Making integrated care happen: Middle managers' views on leadership for promoting multidisciplinary collaboration at the early stage of the Finnish social and healthcare reform.

Different forms of health and social care integration are promoted in many countries to address the complex needs of the population. This qualitative study explores integrative leadership from the perspective of middle managers. The study examines how national and regional integration aspirations are converted into micro-level multidisciplinary collaborations through leadership actions in primary health and social services. The study was conducted at the early stages of major social and health services reform in Finland. The data forms a cross-section of 11 interviews with middle-level managers from different sectors in a new wellbeing services county. Thematic analysis revealed that managers view integrated care positively, considering it efficient and useful. Their main goal is to create public value, including cost-efficiency. The managers believe that their task is to promote multidisciplinary collaboration by developing visions, structures and processes that support professionals in implementing changes in daily work. Many aspects of integrative leadership, such as shared goals and collaborative processes, were identified. More contradictory issues, such as tensions and conflicts between stakeholders, complex accountabilities, legitimacy and power imbalances, were almost absent in the data. These issues should be addressed in organisations, and their role should be studied further as a potential barrier to the successful implementation of integrated care.