Background:
Across Canada, an estimated 5.9 million people lack access to a primary health care provider, underscoring persistent fragmentation within the health system. While federal provincial territorial agreements, remuneration reforms, and investments in team based care signal progress, these efforts alone are insufficient to achieve seamless, equitable, and integrated primary health care. National organizations hold critical levers that can accelerate this transformation, but only if their work is aligned, coordinated, and strategically mobilized. Recognizing this imperative, four national partners the Canadian Medical Association (CMA), Healthcare Excellence Canada (HEC), Health Standards Organization (HSO), and the Canadian Institutes of Health Research’s Institute of Health Services and Policy Research (CIHR IHSPR) have initiated a collaborative approach to drive system level integration and improve population health.

Approach:
This initiative brings together complementary mandates to strengthen the primary health care ecosystem. CMA works to unite physicians and shape policy to improve health system performance; HEC catalyzes improvement through capability building and the spread of innovation; HSO develops national standards and assessment programs that embed quality and safety across care; and CIHR IHSPR drives evidence-informed health system transformation through research and knowledge mobilization. Together, these organizations are coordinating strategies, aligning priorities, and leveraging their respective tools, policy influence, standards development, research investment, and improvement expertise, to accelerate integrated primary care reform. The presentation will share the methods underpinning this collaboration, including joint planning structures, shared problem definition processes, and mechanisms for incorporating patient, caregiver, and provider perspectives.

Results:
Early insights demonstrate that national level alignment can meaningfully strengthen efforts to advance integrated primary health care. Collaboration has surfaced opportunities to reduce duplication, enhance synergy between improvement and regulatory levers, and accelerate the application of evidence into policy and practice. Engagement with patient and caregiver partners reinforces the need for integrated system supports spanning macro, meso, and micro levels, to achieve the quintuple aim and build toward a learning health system. Participants across the initiative emphasize the value of cross organizational coordination in addressing structural barriers, fostering shared priorities, and supporting provinces and territories in implementing sustainable, patient centred primary health care reforms.

Implications:
This work highlights the essential role of national organizations in enabling system wide transformation and advancing equitable access to primary care. It demonstrates that coordinated leadership, evidence informed strategies, and meaningful engagement with patients and caregivers are foundational to achieving integrated care. Next steps include expanding multi partner initiatives, deepening alignment around national priorities, and exploring how this collaborative model can be adapted in other countries pursuing comprehensive primary health care reform. The presentation will offer practical insights into how aligned national efforts can help translate promising policies and innovations into meaningful improvements in care delivery.

Background: Integrated Practice Units (Centros de Responsabilidade Integrados - CRI) in Portugal represent autonomous clinical management structures designed to optimize resource allocation while maintaining integration with broader health services. Despite their operational autonomy, understanding how these units coordinate with other services within Local Health Units is fundamental to realizing effective care integration.
Objectives: This study aimed to map the relationship patterns between CRIs and other health services, examining: (1) frequency and quality of coordination with hospital departments and primary care, (2) communication mechanisms used for inter-service coordination, (3) existence and nature of care protocols linking autonomous units with other services, and (4) barriers and facilitators to effective integration despite organizational autonomy.
Methods: A national survey was conducted across 37 CRIs (Medical=12, Mental Health=11, Surgical=8, Other=5, Emergency=1) focusing on inter-service relationships, coordination mechanisms, and integration challenges within Local Health Units.
Results: While CRIs operate with management autonomy, they maintain variable coordination patterns with other services. Most units (31/37) reported consistent or frequent articulation with hospital departments, though coordination occurred primarily through informal channels (ad-hoc communication) and institutional email (n=30). Emergency departments (n=17) and internal medicine (n=14) were the most frequent hospital partners, while primary care coordination appeared limited. Despite autonomy, teams actively developed inter-service protocols, particularly for internal medicine referrals, emergency liaison, and mental health pathways. Communication mechanisms revealed a hybrid model combining formal tools (clinical reports=27, referral letters=24) with informal channels (WhatsApp groups=25, direct phone lines=18). Significantly, 81% of teams participated in developing access/referral criteria, suggesting efforts to standardize interfaces despite autonomous operations. Major integration needs identified included: coordination with primary care (n=21), shared clinical information systems (n=21), and inter-service communication protocols (n=20). Teams requested support primarily through best practice sharing (n=23) and protocol development (n=17), indicating desire for structured integration frameworks.
Conclusions: Portuguese CRIs demonstrate a paradox of autonomous operation within interconnected systems. While management autonomy enables resource optimization, integration with hospital services remains largely informal and primary care connections are underdeveloped. The predominance of ad-hoc communication and informal digital tools suggests that formal integration mechanisms have not kept pace with organizational autonomy.
Implications for Practice: To optimize the CRI model, Local Health Units should develop formal integration protocols that respect unit autonomy while ensuring systematic coordination. Investment in interoperable information systems, structured liaison roles, and regular inter-service meetings could bridge the gap between autonomy and integration. The strong desire for best practice sharing suggests that CRIs seek balanced models that preserve management flexibility while enhancing care coordination.
Keywords: integrated practice units, autonomous clinical management, inter-service coordination, Local Health Units, care integration, Portugal.

Background
International integrated-care reforms require robust whole-system governance, yet elected politicians' role remains under-researched. Scotland's Health and Social Care Integration positions councillors as voting members of Integration Joint Boards (IJBs), creating a natural laboratory for studying political leadership where traditional hierarchical authority gives way to collaborative governance. This research introduces the 'integrative leader': a nine-dimension framework (vision, inclusivity, participation, pragmatism, cautiousness, engagement, empowerment, adaptive flexibility, innovation) explaining how councillors reconcile democratic accountability with service redesign while managing tensions between political representation and technical expertise.

Aim
To identify how elected councillors exercise leadership within IJBs and determine when their approaches enable or constrain integration outcomes, particularly their navigation of dual accountability to NHS boards and local authorities.

Methods
Qualitative multi-case study across 11 IJB areas. Fieldwork spanned all three regional networks, ensuring variation in socioeconomic deprivation, political control and health-board configuration. Data sources were documentary analysis of 85+ policy documents and audit reports; 22 semi-structured interviews with councillors, chief officers, and senior officials. Contingency and situational leadership theories framed thematic analysis examining five contextual factors: financial pressures, partisan dynamics, political-administrative relationships, geographical variations, and workforce expectations.

Results
Local political leaders demonstrated the 'integrative leader' approach—a new typology characterised by situational adaptation rather than fixed profiles. These leaders fluidly shift between facilitative, directive, pragmatic, and community-advocacy approaches as contexts demand. The integrative leader, embodying all nine dimensions, proves most effective through their adaptive capacity. These leaders excel through four mechanisms:
1. Balance political–managerial tensions, switching between facilitative and directive modes as context shifts
2. Bridging professional boundaries: Creating "safe spaces" for dialogue, transforming GP-nurse tensions into collaborative workforce innovations (particularly crucial in rural areas facing severe staff shortages)
3. Embedding authentic co-production: Moving beyond tokenism through dedicated carer representatives and co-designed "Thrive" programmes, extending voice to seldom-heard groups
4. Adapting to place: Urban boards requiring inclusive facilitation for complex stakeholder landscapes; rural boards demanding pragmatic problem-solving

Synthesising these insights, we propose a Governance-Leadership Matrix that aligns leadership behaviours to contextual risk levels, offering a practical diagnostic for system stewards.

Discussion & Implications
Elected-member leadership provides the "missing link" connecting population accountability with professional authority. This challenges assumptions that political involvement impedes integration. Positioning the Integrative profile as the benchmark clarifies development priorities for councillors and those who train them. Mapping onto IFIC's Pillar 6 (governance) and Theme 4 (workforce/inclusivity), this offers:
• Policy – criteria for selecting and developing councillor leaders (already tabled with Scottish Government directorate of Health and Social care)
• Practice: Self-assessment framework for boards and leadership developers
• International transfer: Guidance for Integrated Care Systems navigating democratic legitimacy and professional complexity, particularly for place-based governance models

Successful integration requires sophisticated political leadership transforming political capital into collaborative advantage.

Keywords: integrated care, political leadership, governance, Integration Joint Boards, Scotland

Background
The Enhanced Community Care programme supports the operationalising of the full end to end Integrated Care programme for the Prevention and management of chronic disease model of care in Ireland . The implementation is built on the nine pillars of Integrated care to implement community based care for chronic disease (type 2 diabetes, respiratory (asthma and COPD) and cardiology at scale across Ireland using a change management approach.


Approach
This paper outlines the approach to creation of shared values and vision through change management approach. In 2021, 30 Chronic disease community specialist teams were newly funded with dedicated specialist multidisciplinary chronic disease staff including: Integrated Care (IC) Consultants which is a new role working across hospital & community; additional nursing & Health and Social Care professionals, and a key role of Operational Lead to manage and co-ordinate the operationalising of services for through new pathways and ways of working.

Change management and clinical guidance to implement the end to end MoC through new pathways and ways of working has been supported and co-ordinated through the National central based team using the HSE Change Guide3 by
• Creating a shared purpose - ensure understanding of the MoC and create commitment to model.
• Stakeholder engagement and planning in each region to ensure stakeholders are involved in the process including patient engagement
• Focus on the people and the culture change –to understand the local context of each team and to move to the new ways of working.

Results
The results of this sustained support and collaboration with the 30 teams has resulted in:
• Teams delivering a range of services for patients with chronic disease to meet population needs.
• Collective approach applied to find solutions to challenges including ICT, equipment, standard operating procedures for pathways.
• Local Chronic disease Governance groups including leadership across community and acute services have been established
• Strong Clinical Leadership at National level and local level HSE regions through network of New Integrated Care Consultants (IC) groups.
• Sustained tailored engagement process designed and implemented all teams and stakeholders
• Monthly engagement with National Operational Leads network focusing on interdisciplinary ways of working and showcasing examples of good practice
• Monthly suite of metrics collected across teams which opportunities for improved productivity through targeted support and change management /service improvement initiatives.
• Patient engagement and involvement through feedback surveys in local teams is used to implement service improvements and increase patient impact of the services.

Implications

Practical change management support across the teams has changed with the evolution of the implementation of the programme, feedback from patient surveys and shared learning across teams. Continued shared learning and service improvement through examples of good practice will continue to increase the impact of services for patients with chronic disease . Focus on increased patient stories and testimonials to demonstrate the impact and benefits of the services for patients with chronic disease and to further co design services into the future.