Who works! from fragmentation to coherence through collaborative, constructive communication

Purpose The paper seeks to assist public sector leaders to take a balanced and impactful approach to transformation programmes which aim to deliver integrated healthcare. The paper highlights the balance of attention paid in these programmes across elements of leadership, strategy, structure and people, and aims to highlight where this balance can sit to encourage more successful and sustainable transformations, with an increased focus on interpersonal and inter-professional engagement and interaction across workforce and service users. Design/methodology/approach The project involved a literature review which identified themes that were in turn used to inform an approach to a desk review of journal articles written about past integration programmes in healthcare. A coding framework was developed to assess the articles in the desk review to identify where the focus of attention lay in the approaches to integration. Findings There is a spread of activity across all four themes (leadership, strategy, structure and people) in the assessed cases, but the emphasis tends to be towards static, short-term approaches, with a noticeable lack of focus on the aspects required to deliver long-term sustained transformation. There is a need for improved balance between structural and relational approaches to transformation. Research limitations/implications The paper focuses on nine examples of transformation programmes and would benefit from further development and use of the coding framework. Practical implications The framework that emerges from this project can contribute to the development of a proactive model to assist transformation leads and decision makers bring a more balanced, thoughtful and impactful approach to integrating health and care services. In particular, the findings point to an overuse of structural approaches to change and transformation, which could include project management methods, for example, which become the product of the initiatives, rather than enablers of leaders’ visions and people’s interpersonal and interprofessional engagement and interactions. Originality/value Building on existing research, this paper makes a valuable contribution to the discourse on how to deliver the required health and care integration agenda in a more accessible way and sustainably, moving away from short-term, quick-fix approaches and considers how to accommodate the role of interpersonal interaction as the vehicle for change.