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Sharing leadership: current attitudes, barriers and needs of clinical and non-clinical managers in UK’s integrated care system
  1. Lisa Aufegger1,2,
  2. Monica Alabi2,
  3. Ara Darzi1,2,
  4. Colin Bicknell1,2
  1. 1Patient Safety Translational Research Centre, Imperial College London, London, UK
  2. 2Centre for Health Policy, Imperial College London, London, UK
  1. Correspondence to Dr Lisa Aufegger, NIHR Imperial Patient Safety Translational Research Centre, London, Imperial College London, London W2 1PE, UK; l.aufegger{at}


Background As systems become more complex, shared leadership (SL) has been suggested to have a dominant role in improving cross-functional working tailored to organisational needs. Little, however, is known about the benefits of SL in healthcare management, especially for UK’s recently formed integrated care system (ICS). The aim of this study was to understand current attitudes, barriers and needs of clinical and non-clinical managers sharing leadership responsibilities in the ICS.

Method Twenty clinical and non-clinical leaders in 15 organisations were interviewed to understand current cross-functional leadership collaborations, and the potential SL may have on the recently established ICS in the National Health Service (NHS). The data were transcribed and analysed thematically.

Results Findings showed perceptions and experiences of clinical and non-clinical healthcare management in relation to: (1) motivation to execute a leadership position, including the need to step up and a sense of duty; (2) attitudes towards interdisciplinary working, which is reflected in conflicts due to different values and expertise; (3) SL skills and behaviours, including the need for mutual understanding and cooperative attitudes by means of effective communication and collaboration; and (4) barriers to achieve SL in the ICS, such as bureaucracy, and a lack of time and support.

Conclusions SL may help improve current leadership cultures within the NHS; however, for SL to have a tangible impact, it needs to be delivered as part of leadership development for doctors in postgraduate training, and development programmes for aspiring, emerging and established leaders, with clear lines of communication.

  • clinical leadership
  • management
  • leadership assessment
  • health system

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  • Contributors LA, MA, CB and AD conceptualised this research. LA and MA designed the protocol and CB and AD contributed to the conceptualisation and commented on the protocol. The data collection and analysis were carried out by MA and LA. The manuscript was written by LA with contributions from all authors. All authors have read and approved the manuscript.

  • Funding This article represents independent research supported by the NIHR Imperial Patient Safety Translational Research Centre.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Care. The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was reviewed and ethically approved by the Joint Research Compliance Office (JRCO; 18IC4917), Imperial College London, UK.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. The data are not available for third entities due to ethical regulations on data collection, analysis and distribution.