Clinical leadership and integrated primary care: A systematic literature review

Background: Leaders are needed to address healthcare changes essential for implementation of integrated primary care. What kind of leadership this needs, which professionals should fulfil this role and how these leaders can be supported remains unclear.
Objectives: To review the literature on the effectiveness of programmes to support leadership, the relationship between clinical leadership and integrated primary care, and important leadership skills for integrated primary care practice.
Methods: We systematically searched PubMed, CINAHL, Embase, PsycINFO until June 2018 for empirical studies situated in an integrated primarycare setting, regarding clinical leadership, leadership skills, support programmes and integrated-care models. Two researchers independently selected relevant studies and critically appraised studies on methodological quality, summarized data and mapped qualitative data on leadership skills.
Results: Of the 3207 articles identified, 56 were selected based on abstract and title, from which 20 met the inclusion criteria. Selected papers were of mediocre quality. Two non-controlled studies suggested that leadership support programmes helped prepare and guide leaders and positively contributed to implementation of integrated primary care. There was little support that leaders positively influence implementation of integrated care. Leaders’ relational and organizational skills as well as process-management and change-management skills were considered important to improve care integration. Physicians seemed to be the most adequate leaders.
Conclusion: Good quality research on clinical leadership in integrated primary care is scarce. More profound knowledge is needed about leadership skills, required for integrated-care implementation, and leadership support aimed at developing these skills.

背景：推进整合式基层医疗（integrated primary care）的落地亟需相关领导者应对医疗体系变革，但目前仍存在诸多待明确的问题：此类场景所需的领导力类型、应承担该角色的专业人员类别，以及如何为这类领导者提供支持均尚未明晰。
研究目标：系统梳理相关文献，涵盖支持类领导力项目的有效性、临床领导力（clinical leadership）与整合式基层医疗间的关联，以及整合式基层医疗实践所需的关键领导力技能。
研究方法：本研究于2018年6月前系统检索PubMed、CINAHL、Embase、PsycINFO数据库，筛选针对整合式基层医疗场景下、围绕临床领导力、领导力技能、支持性项目及整合医疗模式的实证研究。由两名研究者独立筛选相关文献，对文献的方法学质量进行严格评价，汇总定量数据并对领导力技能相关的质性数据进行归纳梳理。
研究结果：本研究共检索到3207篇文献，经摘要与标题初筛后纳入56篇，其中20篇符合纳入标准。纳入文献的方法学质量整体中等。两项非对照研究显示，领导力支持项目有助于培养并指导相关领导者，对整合式基层医疗的落地起到了积极推动作用。但尚无充分证据表明领导者能够对整合医疗的落地产生积极影响。研究认为，领导者的关系协调与组织管理能力，以及流程管理与变革管理技能，对提升医疗整合效果至关重要。医师似乎是最适配该领导角色的专业群体。
研究结论：针对整合式基层医疗场景下临床领导力的高质量研究较为匮乏。当前仍需进一步深化对整合医疗落地所需领导力技能，以及旨在培养此类技能的领导力支持项目的认知。