Liverpool Business School, Liverpool John Moores University, Liverpool, UK.
Leadersh Health Serv (Bradf Engl). 2024 Nov 7;ahead-of-print(ahead-of-print):153-169. doi: 10.1108/LHS-06-2024-0051.
This paper presents a realist evaluation of leadership within an integrated care system (ICS) in England. This paper aims to examine which aspects of leadership are effective, for whom, how and under what circumstances.
DESIGN/METHODOLOGY/APPROACH: Realist evaluation methodology was used, adopting prior realist review findings as the theoretical framework to refine explanations of how and why leadership within an ICS is effective. Between January and November 2023, 23 interviews with ICS leaders took place, alongside 7 meeting observations and documentary analysis. The Realist And Metanarrative Evidence Syntheses: Evolving Standards (RAMESES) guidance informed the study design, conduct and reporting.
The findings highlight two overarching infrastructural contexts influencing leadership in ICSs: the impact of the post-COVID-19 pandemic legacy and the differences between health and social care regulatory and financial environments. Findings demonstrate that ICS leaders identified a strong sense of purpose as crucial for guiding decisions and creating a psychologically safe environment for open, honest discussions, fostering calculated risk-taking. Whilst a shared vision directed priority setting, financial pressures led to siloed thinking. Leadership visibility was linked to workforce morale, with supportive leadership boosting morale amidst evolving ICS landscapes and confidence in data-driven decisions supported prevention activities. However, financial constraints hindered responsiveness and innovation in addressing health inequalities.
ORIGINALITY/VALUE: By examining ICS leadership post-COVID-19 pandemic and amidst varying regulatory and financial environments, this study contributes to the emerging literature on systems leadership and offers practical guidance for leaders navigating the complexities of integrated care.
本文对英国综合护理系统（ICS）中的领导力进行了现实主义评估。本文旨在探讨领导力在哪些方面、对谁、如何以及在什么情况下有效。
设计/方法/途径：采用现实主义评价方法，采用先前的现实主义评价结果作为理论框架，以完善对 ICS 内部领导力有效性的解释。2023 年 1 月至 11 月期间，对 23 名 ICS 领导人进行了访谈，并进行了 7 次会议观察和文献分析。真实主义和元叙述证据综合：演进标准（RAMESES）指南为研究设计、实施和报告提供了信息。
研究结果突出了影响 ICS 领导力的两个总体基础设施背景：后 COVID-19 大流行遗留问题的影响以及卫生和社会保健监管和财务环境之间的差异。研究结果表明，ICS 领导人认为强烈的使命感对于指导决策和为开放、诚实的讨论创造心理安全环境至关重要，从而促进了有计划的冒险行为。虽然共同愿景指导优先事项设定，但财务压力导致了思维的分散。领导力的可见性与员工士气相关联，在不断变化的 ICS 环境中，支持性领导力提高了士气，并对数据驱动的决策充满信心，支持预防活动。然而，财务限制阻碍了在解决健康不平等问题方面的响应能力和创新能力。
原创性/价值：通过研究 COVID-19 大流行后的 ICS 领导力以及不同的监管和财务环境，本研究为系统领导力的新兴文献做出了贡献，并为领导者在应对综合护理的复杂性方面提供了实用指导。
