Article Text

What can clinical leaders contribute to the governance of integrated care systems?
  1. Justin Waring1,
  2. Simon Bishop2,
  3. Georgia Black3,
  4. Jenelle Clarke4,
  5. Bridget Roe1
  1. 1 Health Services Management Centre, University of Birmingham, Birmingham, UK
  2. 2 Centre for Health Innovation, Leadership and Learning, University of Nottingham, Nottingham, UK
  3. 3 Wolfson Institute, Queen Mary, University of London, London, UK
  4. 4 Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
  1. Correspondence to Professor Justin Waring, Health Services Management Centre, University of Birmingham, Birmingham, UK; j.waring{at}


Background Integrated care systems present enduring governance challenges associated with fostering interorganisational collaboration.

Aim To understand how clinical leaders can make a distinct contribution to the governance and system leadership of integrated care systems.

Methods A qualitative interview study carried out between 2018 and 2019 with 24 clinical leaders, and a further 47 non-clinical leaders, involved in the governance of three Sustainability and Transformation Partnership in the English National Health Service.

Results Clinical leaders were found to make four distinct contributions: (1) making analytical insights into integration strategies that ensured their relevance and quality to clinical communities; (2) representing the views of clinicians in system decision-making thereby enhancing the legitimacy of change; (3) translation and communication activities to articulate integration strategies in favourable ways and ensure clinical engagement; and (4) relational work in the form of brokering and building connections and mediating conflict between multiple stakeholders. These activities varied across the levels of system governance and at different stages in the processes of change.

Conclusions Clinical leaders can make a distinct contribution to the governance and leadership of integrated care systems based on their clinical expertise, membership professional networks, reputation and formal authority.

  • clinical leadership
  • integration
  • health system

Data availability statement

Data are available upon reasonable request.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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Data availability statement

Data are available upon reasonable request.

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  • Contributors All authors contributed to the design and conduct of the research, data analysis and writing of the manuscript. JW accepts full responsibility for the work abd conduct of the study, has access to the data and controlled the decision to publish.

  • Funding The study was funded by the NIHR (Health Services and Delivery Research Programme) (16/52/04). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • 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.