Leadership in Transition: Emerging Challenges in Integrated Care System Leadership

Knight, L Leadership in Transition: Emerging Challenges in Integrated Care System Leadership. British Journal of Health Care Management. ISSN 1358-0574 (Accepted)

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Abstract

Aim: This study investigates the emerging leadership challenges within Integrated Care Systems (ICSs) in England. It focuses on identifying the key obstacles ICS leaders have faced in achieving their main objectives since their formation in 2022. By exploring their lived experiences, the study aims to contribute to the growing but underdeveloped evidence base on ICS leadership and the strategies leaders employ to navigate these challenges. Design: A qualitative case study design was utilised to gain in-depth insights into the leadership challenges in ICSs. To gather data on their experiences and perspectives, 28 semi-structured interviews were conducted with 23 ICS leaders. A purposive sampling technique within a case study design was employed, with 23 ICS leaders from one large ICS in England participating. Following Braun and Clarke’s six-phase framework, thematic analysis was applied to analyse the interview data. Results: The analysis revealed several challenges ICS leaders face, including navigating complex governance structures, managing resource constraints, and addressing health inequalities. The tension between immediate operational demands and long-term strategic goals compounded these challenges. Findings should be understood in the context of a rapidly evolving policy landscape. Interviews were conducted before the 2024 General Election and within the first 18 months of ICSs becoming statutory entities. Conclusions: Addressing governance complexity requires enhanced decision-making autonomy. Leaders must be able to implement system-wide improvements while balancing operational and strategic demands. Leadership development frameworks should equip ICS leaders with the skills to navigate multi-tiered governance and financial constraint including strategic negotiation, adaptive leadership, systems thinking, and political astuteness.

Item Type:	Article
Uncontrolled Keywords:	15 Commerce, Management, Tourism and Services; 35 Commerce, management, tourism and services
Subjects:	H Social Sciences > HF Commerce > HF5001 Business H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Liverpool Business School
Publisher:	MA Healthcare
Date of acceptance:	23 April 2025
Date Deposited:	14 May 2025 09:42
Last Modified:	14 May 2025 09:45
URI:	https://researchonline.ljmu.ac.uk/id/eprint/26354

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