Emerging Competencies for Leading and Managing Integrated Systems of Care in a post-COVID world: What’s next?

Earlier this year, we published our first blog “Reflections in a Time of Crisis: What it Takes to Manage and Lead Integrated Systems of Care”. In our second blog, we expand on the leadership lessons we are learning during the COVID-19 pandemic and consider how leadership and management are changing to shape the future of integrated care and, ultimately, population health.

Our reflections on the emerging future state are informed by roundtable discussions with participants at the 2020 and 2021 International Conferences on Integrated Care (ICIC) and our own experiences leading transformation at local and international levels. At ICIC20, we highlighted a missing piece in our existing competency frameworks – the ability to design and implement clear, effective mechanisms for accountability as we move towards more distributed leadership. At ICIC21, we went deeper in our discussions of the impact of COVID-19. We invited participants to share stories of both exemplary and poor crisis leadership through the pandemic. This led us to identify additional critical shifts in our healthcare environment and the implications for leaders and managers:

  • Health and social inequities are more evident…and growing – COVID has exacerbated the gross inequities that already existed within our populations at local, national, and global levels. Creating more integrated systems of care is a critical means to address inequities and improve population health. The need to make health and social care, as well as the rest of society, more equitable is a daunting leadership challenge for all of us.
  • The pace of change has accelerated – The pressure for more rapid transformation was mounting before COVID and has only accelerated with the global pandemic. Our traditional approaches to quality improvement, evaluation, change and learning, such as extended research studies and plan-do-study-act (PDSA) cycles, are becoming less practical and therefore, less valuable. Instead, we need to be open to emergent ways to tackle pressing needs and embrace uncertainty by enabling widespread interactions, co-creating and co-delivering solutions, using rapid learning cycles, being more accepting of trial and error, and adapting as we go.
  • Focus needs to shift from service improvement to system transformation – The large-scale activity required to address COVID outbreaks and mount population-wide testing and vaccination has illustrated that, at least in some parts of the world, we have the capacity to transform our health and social care systems at scale, powered by the right resources, policy, and leadership, as well as a compelling, shared goal. The efforts and skill set we have used to collaborate in battling COVID-19 are likewise needed to accelerate systems integration.
  • The power of networks and communities is being realized – It has taken collaboration on a massive scale to address the COVID-19 pandemic. Out of necessity we have built new connections and pulled together leaders from different sectors, partners, and communities. Shared power and distributed leadership are the opposite of the command-and-control-type structures that are the usual response to crisis management. As one of our conference participants commented “The uncertainty of a pandemic era has led some to “stockpile” their power, and so we need to be brave enough to step forward together.” The same level of collaboration and distribution of power and leadership we have observed in some jurisdictions during COVID will be needed in integrated systems of care to truly drive improvements in population health.
  • Communication is key – The pandemic has underscored the power of communication, including both mainstream media and social media, and the devastating impact of misinformation. Evidence and heartfelt stories from the front-lines of healthcare have been in direct competition with falsehoods, denial, and conspiracy theories. Media have divided along political lines and this has highlighted how calm, clear and honest communication is a critical skill for managing through the crisis. Going forward, we need to become much better at bringing people together through open and transparent communication, listening, and inviting criticism, while credibly debunking misinformation.
  • Nothing for the people without the people – Synthesising the previous points, the pandemic has highlighted on a massive scale that no system can work effectively without sustained collaboration across citizens and service providers. Building and maintaining trust are among the most important tasks of leaders and managers, and this can only be achieved through active involvement and open dialogue. This includes making space for diverse voices and being creative in connecting with populations that often struggle to be heard.

The feedback from the conference discussions as well as our own reflections on the past 20 months of the global pandemic have led us to expand the existing list in our first blog on emergent skills for leading integrated care, including:

  • Connecting with people (staff, patients, partners, communities) in creative ways and through a variety of media
  • Embracing uncertainty and change through rapid learning cycles
  • Presenting data and information in a meaningful and accessible way
  • Being reflexive, adaptive, and nimble (now more than ever)
  • Seeking, recognizing, and utilizing assets from a diverse range of partners
  • Using ‘abundance theory’ to help keep people focused on what’s most important
  • Harnessing the new power of networks and communities through distributed leadership

As we emerge from the COVID-19 pandemic we are reshaping the future of integrated systems of care to achieve improved population health and well-being. We have much to consider in addressing the challenges that lay ahead and the skills that our leaders and managers will need to help us chart a path forward.

Our third interactive session will take place at ICIC22. We invite you register for the conference and participate in our continued exploration of what it will take to truly improve population health through integrated systems of care.

Join the conversation! Share your perspectives on our questions, or add new questions to the dialogue:

  • How do you see leadership and management changing as we emerge from the acute phase of the pandemic?
  • How will leadership and management skills need to change as virtual ways of working become the new normal?
  • In our new context, how can we support managers and leaders to develop their competencies and see emerging opportunities?


Anne Wojtak
East Toronto Health Partners


Viktoria Stein
VM Partners Integrating Health and Care
Leiden University Medical Center


Jodeme Goldhar
IFIC Board
IFIC Canada


Prof Robin Miller
University of Birmingham