. Thus, the purpose of this review was to map existing literature and research themes of remote leadership in health care and identify potential research gaps to guide future studies.

Design/methodology/approach

A scoping review with narrative synthesis was conducted, covering all published literature addressing remote, virtual, online or distance leadership practices. The ABI/INFORM Collection, CINALH, PsycArticles, Scopus and Web of Science, MedNar, Open Grey and PQDT Open databases were searched electronically, and Finnish Journal of eHealth and eWelfare was searched manually.

Findings

In total 15 articles were included in the review. Most literature concerning remote leadership in health care has been published during the past three decades. The main themes discerned in this research stream are related to interactions, work environments, leadership in practice, use of technology and needs for more study of remote leadership and guidance for remote leaders.

Research limitations/implications

Research on remote leadership in health care is limited, patchy and associated concepts vary substantially. More comprehensive research on the phenomenon is needed, with more systematic attention to, and coverage of, relevant populations, concepts, contexts and the identified themes.

Originality/value

To the best of the authors’ knowledge, this appears to be the first review to map research on remote leadership in health care and identify research gaps, which is important as its prevalence has rapidly increased.

Details

Leadership in Health Services, vol. 35 no. 1
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 13 February 2017

Gregory Stewart, Patricia Bradd, Tish Bruce, Thomas Chapman, Brendon McDougall, Daniel Shaw and Linda Soars

The purpose of this paper is to describe the recent efforts of a large publicly funded healthcare organisation in Sydney, Australia to implement integrated care (IC) “at…

1051

Abstract

Purpose

The purpose of this paper is to describe the recent efforts of a large publicly funded healthcare organisation in Sydney, Australia to implement integrated care (IC) “at scale and pace” in the messy, real-world context of a District Health Service.

Design/methodology/approach

The paper outlines the theoretical and practical considerations used to design and develop a localised IC Strategy informed by the “House of Care” model (NHS England, 2016).

Findings

The need for cross-agency partnership, a shared narrative, joint leadership and an IC Strategy underpinned by proven theoretical models model is described.

Originality/value

This paper highlights key factors relating to implementation and evaluation of a local IC Strategy in the real world.

Details

Journal of Integrated Care, vol. 25 no. 1
Type: Research Article
ISSN: 1476-9018

Keywords

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