Distributed versus centralized leadership in the implementation of a Canadian integrated care initiative

Abstract

Introduction: Traditional notions of leadership involve more centralized power at the senior levels, with the expectation that vision and strategy will trickle down to operational levels. This type of leadership may work well in smaller organizations, but the complexity of integrated health models involving large inter-organizational networks may challenge this notion of leadership. To date, the evidence on how traditional centralized leadership impacts the implementation and functioning of integrated care networks is unclear. There is a need to understand different forms of leadership within and across organizations that are involved in integrated care networks. Theory/Methods: We conducted multiple case studies evaluating the implementation of Health Links (HL), a "low-rules"/bottom-up integrated care model in Ontario, Canada. Through an analysis of the qualitative data via semi-structured interviews, this study provides a practical exploration of leadership in the HL context. Our analysis draws on process- or action-oriented theories of leadership that look beyond senior leadership (e.g., distributed and shared leadership, complexity leadership theory). These theories posit that non-formal leaders are critical to the functioning of complex organizations and systems, and consider leadership as an interactive adaptive process, often emergent in nature. Results: Preliminary results show that leadership was highly centralized in implementing HL and concentrated almost exclusively at the senior level, which entailed governance committees involving CEOs and upper management. This centralized leadership seemed to result from a failure to develop capacity for distributed leadership throughout partner organizations, which further impeded front-line workers from understanding the goals of HLs to provide integrated care. That is, due to factors such as insufficient education/communication regarding HLs, lack of delegation of more operational tasks, and failure to meaningfully seek out front-line support, there was limited ability within the organizations to sustain the integrated care effort without an 'overreliance' on senior leadership to drive HLs forward. Conclusions: Though senior leadership is critical in setting a vision for integrated care networks, our findings indicate that a centralized leadership approach may not be optimally effective at the stage of implementation and ongoing functioning of these networks. [ABSTRACT FROM AUTHOR]