A few other studies focus on the policy level including citizens, patients and payers, showing how leadership influences access to care [11, 12, 42, 56, 66, 74], service quality [13, 41, 42, 43, 66, 74, 83, 85, 86], efficiency [12, 14, 42, 74, 83] and care outcomes [12, 56, 76, 83, 86]. Researchers have applied the term “network” both as an analytic perspective and as a concept for describing a separate mode of governing economic activities [20]. Future research could explore how actors cope with inherent tensions, assuming that persistent contradictions between opposite elements are both media and consequences of leadership in integrated care networks. This pertains particularly to patients with complex and unpredictable needs [1, 5]. What is the Integrated Service Delivery Model? DOI: https://doi.org/10.5334/ijic.5499, Muller-Seitz G, Sydow J. by reading the articles in depth and refining the focus of the review). NWT Integrated Service Delivery Model 2 of 29 What information is in this summary? Not affiliated Finally, while focusing on the network level, it recognises that networks are recursively situated in “neighbouring” levels including those of the institutional field (policy level) and network members (organisation level) [23]. DOI: https://doi.org/10.2105/AJPH.2009.184358, Hermens N, Verkooijen KT, Koelen MA. Against this background, the literature argues that the formation of integrated care networks needs to be accompanied by considerable investment in supporting the change of professional work practices within network member organisations [48, 53]. In contrast, network breadth can decrease performance, creating difficulties in reaching consensus and creating trust within a network [75]. On the other hand, it alerts practitioners to manifold tensions constituting leadership in integrated care networks. By challenging siloed care management infrastructure and operations, GE Healthcare Partners works with organizations to fundamentally transform how an integrated care management system operates. Neither market nor hierarchy: Network forms of organizations. Relatively little is known how leadership relates to the organisation level of analysis. Network-based collaboration arises more easily if it does not disturb professionals’ previous work routines [46, 100]. Mitterlechner M. Leadership in Integrated Care Networks: A Literature Review and Opportunities for Future Research. DOI: https://doi.org/10.1093/heapro/dau021, Vendetti J, Gmyrek A, Damon D, Singh M, McRee B, Del Boca F. Screening, brief intervention and referral to treatment (SBIRT): implementation barriers, facilitators and model migration. DOI: https://doi.org/10.1016/j.ijmedinf.2011.01.010, Tung EL, Gunter KE, Bergeron NQ, Lindau ST, Chin MH, Peek ME. Public Management Review, 2015; 17(7): 981–1001. Psychiatr Rehabil J, 2012; 35(3): 265-272. Administration and Policy in Mental Health, 1995; 22(4): 361–388. The key to successful implementation and development of … These decisions restrict the scope of evidence reported in this review at the expense of relevant research published in other journals, monographs, edited books and languages. Critical Factors Influencing Hospitals’ Adoption of HL7 Version 2 Standards: An Empirical Investigation. J Interprof Care, 2003; 17(1): 69–83. Leadership Quarterly, 2009; 20(4): 631–650. DOI: https://doi.org/10.1007/s10916-010-9580-2, Javanparast S, Baum F, Freeman T, Ziersch A, Henderson J, Mackean T. Collaborative population health planning between Australian primary health care organisations and local government: Lost opportunity. BMC Health Serv Res, 2017; 17(149): 1–14. DOI: https://doi.org/10.1016/j.socscimed.2016.09.005, Breton M, Pineault R, Levesque JF, Roberge D, Da Silva RB, Prud’homme A. Reforming healthcare systems on a locally integrated basis: Is there a potential for increasing collaborations in primary healthcare? On the other hand, they show how financial incentives can undermine collaboration [50]. After the removal of 68 duplicates and 1 non-English article, the search produced 365 hits (see Figure 1). Future research could explore how leadership is related not only to the network itself, but also to patients’ experiences of care, population health outcomes, per capita spending and caregivers’ satisfaction, and how these outcomes enable and constrain subsequent leadership practice. Background: Leaders are needed to address healthcare changes essential for implementation of integrated primary care. International Journal of Integrated Care. 2011). International Journal of Integrated Care, 2020; 20(1): 15. What is a Care Manager? DOI: https://doi.org/10.1002/hpm.826, Leutz WN. DOI: https://doi.org/10.1111/add.13652, Carstens CA, Panzano PC, Massatti R, Roth D, Sweeney HA. Leadership in integrated care. Public Administration, 2016; 94(1): 89–110. The list of countries advancing network-based care integration is long. Trust is a prerequisite for network members to express uncertainty [10] and share professional knowledge [71, 73]. Part A of this summary gives you the philosophy and vision of the ISDM. Am J Community Psychol, 2001; 29(6): 875–905. (2010). Moreover, they have shed light on multiple tensions challenging leadership in integrated care networks, often drawing on integrated care, organisation and social network theory. I am also grateful to four reviewers and their helpful comments on earlier versions of the paper. network member organisations and third parties, do to move a network forward. study the practices of boundary spanners in the formation and implementation of a Dutch healthcare network [101]. Networks. Systems analysis of collaboration in 5 national tobacco control networks. Depending on the situation, networks are supported or constrained by pro-competitive policy reforms [6, 41, 42, 43, 44], government legislation [7, 44, 46, 47], financial incentives [11, 50, 51, 52] and intra-organisational changes like ownership transitions [102]. The triple aim: Care, health, and cost. International Journal of Integrated Care 20, no. DOI: https://doi.org/10.1016/j.lrp.2012.02.001, Majchrzak A, Jarvenpaa SL, Bagherzadeh M. A review of interorganizational collaboration dynamics. The mission of the Integrated Care Management LLC is to identify & assist individuals with challenging medical or psychosocial needs to age in place for as long as safely possible in Sarasota, Bradenton, FL and neighboring areas. Information Systems Research, 2018; 29(2): 341–361. International Journal of Integrated Care, 2013; 13(3): 1–10. The majority of work focuses on outcomes at the network level, including the coordination of activities and network structural variables like the number and strength of network ties. DOI: https://doi.org/10.1186/s12913-017-2096-4, Scheele CE, Vrangbaek K. Co-location as a driver for cross-sectoral collaboration with general practitioners as coordinators: The case of a Danish municipal health centre. Discussion and conclusion: These findings contribute to the debate on leadership in integrated care networks. Social Science & Medicine, 1998; 46(9): 1137–1149. At the network level, many studies emphasise the role of network governance [ 105 ], i.e. International Journal of Integrated Care, 2011; 11(e122): 1–9. First, it excludes dyads, recognising that third actors give such relationships a distinct social quality, e.g. International Journal of Medical Informatics, 2011; 80(8): 178–188. 2020;20(3):6. International Journal of Health Planning and Management, 2019; 34(1): E646–E660. Bmj Open, 2015; 5(11): 1–11. The Integrated Care Leadership Network (ICLN) is a 501(c)(3) nonprofit funded in part by the Gordon and Betty Moore Foundation. While these outcomes are important, future research should investigate the degree to which leadership affects not only the network itself, but also indicators at the policy and organisation level, in particular patients’ experience of care, population health outcomes, per capita costs of care provision and caregivers’ satisfaction [2]. Health Policy, 2015; 119(1): 1–8. DOI: https://doi.org/10.1215/03616878-23-5-771, Pucher KK, Candel M, Krumeich A, Boot N, De Vries NK. They find that the effects of ownership transitions on the network are not linear but depend on the responses of actors at the network and policy level. In developing the ideas presented in this paper, I have benefited greatly from the continuous exchange with Johannes Rüegg-Stürm, Harald Tuckermann and Anna-Sophia Bilgeri. Bmc Family Practice, 2012; 13(36): 1–11. Health Education & Behavior, 2016; 43(6): 674–682. Of course, like other reviews, this paper has several limitations, including its particular definitions of integrated care, networks and leadership and a rather narrow focus on peer-reviewed articles in English-language journals with high impact factors. DOI: https://doi.org/10.1093/heapro/das051, Nuti S, Noto G, Vola F, Vainieri M. Let’s play the patients music: A new generation of performance measurement systems in healthcare. DOI: https://doi.org/10.1016/S0168-8510(02)00205-1, La Rocca A, Hoholm T. Coordination between primary and secondary care: The role of electronic messages and economic incentives. Future research could analyse how actors proceed to create and re-create these leadership media and explore required skills and competencies, starting from the valuable insights previous work has contributed to this area. Cite as. Torn by several contradictions between opposite elements across levels, leadership appears to be less orderly than perhaps expected. Integrated care: Meaning, logic, applications, and implications – A discussion paper. How does shared system leadership support integrated care? Academy of Management Journal, 2000; 43(6): 1159–1175. Some find that networks are more likely to emerge in communities with higher levels of local social capital, measured by active participation in public life, trust and voter participation [56]. A few studies analyse leadership media and leadership activities in their dynamic interplay. Health Services Research, 2018; 53(5): 3416–3436. Second, the leadership challenge is greater in inter-organisational networks than in traditional organisations due to a lack of hierarchical influence. Human Relations, 2007; 60(7): 1065–1090. Nobody in charge: Distributed change agency in healthcare. Leadership in organizations. While some researchers recommend dispensing with dedicated network coordinators to encourage fluid and migratory responsibilities [13], others argue that these coordinators play a key role in managing the process and building trust and relationships across organisations [86]. Leadership in Integrated Care Networks: A Literature Review and Opportunities for Future Research. Organizational capacity for service integration in community-based addiction health services. Gurewich et al. DOI: https://doi.org/10.1186/1472-6963-13-262, Hjelmar U, Hendriksen C, Hansen K. Motivation to take part in integrated care: An assessment of follow-up home visits to elderly persons. For example, observing how persistent organisational work routines constrain service integration, Glendinning suggests relinquishing traditional professional domains without explicating how this happens in practice [48]. A few exceptions show how leadership enhances caregiver satisfaction [41, 86] and the ability of providers to participate in a network [81]. DOI: https://doi.org/10.1016/j.jclinepi.2009.06.005, Auschra C. Barriers to the integration of care in inter-organisational settings: A literature review. both within and across organisations over time, boundary spanners generate virtuous cycles in the development of network structures. Strategic Management Journal, 1992; 13: 163–182. Oakland, CA: Berrett-Koehler; 2017. At the same time, unintended side effects remain to be expected, which constructs an evolving contradictory context for subsequent action and turns the handling of tensions into a persistent challenge of leading in integrated care networks. ICM Training is part of the Open Colleges Group. Leading interagency planning and collaboration in mass gatherings: Public health and safety in the 2012 London Olympics. 3 International Journal of Integrated Care, vol. Like traditional organisations, networks require leadership to function effectively. Swensen, S. J., Dilling, J. At the same time, they ensure a focus on state-of-the art and quality-controlled studies in the field. Health Policy, 2004; 69(1): 33–43. DOI: https://doi.org/10.2975/35.3.2012.265.272, Jain KM, Maulsby C, Kinsky S, Khosla N, Charles V, Riordan M, et al. Reviewing these findings, this section highlights gaps in the literature demanding attention in the future (see Table 2 for a summary). To establish common understanding, this section defines the three terms and specifies the conceptual boundaries guiding this study. Health Education & Behavior, 2013; 40: 13–23. Further positions will be announced in due course. of integrated care Helen Bevan @HelenBevan. A map of the field of leadership in integrated care networks (including double counts). In a next step, the 73 articles were analysed and coded according to 11 different criteria, which were derived both deductively (e.g. Fourth, it includes multiple directions and covers vertical, horizontal, cross-sectoral or population-centred networks [1]. Who We Are | What We Do. Working towards integrated community care for older people: Empowering organisational features from a professional perspective. Harvard Business School Case 9-399-150. Barriers to co-governance: Examining the “chemistry” of home-care networks in Germany, England, and Quebec. American Journal of Public Health, 2010; 100(7): 1290–1297. In: Amelung V, Stein V, Goodwin N, Balicer R, Nolte E, Suter E (eds. Leadership Programmes for Integrated Care. System leadership in the current health and care landscape does present challenges. context-specific mixtures between hierarchies, markets and networks [106], is subject to considerable debate [6, 9, 41, 42, 43, 44]. Health and Social Care in the Community, 2009; 17(5): 485–494. To this end, it proceeds as follows. Future research could explore how actors proceed to create and re-create leadership media enabling and/or constraining the emergence and development of integrated care networks. It shows that integrated care networks depend on credible and committed “network champions” who promote collaboration to other network members and stakeholders at the policy level [90, 91, 92, 93]. Journal of Management, 2015; 41(5): 1338–1360. Paradox research in management science: Looking back to move forward. Change agency in a primary health care context: The case of distributed leadership. Axelsson R, Axelsson, SB. DOI: https://doi.org/10.1080/1471903032000146964, Huxham C, Vangen, S. Leadership in the shaping and implementation of collaboration agendas: How things happen in a (not quite) joined-up world. Public Money & Management, 1999; 19(4): 15–22. London: Palgrave Macmillan; 2016. In networks, leadership involves the coordination of several legally autonomous organisations [17]. Implications of network structure on public health collaboratives. Exertion of influence by governments and health departments [, Using dialogue vs. the shadow of hierarchy [, Aligning goals and creating shared understandings [, Organisational priorities and resources [. Moreover, they use local events to articulate network goals [98] and create shared understanding of network values [95]. DOI: https://doi.org/10.1002/hpm.684, Voets J, Verhoest K, Molenveld A. Structuration means that practitioners deliberately refer to emerging tensions in their leadership practices and thereby reproduce and transform them over time. Organizing AIDS service consortia: Lead agency identity and consortium cohesion. Leadership in Integrated Care Networks: A Literature Review and Opportunities for Future Research. International Journal of Management Reviews, 2012; 14: 428–443. This definition has several implications. View biographies. What remains less clear, however, is how these actors assume their role. This paper reviews central characteristics of leadership in integrated care networks and proposes opportunities for future research. The ties that bind: Interorganizational linkages and physician-system alignment. DOI: http://doi.org/10.5334/ijic.5420, Mitterlechner M, ‘Leadership in Integrated Care Networks: A Literature Review and Opportunities for Future Research’ (2020) 20 International Journal of Integrated Care 6 DOI: http://doi.org/10.5334/ijic.5420, Mitterlechner, Matthias. While these tensions interrupt routine, raise ambiguity and may lead to conflict, they are also important sources of change, providing practitioners with occasions for “reflexive structuration” [23]. They also suggest that leadership in integrated care networks faces multiple tensions. Moreover, performance is improved by network members working through cliques, which unite complementary services and establish trust among clique members [74]. The iCMP is one of many programs available through the primary care practices at Mass General. 1 was here. Experienced Care Advocate What is a Care Manager? The next two sections define key terms, delineate conceptual boundaries and describe the methods used for conducting this review. Coordinating for Integrated Youth Care: The need for smart metagovernance. Provan KG, Fish A, Sydow J. Interorganizational networks at the network level: A review of the empirical literature on whole networks. In networks, organisations coordinate activities through reciprocal, preferential and mutually supportive actions rather than through discrete market exchanges or by administrative fiat [3]. Several studies recommend coordinating different funding streams and creating collaborative financial contracts among providers and insurers, which support patient coordination and information exchange across organisations [14, 41, 48, 49]. Fewer studies use quantitative (17), mixed (11) or non-empirical conceptual (4) methods. DOI: https://doi.org/10.1016/j.healthpol.2016.11.018, Carter P, Ozieranski P, McNicol S, Power M, Dixon-Woods M. How collaborative are quality improvement collaboratives: A qualitative study in stroke care. International Journal of Integrated Care, 2016; 16(4): 1–11. The additional files for this article can be found as follows: Matched search terms. Furthermore, 6 articles recommended by topic experts in the field were added. DOI: https://doi.org/10.1016/j.mar.2010.08.004, Page S. “Virtual” health care organizations and the challenges of improving quality. 3 (2020): 6. They also inform practice, drawing attention to persistent tensions as a core leadership challenge and offering latest scholarly evidence practitioners can use to reflect on and advance their own leadership practice. At the same time, it is rather silent on how actors implement and change these media. This is surprising, as the leadership challenge is greater in networks for integrated care than in typical organizations (Sydow et al. DOI: https://doi.org/10.1016/S0277-9536(97)10053-3, Bistaraki A, McKeown E, Kyratsis, Y. International Journal of Medical Informatics, 2017; 97: 247–260. On this basis, the paper suggests opportunities for future research and closes with summarising considerations. argue that networks seem to struggle with tensions resulting from conflicting public governance regimes, whereby these tensions are context-specific and tied to the mix of public governance in each place [9]. In view of their global importance, it is surprising how little we know how these networks are led. International Journal of Integrated Care. DOI: https://doi.org/10.1111/1468-0009.00125, Baum F, Freeman T, Sanders D, Labonte R, Lawless A, Javanparast S. Comprehensive primary health care under neo-liberalism in Australia. Regarding network structures, they explore how leadership impacts the formation of networks [8, 44, 47, 58, 61, 68, 69, 71, 82, 90, 100, 101], the number and strength of network ties [51, 56, 63, 64, 67, 77, 78], network density [51, 52], network centrality [9, 51], network trust [70, 72, 75], network consensus [78] and network identity [84]. It thereby adds to the literature on integrated care and, more narrowly, the debate on leadership in integrated care networks. Long Range Planning, 2012; 45(2/3): 105–135. DOI: https://doi.org/10.1177/1090198113492759, Spear SE. DOI: https://doi.org/10.1108/MD-09-2017-0907, Kurunmaki L, Miller P. Regulatory hybrids: Partnerships, budgeting and modernising government. Developing design propositions through research synthesis. DOI: https://doi.org/10.1136/bmjopen-2015-008593, Van Haute D, Roets G, Alasuutari M, Vandenbroeck M. Managing the flow of private information on children and parents in poverty situations: Creating a panoptic eye in interorganizational networks? 41]. As one of the few studies adopting this perspective, Tsasis et al. International Journal of Integrated Care 20 (3): 6. Some show how government reforms aimed at improving collaboration among providers support the creation of horizontal and vertical service networks [7] and exchange of patient-related information [44, 47]. DOI: https://doi.org/10.1080/19416520.2016.1162422. Future research could examine in more depth how leadership happens at the neighbouring policy and organisation levels of analysis and how it affects and is affected by the network level. The majority of work focuses on outcomes at the network level. DOI: https://doi.org/10.5334/ijic.843, Fleishman JA, Mor V, Piette JD, Allen SM. DOI: https://doi.org/10.1097/HMR.0b013e31828c8b76, Retrum JH, Chapman CL, Varda DM. The Integrated Care Management (ICM) Transitions of Care (TOC) program is founded on the principles of ICM, which are person-centered, evidence-based care delivery promoting care coordination and supporting patients across providers, settings and time. DOI: https://doi.org/10.1016/j.puhe.2018.09.031, Morgan S, Pullon S, Garrett S, McKinlay E. Interagency collaborative care for young people with complex needs: Front-line staff perspectives. Giddens A. DOI: https://doi.org/10.5334/ijic.5420.s2. The influence of governmental policy on community health partnerships and community care networks: An analysis of three cases. Get the inside scoop on jobs, salaries, top office locations, and CEO insights. Finally, writers note that integrated care networks are affected by the broader social environment in which they are embedded [56, 57]. In: Clegg SR, Hardy C, Lawrence TB, Nord WR (eds. They tend to argue for shared governance in which activities are coordinated by all network members [45]. DOI: https://doi.org/10.1080/1356182021000044166, Grimshaw D, Rubery J, Marchington M. Managing people across hospital networks in the UK: Multiple employers and the shaping of HRM. DOI: https://doi.org/10.5334/ijic.649, Bode I, Firbank O. Social capital and transaction cost on co-creating IT value towards inter-organizational EMR exchange. Reflexive means that practitioners accept tensions as the basic condition of their work and take precautions that the intended structuring works, for example by remaining alert to contradictory structures and processes, by exploring synergies between competing demands, by reframing tensions, and replacing either-or-assumptions with both-and-alternatives [29]. This article reviews research on leadership in integrated care networks. Chronic diseases are responsible for 7 of 10 deaths each year, killing more than 1.7 million Americans annually. Development of a program for tele-rehabilitation of COPD patients across sectors: Co-innovation in a network. DOI: https://doi.org/10.5334/ijic.582, Patru D, Lauche K, van Kranenburg H, Ziggers GW. DOI: https://doi.org/10.2105/AJPH.2013.301842, Kominis G, Dudau, AI. Most studies target the network level, analysing how leadership affects network structures and the coordination of network activities. These practices are situated in histories of existing cultures of clinician engagement and established partnerships. Health Policy, 2018; 122(12): 1356–1363. For example, the topic can be studied from network theory, integrated care theory or other theoretical angles, each perspective using its own definitions and illuminating different aspects of the phenomenon. 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