Understanding key mechanisms of successfully leading integrated team-based services in health and social care: A realist synthesis: First Look Summary

Ruth Harris, Simon Fletcher, Sarah Sims, Fiona Ross, Sally Brearley, Jill Manthorpe

Research output: Book/ReportCommissioned reportpeer-review

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Background Effective leadership is a core element of well-coordinated/safe care. Where leadership is ineffective services fail and users are harmed. As the organisation of health/social care becomes more integrated with increasing cross-sector/interagency collaboration, leadership has become more complex. Leading integrated teams across professional/organisational/sectorial boundaries to achieve high quality/effective care is a key goal. While there is a great deal of descriptive research on leadership, its focus has been largely profession-specific. As a result, this work has rarely addressed the situation faced by leaders working across care boundaries. There is also little insight into which mechanisms are effective for leaders across care boundaries, how contexts influence leadership, or resulting outcomes. Aims This review aims to identify and refine the programme theories of leadership of integrated team-based services in health/social care, exploring what works, for whom and in what circumstances. It will provide guidelines for policy makers, leaders/managers and clinicians to help them design work systems and development activities to support effective leadership of complex services. Methods A realist review will be used to develop a detailed understanding of integrated team leadership. Previous findings from a realist synthesis of teamwork undertaken by the team identified 13 key mechanisms that affected how teams functioned in care settings. Leadership was one of the mechanisms. The synthesis revealed that leadership influenced a range of attitudes/actions by team members. Based on this initial work, we propose to undertake a full synthesis of team leadership. Literature will be identified from searches of electronic database (e.g. Medline, CINAHL, Embase), reference lists, citations and grey literature. In line with realist methods, we do not have specific inclusion/exclusion criteria based upon research method or quality, but will report areas of general and individual study weakness where appropriate. Relevant materials will be obtained and added into a data extraction form. These forms will be independently examined for inclusion. Data will be analysed to provide a comprehensive description of mechanisms, contexts and outcomes. We will identify prominent/recurrent patterns of context and outcome configurations and seek to explain how these occurred by use of specific mechanisms. Due to the complexity of the review, we will hold 3 stakeholder consultation events involving leaders and realist review experts who together with the advisory group and researchers will identify/agree 'realist theories' on the contexts/mechanisms of leadership. Timelines This review will last for 18 months. Key activities include: literature searching/screening; data abstraction; analysis/synthesis; consultation events and dissemination. Impact/dissemination Potential impacts include: informing future research into integrated team-based leadership; refining theoretical understanding of leadership; informing policies/practices to directly influence care delivery; informing leadership development programmes. Findings will be shared with stakeholders (e.g. health/social care staff, managers/leaders, local authorities, policy makers, leadership groups, service user/carer organisations). Dissemination activities will include: papers submitted to journals, presentations and use of social media.
Original languageEnglish
Place of PublicationLondon
PublisherNIHR Journals Library
Commissioning bodyNational Institute for Health Research Health Services and Delivery Research Progranne
Number of pages7
Publication statusPublished - 1 Dec 2021


  • Integrated care
  • Leadership
  • Integration


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