The need to find practical solutions for integrated care is continuously sought after by policy makers and practitioners. Yet experience tells us that the collaboration needed for integrated care is far from easy. A central issue that arises is often how collaboration is framed, where the ambiguities and uncertainties surrounding the term can gloss over an array of ideas, concepts and mechanisms. Paradox and tensions are often inherent in collaborative working and in this Viewpoint we contemplate how competing metaphors of collaboration have direct relevance to the current integrated care system landscape in England. The review presents these metaphors before going on to assess the leadership implications for those currently engaged with leading collaboration across integrated care settings.
Drawing on policy and practice evidence from the current integrated care system landscape in England, our Viewpoint draws on the tradition of metaphorical analysis and identifies three metaphors that capture how collaboration is currently being understood and enacted within the context of integrated care systems (ICSs).
Our analysis shows that metaphors of efficiency, ecology and mimicry illuminate the paradoxical and dynamic nature of integrated care agendas.
Within the context of integrated care, leadership success will require managing the tensions or dualities of collaboration, reconciling the coordination and engagement with populations and places alongside the demands of market efficiency and government mandates to conform and comply.
Given the pressures being faced across ICSs, the bandwidth to strategise and reflect on any metaphorical tension and paradox remains an extremely challenging one. However, by encouraging a metaphorical mindset, the aim of this Viewpoint is to support leaders by unearthing the mental models that are driving system behaviours. It encourages those leading integrated care agendas to see the less visible forces at work, and provide opportunities for learning and development for workforce and population groups.
We argue that by engaging with metaphors and metaphorical mindset, leaders are better able to understand the characteristics and consequences of collaboration for integrated health systems. The art of leading integrated care is rooted in the ability to combine metaphors in a language and framing for collaboration to develop. We provide practical implications for training and development agendas and call for further research to better understand the translation of metaphors across workforce and population groups.
