Emerging challenges in integrated care system leadership: a qualitative case study

Background/Aims There is a growing but still underdeveloped evidence base regarding challenges in integrated care system leadership. This study investigated the leadership challenges in integrated care systems in England since their formation in 2022, aiming to contribute to the evidence base and suggest ways of navigating these challenges. Methods A qualitative case study design was used to gain in-depth insights into leadership challenges in integrated care systems. A purposive sampling technique was used to recruit 23 integrated care system leaders from one large integrated care system in England. To gather data on their experiences and perspectives, 28 semi-structured interviews were conducted with participants in June–September 2023. Data were analysed thematically, using Braun and Clarke's six-phase framework. Results The analysis identified four key themes related to leadership challenges in integrated care systems: difficulties balancing operational vs strategic goals, limited focus on tackling health inequalities, resource constraints and governance complexities. These challenges hindered innovation and the shift to preventive care. Conclusions Addressing the complexity of integrated care system governance requires enhanced decision-making autonomy. Leaders must be able to implement system-wide improvements while balancing operational and strategic demands. Rigid funding and governance structures can hinder focus on preventive care and the specific needs of the local population. Implications for practice Leadership development frameworks should equip integrated care system leaders with the skills to navigate multi-tiered governance and financial constraint including strategic negotiation, adaptive leadership, systems thinking and political astuteness.