Article Text

Original research
The role of leadership in times of systems disruption: a qualitative study of health and social care integration
  1. Leslie Curry1,
  2. Adeola Ayedun1,
  3. Emily Cherlin1,
  4. Beck Taylor2,
  5. Sophie Castle-Clarke3,
  6. Erika Linnander1
  1. 1 Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA
  2. 2 Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  3. 3 Eastern Academic Health Science Network, Cambridge, UK
  1. Correspondence to Dr Leslie Curry; leslie.curry{at}yale.edu

Abstract

Objectives To understand whether and how effective integration of health and social care might occur in the context of major system disruption (the COVID-19 pandemic), with a focus on how the initiative may overcome past barriers to integration.

Design Rapid, descriptive case study approach with deviant case sampling to gather and analyse key informant interviews and relevant archival documents.

Setting The innovation (‘COVID-19 Protect’) took place in Norfolk and Waveney, UK, and aimed to foster integration across highly diverse organisations, capitalising on existing digital technology to proactively identify and support individuals most at risk of severe illness from COVID-19.

Participants Twenty-six key informants directly involved with project conceptualisation and early implementation. Participants included clinicians, executives, digital/information technology leads, and others. Final sample size was determined by theoretical saturation.

Results Four primary recurrent themes characterised the experiences of diverse team members in the project: (1) ways of working that supported rapid collaboration, (2) leveraging diversity and clinician input for systems change, (3) allowing for both central control and local adaptation and (4) balancing risk taking and accountability.

Conclusions This rapid case study underscores the role of leadership in large systems change efforts, particularly in times of major disruption. Project leadership overcame barriers to integration highlighted by prior studies, including engaging with aversion to clinical/safety risk, fostering distributed leadership and developing shared organisational practices for data sharing and service delivery. These insights offer considerations for future efforts to support strategic integration of health and social care.

  • leadership
  • integration
  • health systems reform
  • COVID-19
  • digital health

Data availability statement

No data are available. Primary data collected for this study are not available to be publicly shared, as participants were assured confidentiality during the informed consent process. Given the small sample size and specifics of this case study, there is a risk of participant identification within the dataset.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

No data are available. Primary data collected for this study are not available to be publicly shared, as participants were assured confidentiality during the informed consent process. Given the small sample size and specifics of this case study, there is a risk of participant identification within the dataset.

View Full Text

Supplementary materials

Footnotes

  • Contributors All authors substantially contributed to the manuscript. LC is the guarantor. LC: conceptual design, data collection and analysis, drafting of the manuscript, funding and supervision; AA: data collection and analysis, drafting of the manuscript; EC: data analysis, drafting of the manuscript; SC-C: data collection and analysis and drafting of the manuscript; BT: data analysis, drafting of the manuscript; EL: conceptual design, data analysis, drafting of the manuscript.

  • Funding The project was funded by the Norfolk and Waveney CCG and the Eastern Academic Health Science Network. BT was funded by the National Institute for Health Research (NIHR) West Midlands Applied Research Collaboration, https://warwick.ac.uk/fac/sci/med/about/centres/arc-wm/

  • Disclaimer The views expressed are by BT, and not necessarily those of the NIHR or the UK Department of Health and Social Care.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.