Abstract：
OBJECTIVE: Given the complex nature of integrated care systems (ICSs), the geographical spread and the large number of organisations involved in partnership delivery, the importance of leadership cannot be overstated. This paper aims to present novel findings from a rapid realist review of ICS leadership in England. The overall review question was: how does leadership in ICSs work, for whom and in what circumstances?
METHODS: Development of initial programme theories and associated context-mechanism-outcome configurations (CMOCs) were supported by the theory-gleaning activities of a review of ICS strategies and guidance documents, a scoping review of the literature and interviews with key informants. A refined programme theory was then developed by testing these CMOCs against empirical data published in academic literature. Following screening and testing, six CMOCs were extracted from 18 documents. The study design, conduct and reporting were informed by the Realist And Metanarrative Evidence Syntheses: Evolving Standards (RAMESES) training materials (Wong et al., 2013).
RESULTS: The review informed four programme theories explaining that leadership in ICSs works when ICS leaders hold themselves and others to account for improving population health, a sense of purpose is fostered through a clear vision, partners across the system are engaged in problem ownership and relationships are built at all levels of the system.
CONCLUSIONS: Despite being a rigorous and comprehensive investigation, stakeholder input was limited to one ICS, potentially restricting insights from varied geographical contexts. In addition, the recent establishment of ICSs meant limited literature availability, with few empirical studies conducted. Although this emphasises the importance and originality of the research, this scarcity posed challenges in extracting and applying certain programme theory elements, particularly context.
CONCLUSIONS: This review will be of relevance to academics and health-care leaders within ICSs in England, offering critical insights into ICS leadership, integrating diverse evidence to develop new evidence-based recommendations, filling a gap in the current literature and informing leadership practice and health-care systems.
METHODS: Development of initial programme theories and associated context-mechanism-outcome configurations (CMOCs) were supported by the theory-gleaning activities of a review of ICS strategies and guidance documents, a scoping review of the literature and interviews with key informants. A refined programme theory was then developed by testing these CMOCs against empirical data published in academic literature. Following screening and testing, six CMOCs were extracted from 18 documents. The study design, conduct and reporting were informed by the Realist And Metanarrative Evidence Syntheses: Evolving Standards (RAMESES) training materials (Wong et al., 2013).
RESULTS: The review informed four programme theories explaining that leadership in ICSs works when ICS leaders hold themselves and others to account for improving population health, a sense of purpose is fostered through a clear vision, partners across the system are engaged in problem ownership and relationships are built at all levels of the system.
CONCLUSIONS: Despite being a rigorous and comprehensive investigation, stakeholder input was limited to one ICS, potentially restricting insights from varied geographical contexts. In addition, the recent establishment of ICSs meant limited literature availability, with few empirical studies conducted. Although this emphasises the importance and originality of the research, this scarcity posed challenges in extracting and applying certain programme theory elements, particularly context.
CONCLUSIONS: This review will be of relevance to academics and health-care leaders within ICSs in England, offering critical insights into ICS leadership, integrating diverse evidence to develop new evidence-based recommendations, filling a gap in the current literature and informing leadership practice and health-care systems.
摘要：
目标：鉴于综合护理系统（ICS）的复杂性，地域分布和参与伙伴关系交付的大量组织，领导的重要性怎么强调都不为过。本文旨在通过对英国ICS领导力的快速现实主义回顾，提出新的发现。总体审查问题是：ICSs中的领导力是如何工作的，为谁和在什么情况下？
方法：初始计划理论和相关的上下文机制结果配置（CMOC）的发展得到了ICS战略和指导文件审查的理论收集活动的支持，对文献进行范围审查，并对关键线人进行访谈。然后，通过根据学术文献中发布的经验数据对这些CMOC进行测试，开发了一种完善的程序理论。经过筛选和测试，从18个文档中提取了6个CMOC。研究设计，行为和报告由现实主义者和元叙事证据综合：演进标准(RAMESES)培训材料(Wong等人。,2013).
结果：该评论提供了四种计划理论，这些理论解释说，当ICS领导者认为自己和其他人负责改善人口健康时，ICS中的领导力就会起作用。目的感是通过清晰的视野来培养的，整个系统的合作伙伴参与问题所有权，并在系统的各个级别建立关系。
结论：尽管进行了严格而全面的调查，利益相关者的投入仅限于一个ICS，可能限制来自不同地理环境的见解。此外,最近建立的ICSs意味着文献的可用性有限，很少进行实证研究。尽管这强调了研究的重要性和原创性，这种稀缺性在提取和应用某些程序理论要素方面提出了挑战，特别是背景。
结论：这篇综述将与英格兰ICS中的学者和医疗保健领导者相关，提供对ICS领导力的重要见解，整合各种证据以制定新的循证建议，填补了当前文献中的空白，并为领导实践和医疗保健系统提供了信息。
方法：初始计划理论和相关的上下文机制结果配置（CMOC）的发展得到了ICS战略和指导文件审查的理论收集活动的支持，对文献进行范围审查，并对关键线人进行访谈。然后，通过根据学术文献中发布的经验数据对这些CMOC进行测试，开发了一种完善的程序理论。经过筛选和测试，从18个文档中提取了6个CMOC。研究设计，行为和报告由现实主义者和元叙事证据综合：演进标准(RAMESES)培训材料(Wong等人。,2013).
结果：该评论提供了四种计划理论，这些理论解释说，当ICS领导者认为自己和其他人负责改善人口健康时，ICS中的领导力就会起作用。目的感是通过清晰的视野来培养的，整个系统的合作伙伴参与问题所有权，并在系统的各个级别建立关系。
结论：尽管进行了严格而全面的调查，利益相关者的投入仅限于一个ICS，可能限制来自不同地理环境的见解。此外,最近建立的ICSs意味着文献的可用性有限，很少进行实证研究。尽管这强调了研究的重要性和原创性，这种稀缺性在提取和应用某些程序理论要素方面提出了挑战，特别是背景。
结论：这篇综述将与英格兰ICS中的学者和医疗保健领导者相关，提供对ICS领导力的重要见解，整合各种证据以制定新的循证建议，填补了当前文献中的空白，并为领导实践和医疗保健系统提供了信息。
