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Developing collective leadership for health care


With the NHS facing bigger challenges than ever before, leaders must ensure that cultures within health care organisations sustain high-quality, compassionate and ever-improving care. Key to shaping these cultures is leadership.

This paper argues that collective leadership – as opposed to command-and-control structures – provides the optimum basis for caring cultures. Collective leadership entails distributing and allocating leadership power to wherever expertise, capability and motivation sit within organisations. NHS boards bear ultimate responsibility for developing strategies for coherent, effective and forward-looking collective leadership.

This paper explains the interaction between collective leadership and cultures that value compassionate care, by drawing on wider literature and case studies of good organisational practice. It outlines the main characteristics of a collective leadership strategy and the process for developing this.

Key messages

  • Collective leadership means everyone taking responsibility for the success of the organisation as a whole – not just for their own jobs or area. This contrasts with traditional approaches focused on developing individual capability.

  • If leaders and managers create positive, supportive environments for staff, those staff then create caring, supportive environments for patients, delivering higher quality care.

  • Where there is a culture of collective leadership, all staff members are likely to intervene to solve problems, to ensure quality of care and to promote responsible, safe innovation.

  • Organisational performance does not rest simply on the number or quality of individual leaders. Research shows that where relationships between leaders are well developed, trusts will benefit from direction, alignment and commitment.

  • Vision and mission statements must be translated into clear, aligned, agreed and challenging objectives at all levels of the organisation, from the board to frontline teams and individuals.

Policy implications

  • The process of developing a collective leadership strategy must begin with the board since the scale of the change process and resources required demand complete commitment from the most senior leaders.

  • A collective leadership strategy focuses on the skills and behaviours that leaders will bring to shape the desired culture, including generic and specific behavioural competencies. It also designs systems for ensuring leaders act together.

  • Collective leadership implies all staff welcoming feedback, treating complaints and errors as opportunities for system learning rather than as prompts for blame. This encourages collective openness to and learning from errors, near misses and incidents.