Table 3.
Knowledge, Skills and Attitudes for Managers of Integrated Care.
| Explanation | Quote | |
|---|---|---|
| Knowledge | ||
| Technical knowledge | This includes professional knowledge; management theory and theories of innovation; understanding of the workings of the overall system (and not just their own organization or sector); being able to understand social determinants of health; and being able to apply knowledge in the context of integrated care. | “the knowledge that she had from the actual needs and the actual how things operate was probably critical to navigate the landscape and then … she had knowledge of the political setting and how policy works and she managed to play very well between those two fields and make something that is a compromise that fits both sides.” (Interviewee 19) |
| Skills | ||
| Taking a people-centred approach | Involving patients, people and communities in every step of the way; using their perspective as the guiding principle in the design, implementation and evaluation of care; challenging existing power bases which could diminish the importance of lived experiences; engaging communities whose voice is often unheard due to disadvantage and exclusion | “a the fundamental rethink is they’re the managers. They manage their care, they coordinate the team, not that a patient or family has to do all those but we have to flip on its head the notion of who we work for. And we work for people and their families.” (Interviewee 9) |
| Communication | Communicating through alternative means and formats, including social media in order to engage a broader range of stakeholders; framing opportunities in paradigms and language that will be relevant to different professional and sectorial groups; ability of listening actively, being present during a conversation; creating the time to go out and listen to people. | “you have to check in so many times to make sure that what you have either said or communicated has been received in the way that you thought it was being communicated, because I have found that most of the time it’s not and I have been completely gobsmacked by how differently people have – even from what I have said and what I have communicated – they have received something completely different, a completely different message than the one that I was sending out and I find that absolutely fascinating.” (Interviewee 1) |
| Building and maintaining relationships | Bringing people together who previously had little contact and/or experienced tensions; fostering a supportive and trusting environment; creating the space for new solutions to emerge; building networks; understanding relationship management as an integral and ongoing task. | “…because I’ve realised that you could have all the intellectual prowess you want but if you don’t know how to help people and teams and integrated teams and cross-organisations and systems thrive, you can’t integrate care. It’s all relational. So I think it has to be taught in every aspect of every curriculum.” (Interviewee 9) |
| Distributive leadership and collaborative approach to management | Being able to let go; trusting your team; creating the conditions; managing by shared outcomes; managing teams across professions and organisations; giving permission to innovate and be flexible. | “…something requiring tolerance, ambiguity, organic iterative and allowing people latitude to be able to do stuff and one of the things that’s emerged strongly is the tension between central control and command at the centre of organisations, … just as letting go of that control and trusting to people who know their business and empowering them to do stuff and when you do that, that tends to work out well.” (Interviewee 17) |
| Being a coach and a mentor | Developing and implementing inter-disciplinary CPD programmes; giving constructive feedback; understanding management as a coaching role rather than a ‘command and control’ role. | “So I think that issue about how do we invest, not just in the formation but actually in the development. And I think that’s about giving people opportunities to learn, to share, to innovate, to fail and to hopefully move on and do things better.” (Interviewee 5) |
| Managing culture change | Identifying culture as a key topic to be managed; understanding different cultures and culture change; managing culture as a continuous work in progress. | “This is a big culture change and you don’t find people and you don’t change people easily to a completely different culture than the one that they signed up for in the first place… you tend to revert to the average or revert to the norm if you don’t continue, to continually renew the new reality and that’s hard work, because we’re trying to do something that’s not just a little bit different but something that’s significantly different from the norm.” (Interviewee 12) |
| Attitudes | ||
| Resilience | Being able to weather the storm; be persistent; withstand constant resistance; being able to cope with loneliness. | “you really have to have the skills of a change manager and you need I think a lot of resilience and endurance to knock on every door again and again and again and a tenth time it will maybe open a little bit.” (Interviewee 16) |
| Courage | Standing up against the norm; addressing uncomfortable truths; approaching people and organisations, which are opposing the change. | “I think that’s a really important part of encouraging people to be brave in integrated care, so if you think of the characteristics of a good chief executive, you know, there’s all of that high EQ stuff, there’s all of the competencies that come with leadership, but one of those competencies is bravery and bravery is not just about being stuck on your idea, it’s about being brave enough to fail and to learn the lessons of those failures…, so that characteristic of teaching flexibility …is something that can be taught and that comes through in that experiential learning.” (Interviewee 2) |
| Humility | Accepting mistakes and learning from them; helping others to thrive; taking another persons’ perspective; being able to see the big picture. | “And the ones that I’m attracted to in terms of a role are the people who are reflective about the failure and can understand the multidimensional aspects of that and, most importantly, understand their role in that failure. So did they listen enough, did they codesign enough, did they stay in the problem long enough. How did they deal with it when it was all going wrong, did they offer the resignation or did they go and say ‘mea culpa’ and then what was their response.” (Interviewee 2) |