IFIC 9 Pillars of Integrated Care
Shared accountability, governance and leadership
This Pillar can feel abstract, but in practice, it is about how decisions are made, who is involved, and how people work together to achieve shared goals.
Governance refers to how decisions are structured: who has a voice, how priorities are set, and how progress is tracked. The design of governance for integrated care is guided by shared decision-making.
Leadership for integrated care creates a shared direction and motivates people across teams, organisations, and communities to work together.
These two elements create accountability for delivering integrated care. They ensure that action happens with -or even by- people and communities, not just for them.
For people and communities
Community sector organisations, citizen leaders and people with lived experience are involved in the governance of integrated care as equal partners. Collaborating with health and care providers and system-level decision-makers, they co-create enabling local policies, oversee integrated care performance, and ensure the integrated care system is accountable to the population. Their involvement in decision-making and leadership roles strengthens the system's legitimacy, equity, and responsiveness, ensuring that services align with the values of people and communities.
For care providers
Care providers are clear in their definition of roles, competencies and responsibilities to ensure effective and safe integrated care delivery. Governance arrangements foster collaboration and integration of care to deliver the shared purpose and goals. Lines of accountability are established, focusing on financial sustainability, value, health outcomes, and people's and communities’ experience of care. Collective continuous monitoring and learning ensures care standards and needs are met. Inter-disciplinary leadership aligns care provision towards people-centred goals, prioritising the integration while maintaining safety, quality, ethical oversight and regulatory compliance.
For system-level decision-makers
System-level decision-makers provide enabling policies and guidance to allow partners to create governance arrangements that cultivate collaboration and cooperation for integration (for example, pooled budgets). These mechanisms are the means through which they collectively share authority, legitimacy and capacity to oversee integrated care across the system and make collective decisions. Leadership at this level also models and promotes collaboration across multiple disciplines and sectors, aligning them with the overarching goals of people- and community-centred care.