Evaluation and research consistently highlight that successful implementation of integrated care programmes relies on the support of the employing organisations and/or organisational partnerships. Where this is the case, there is a greater likelihood that good practice can become embedded and sustained, but if it is lacking then it is common for initial progress to be lost. A key element of these organisations (and the partnerships which may be developed) are the people who manage their strategy and operations. Despite the centrality of management to the effective delivery of integrated care there is surprisingly little known about the specifics of its contribution. It is unclear for example if integration requires a different set of management competences, or if managers have the skills and knowledge but not necessarily the capacity, commitment or context to deploy them as required. This results in a ‘black box’ in which we recognise the importance of management but are unable to codify, assess and develop as appropriate.
Based on Mintzberg (1975) strategic managers make decisions on behalf of the organisations, interact with environment, set policies, goals & frameworks, and supervise operational managers. Operational managers are the implementers, who mediate between strategic and core, and deliver departmental objectives within strategic framework. Managers may be generalist or work within a specific function such as human resources, finance or information technology.
This qualitative research project aims to address this fundamental gap in our knowledge. It has undertaken semi-structured interviews with a purposive sample of 30 international leaders in the design, delivery and research of integrated care. Interviewees have provided their perspective and experience of strategic and operational management in practice. This includes examples in which management has supported transformation as well as those in which integrated care has not been successfully implemented. Participants bring experience of clinical, management, policy, academic and patient representative roles within Europe, North America, and Australasia. Data gathering will be complete by the end of October 2018.
Preliminary results highlight the divide even among integrated care paragons, of whether integrated care is a world of its own, which requires very distinct management skills, whether leaders can be managers and vice versa, or whether there still is a clear divide between strategic and operational management. What they all concur on is the fact that integrated care is a very arduous journey, which asks for resilient managers, and that there is a lack of support for them, as the management capacity is often not considered. The presentation will present the findings and consider what this means for the future implementation of integrated care.