NHS managers perspectives of leading and managing the implementation of integrated care

This aim of this study was to understand more about the challenges facing managers implementing integrated care. Qualitative interpretative methodology was used to explore the perspectives of managers in a newly integrated Community and Mental Health Organisation during their first year of implementation. The study site consisted of two newly merged organisations which transferred Community Therapy and District Nursing workforce to an established Mental Health Organisation after the Social Care workforce transferred back to the County Council. The sample were made up of newly appointed Neighbourhood Team Managers (n=9) and the Organisation's Senior Managers (n=10). Data was collected using semi-structured in-depth interviews and discussion of the study findings are organised around the 'Rainbow Framework', by Valentijn, et al. (2013) as this offered a validated conceptualisation of the contested meaning of integrated care. Key findings identified it was critical for managers to understand the intended vision for integrated care and the implementation objectives of integration at the very outset, for example patient-centred changes or cost savings. Equally important was the need for managers to be able to adjust the vision, objectives and plans for integration in the light of unexpected changes. Limited resources, available workforce, interprofessional and interorganisational relationships affected the manager's belief that integration was deliverable. There was minimal shared patient caseload between the newly amalgamated services which this study found impacted upon professional integration. This study contributes to the body of evidence that suggest co-location does not necessarily facilitate professional integration. Instead, activities such as getting together to share, and problem solve with peers, enabled the managers to make progress towards integration. It also considers evidence around how a just and accountable organisational culture and the challenge of implementing it within an NHS scenario can support significant change. It offers the leadership and management research field new evidence on the leadership qualities specifically needed by the integrated care leader. This study has developed an integrated leadership conceptual framework providing a new and context-focused approach to support managers leading integration. Recommendations for practice are made that are intended to aid managers in their advancement towards implementing integrated care