Table 3.

Leadership skills required for integrated primary care.

Subthemes	Reference	Method for data collection	Leadership skills required
Shared ambition (shared commitment of the involved partners)
Commitment	[32]	Interviews, observation, focus groups	Ensuring the broadening commitment of different health and social services
	[35]	In-depth interviews	Helping to develop and negotiate shared purpose
Relationship dynamics (relational capital among the partners)
Team culture	[29]	Focus groups	Shared leadership: team members empowering each other in their team
	[30]	Case-study journals, interviews, focus group and surveys	Being able to function in a networked rather than a hierarchical manner
	[32]	Interviews, observation, focus groups	Maintain trusting relationships
			Establishing a collaborative culture: sensitivity to roles and contributions of different staff members
	[35]	In-depth interviews	Encouraging working in groups and teams
	[36]	Focus groups	Fostering culture of teamwork
			Sensitivity to issues learning to ‘work together’
	[43]	Observation during site visits, interviews	Valuing contribution of team member
			Creating safe space for team members
	[44]	Semi-structured interviews	Being able to consider the circumstances and ways of thinking of each discipline
Interpersonal communication	[29]	Focus groups	Conflict resolution
			Facilitate meetings
	[43]	Observation during site visits, interviews	Communicating expectations of team member overtly or implicitly
	[44]	Semi-structured interviews	Promoting the creation of good communication and close interaction between disciplines
Responsibilities	[29]	Focus groups	Foster accountability
			Divide responsibilities for different tasks to different team members
	[32]	Interviews, observation, focus groups	Clarifying dysfunctional areas and revising task distributions
	[42]	Observation of team monthly meetings	To champion protocol adherence
Role modelling	[30]	Case-study journals, interviews, focus group and surveys	Positive professional role modelling, to share expertise
			Developing transboundary role
	[33]	Semi-structured interviews	Positive physician role modelling
	[45]	Focus groups, observation	Taking initiative to build multidisciplinary teams
			Emphasizing the role of professionals close to patients, especially nurses and social workers
Role developing	[32]	Interviews, observation, focus groups	Refining and legitimating the role of the case manager
	[38]	Interviews, web-based survey	Providing confidence among individuals in adopting new roles
			Clarifying the scope of new role and responsibilities
			Providing a vehicle for incorporating new roles into routine practice
Organization dynamics (governance arrangements among the partners)
Visionary	[26]	Telephone interviews	Visionary and committed
	[36]	Focus groups	Vision about the importance of the work
	[43]	Observation during site visits, interviews	Vision on IPP, including patient- and family-centred care, high-quality care
	[45]	Focus groups, observation	Passionate about delivering integrated, good quality, person-centred care
Decisiveness	[30]	Case-study journals, interviews, focus group and surveys	Evolving sense of authority
	[31]	Interviews, focus groups, non-participant observation and document analysis	Having determinative influence
			Having clearly decisiveness to implement practice changes
			Taking personal initiatives to set events in motion aimed at integrating healthcare resources
	[40]	In-depth interviews	Display of determination to persevere when faced with challenges an barriers to change
			Persistence in facing resistance to change from staff
	[45]	Focus groups and observation	Deciding on the composition of the multidisciplinary team
Catalyst problem solving	[36]	Focus groups	Serve as link between top management and staff
	[30]	Case-study journals, interviews, focus group and surveys	Taking positive action to resolve problems
	[40]	In-depth interviews	Overcome bureaucratic hurdles
Process management (process steering among the partners)
Change management	[26]	Telephone interviews	Supporting improvement change culture, that permeates the organization
	[29]	Focus groups	Should have knowledge of change theory
	[32]	Interviews, observation, focus groups	Transforming the classic hierarchical relationship between GPs and nurses/case managers
	[33]	Semi-structured interviews	Should encourage change
			Should be innovative, creative and possess project development and management skills
	[36]	Focus groups	Test and implement innovations
Project management	[29]	Focus groups	Public speaking, presentation skills, coaching skills, writing proposals and abstracts
	[31]	Interviews, focus groups, non-participant observation and document analysis	To empower individuals to participate in transformation activities
	[32]	Interviews, observation, focus groups	Tailoring to the various phases of the diagnostic, design and implementation process
	[36]	Focus groups	Taking personal initiative to set events in motion aimed at integrating healthcare resources
	[45]	Focus groups, observation	Networking at the strategic level: connecting primary and secondary care, social services, and the community

GP, general practitioner; IPP, interprofessional practice; QI, quality improvement.

Bells Framework consists of [1] shared ambition, [2] mutual gains, [3] relationship dynamics, [4] organization dynamics and [5] process management.

Mutual gains was not mentioned.