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FMLM is undertaking a research study to understand how chief medical officers understand, experience, and carry out new system leadership roles (ICS CMO) and what impact they have.

The NHS in England has recently restructured with a view to improving collaboration and alignment of health and social care services (NHS England, 2022). Integrated care is perceived as an opportunity to create a sustainable NHS by bringing together health and care professionals to work in partnership with other sectors to improve healthcare outcomes (NHS England, 2022; King’s Fund, 2022). Forty-two integrated care systems (ICSs) have been established across England. ICSs are led and managed by integrated care boards with responsibility for the planning, financial management and provision of healthcare services (NHS England, 2022). Chief Medical Officers are one of several statutory roles on these boards.

Research in healthcare organisations has found positive relationships between medical leadership and healthcare quality, financial and service outcomes (Clay-Williams et al, 2017; Molinari et al, 1995; Prybil, 2006; Goodall, 2011). Increased numbers of doctors on Trust boards have also been associated with improved quality of services (Veronesi et al., 2013). Doctors knowledge of the ‘core business’ of healthcare organisations (Goodall 2011) and their ability to engage fellow medical professionals in quality improvement initiatives (Weiner et al., 1997) have been cited as possible explanations for this relationship.

Research by Jones and Fulop (2021) found that in high performing organisations medical directors undertake several important areas of work. Firstly, the authors found that medical directors have an important role in interpreting and translating their knowledge and experience to Board colleagues and medical staff in the organisation – ‘translation work’ (Jones and Fulop, 2021). Secondly, medical directors undertake ‘diplomatic work’, spending considerable time building and maintaining relationships within and outside of the organisation and utilising their professional and corporate experience to support improvements (Jones and Fulop, 2021). Finally, the authors found that medical directors spent time repairing relationships between medical staff and management and with external organisations – ‘repair work’ (Jones and Fulop, 2021).

Recent reviews have highlighted that system leadership will involve skills to effectively lead in a volatile, uncertain, complex and ambiguous (VUCA) environment, to work collaboratively across organisational boundaries, navigate local politics, and lead and implement change and improvement (Kaehne et al, 2022; Kings Fund, 2022). Whilst the organisational research mentioned above suggests that experienced medical leaders may have a positive impact on organisational outcomes, their impact on leading and improving outcomes in integrated care systems is untested but potentially crucial. The establishment of ICSs presents an opportunity to explore this and understand their contribution and potential contribution to this collective endeavour.

Findings from the research are expected to be shared intermittently over the coming months.

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