What elements of Leadership have most impact in Integrated Care Teams and Do They Have a Measurable Effect on Patient Outcomes?

Background: Current NHS policy is focused on creating regional "Integrated Care Systems" (ICS) across England. The aim of ICS are to cost effectively deliver more integrated and cost-effective health and social care services, eliminating competition and duplication and creating more seamless services. To fully realise these aims, the health and social care workforce, need to work effectively together in integrated teams. A key to maximising the effectiveness of these teams will be to ensure that they have leaders with the appropriate skills. Integrated team leadership (ITL)is still a relatively new concept. This study built on previous work to define integrated team leadership, by exploring its impact of on staff and patients. Study Design: Eleven (11) community based rehabilitation, integrated health and social care teams (CRAICS) were recruited into this research. Team members (253) completed a 360 degree feedback exercise for 11 team leaders, utilising a highly validated leadership questionnaire. They also completed a validated tool to measure team level dynamics. Cross sectional patient outcome data was also collected in the same period, utilising the Therapy Outcome Measures (TOMs) (Enderby et al. 2006) and European Quality of Life indicator, EQ5D (EUROQOL-GROUP, 2006). Results: Data was analysed to answer 3 questions: 1. What is the relationship between effective Leadership, and Team Level Dynamics in integrated health and social care teams? Leadership variables "Person-focused" and "Task-focused" leadership, were found to have a highly significant (0.005) association with and effect upon a wide range of individual staff and Team level dynamics variables. Passive-Avoidant Leadership behaviours were also found to have a highly significant negative association with individual and team level variables. 2. Does leadership in integrated health and social care teams have an observable effect on patient outcomes? Leadership variables were found to have no observable effect on Patient Outcomes. 3. Do team dynamics, in integrated health and social care teams, have an observable affect on patient outcomes? A number of team level variables when combined had highly significant effects on Quality of Life. Effects on Therapy Outcomes were close to significant. Individual level variables had close to significant effect on patient outcomes Conclusions: Leadership in integrated teams has a significant and consistently strong effect on both team and individual staff level dynamics. And there are indications that team level and individual level dynamics have some effect on patient outcomes. Further research is needed to investigate these relationships more fully, perhaps utilising a multilevel statistical model.