Adapting but not in rhythm: the realities of integrated care leadership

Purpose To explore the nature and realities of integrated care leadership through the perspectives of systems leaders and the theoretical lens of adaptive leadership. Design/methodology/approach A qualitative methodology involving interviews and focus groups with twenty-seven participants from social care, health care, public health and lived experience. These participants were drawn from six integrated care systems (ICSs) within a single English region. Findings Integration was seen as involving both technical (i.e. can be understood and addressed through existing knowledge and resources) and adaptive (i.e. requires learning new practices and behaviours) challenges. Integrated care required leaders to have both strategic (balcony) and operational (dance floor) perspectives, with national targets and priorities seen to limit opportunity for local patterns emerging. In general, ICSs were seen to not yet have the correct balance between balcony and dance floor. Anxiety was felt throughout, but in particular by people with lived experience and the voluntary and community sector who still felt unequal partners in their local systems. Research limitations/implications This study was completed in one region of England and did not include those with practice roles. Practical implications Integrated care leaders must embrace diverse perspectives in their thinking, planning and implementing through learning together about what works and what should be discarded. Enablers include national performance regimes emphasising holistic outcomes for people and communities, creation of shared data and improvement processes that work across sectors and national bodies, including professional associations, supporting the necessity, scale and pace of change required. Originality/value This research shares the experiences of senior leaders of integrated care at a time of considerable policy turbulence and demand pressures and deploys the theoretical lens of adaptive leadership.