Collective and compassionate leadership

An extract from 'Compassionate leadership: Sustaining wisdom, humanity and presence in health and social care', by Michael West, published by Swirling Leaf Press.

Traditional approaches to leadership have important limitations, with an emphasis on developing individual capability while neglecting collective leadership capability. They are also limited in that they can hamper the dialogue, debate and discussion that enable a shared understanding about care quality problems and solutions. Compassionate leadership, in contrast, enables all to feel they have leadership responsibility, rights, and accountability, effectively ensuring the skills of all are harnessed in the delivery of high-quality care. This chapter describes how compassionate leadership enables collective leadership: all contributing to leadership; shared leadership in teams; leaders working collaboratively across boundaries; and consistent approaches to leadership across the leadership community of health and social care organisations. 

Collective leadership focuses on ensuring dialogue and encouraging and enabling all staff to adopt leadership roles in their work1,2. They are then more likely to take individual and collective responsibility for delivering safe, effective, high-quality and compassionate care for patients and service users. In health and social care delivery or corporate services, monitoring safety and quality is far more effective when these responsibilities are owned, managed and promoted by the staff who deliver those services. This has long been the practice in other industries that recognise that local ownership and management of quality and safety issues is far more effective than top-down control. 

In compassionate and collective leadership cultures, responsibility and accountability function simultaneously at both individual and collective levels. They breed regular reflective practice focused on failure, exploratory learning and making continuous improvement an organisational habit3. By contrast, command-and-control leadership cultures invite the displacement of responsibility and accountability onto single individuals, which can lead to scapegoating and climates of fear of failure, rather than an appetite for innovation. 

Leadership comes from both the leaders themselves and the relationships among them. Organisational performance does not rest simply on the number or quality of individual leaders. What counts is the extent to which formal and informal leaders work collectively in support of the organisation’s goals and in embodying the values that underpin the desired culture. Leadership also incorporates the concept of followership – everyone supporting each other, including leaders, to deliver high-quality care, and everyone taking responsibility for the success of the organisation or system1,2,4,5.

Why collective leadership?

Leaders can use their privileged positions to acquire more power and limit others’ access to it, and we see many examples of this in political leadership and in work organisations. It is referred to by researchers as ‘personalised power’. This approach includes acquiring information that is of value to others and not making it available; building cabals that accumulate power, information and resources; undermining others’ power and success; using aggression and intimidation overtly or subtly; and manipulating uncertainty in difficult situations to accrete power and influence. Such leadership may also focus on sustaining, extending or strengthening hierarchies so that leadership power is protected or enhanced6.

Compassionate leadership is the opposite of personalised power. Compassionate leadership involves seeking to share power and resources so that leadership is deployed most effectively in delivering health and social care services - what is called ‘socialised power’. The focus of compassionate leadership in health and social care is on ensuring the provision of high-quality, continually improving and compassionate health and social care services for those in our communities. It is also focused on providing high-quality, continually improving and compassionate support for the staff who provide that care. 

Collective leadership is focused on engaging all in leadership and decision-making in health and social care – effectively promoting staff engagement5. Engagement at work is characterised by strong identification with the organisation and a drive to be involved in decision-making and innovation – in the case of health and social care, to improve the quality of care7,8. Data from the NHS England National Staff Survey reveals that staff engagement trumps all other measures as the best overall predictor of NHS Trusts’ outcomes. It predicts care quality and financial performance (based on Care Quality Commission ratings), patient satisfaction, and patient mortality (in the acute sector)8,9

Leaders help create the conditions for high levels of staff engagement through compassionate leadership and by: 

• Promoting a positive climate 

• Recognising staff contributions 

• Providing information relevant to people’s jobs

• Giving helpful feedback 

• Supporting staff innovation 

• Promoting fairness and transparency 

• Developing trusting relationships8-10.

Sustaining cultures of high-quality care involves all staff focusing on continual learning and improvement of patient care, ‘top to bottom and end to end’, and thereby taking leadership responsibility for improving quality11. The same applies to staff ‘continually and forever reducing harm’ - ensuring reflective practice is endemic and taking responsibility for giving both positive and negative feedback on safety behaviours to colleagues (regardless of seniority). 

Compassionate leadership seeks to ensure that everyone has and feels responsibility for leading in service of the communities cared for by health and social care organisations. It is manifested in an ethos of shared leadership in teams (which is explored in more depth below). There is also a focus on collective leadership, whereby leaders work together across boundaries (teams, departments, organisations and sectors) to collectively deliver for the communities they jointly serve. This involves prioritising the delivery of high-quality care overall, rather than focusing exclusively on the success of one’s own specific area of delivery, potentially at the expense of others. It also involves consistent approaches to leadership characterised by authenticity, openness, optimism, humility, appreciativeness and of course, compassion. 

When we consider traditional leadership in the context of healthcare, there is an obvious paradox. The NHS in the UK has the largest, most skilled and motivated workforce in any area of industry – 1.4 million people, the vast majority of whom are highly educated and skilled. They are also a group of people who have dedicated a large proportion of their precious, unique lives to caring for those around them by becoming healthcare professionals. Highly motivated and skilled people do not need command and control environments to do their jobs well – on the contrary, it will undermine their motivation and well-being1,12. Yes, they need an overall direction for their work, but they are well able to determine goals, gather feedback and develop new and improved ways of delivering services. Yet, the NHS is probably more hierarchical than any other sector. Take nursing for example. In a typical hospital setting, there may be as many as five levels of nursing hierarchy on a ward alone. 

During the covid-19 pandemic, there have been many examples of hierarchies being blurred or erased altogether. Frontline healthcare and corporate teams have developed new and improved ways of working at scale and pace, freed from some of the constraints of hierarchy and bureaucracy. Consequently, hospitals, primary healthcare teams, mental health services and community healthcare organisations have adapted quickly and effectively to respond to the crisis. 

It is important that this learning shapes the future of services. Reverting to the past should not be an option – we need to transform rigid hierarchies and excessive bureaucracies to ensure more collective, enabling and empowering leadership across our health and social care organisations. This is intrinsic to compassionate leadership. Compassionate leadership involves helping and valuing others as much as we would help and value ourselves. 

The arguments above imply a collective approach to leadership: leadership of all, by all, and for all. 

Such collective leadership is characterised by constant changes in leadership and followership, dependent on the task at hand or the unfolding situational challenges. There is still a formal hierarchy, but the ebb and flow of power is dependent on expertise at each moment.

Collective leadership in practice involves:

  • Enabling all to lead
  • Shared team leadership
  • Leaders working together across boundaries
  • Leaders working with the community
  • Consistent leadership styles and values.

Enabling all to lead

Collective leadership means the distribution and allocation of leadership power to wherever expertise, capability and motivation sit within (or outside) organisations1. Collective leadership ensures that leadership and expertise are correlated at every level in relation to every task. This means that, regardless of rank, status, pay band or title, those with expertise, skills or experience relevant to the task in hand, are naturally accorded leadership rights and responsibilities. The domestic worker who raises an issue to do with hygiene in the ward should have as much power in initiating action as the chief executive in their shared commitment to safe patient care. Collective leadership means valuing everyone’s voice in healthcare, not just that of those with senior hierarchical ranks13.

The purposeful, visible distribution of leadership responsibility onto the shoulders of every person in the organisation is vital for creating the type of collective leadership that will nurture the right culture for healthcare14. In such a culture, roles of leadership and ‘followership’ shift depending on the situation. 

Compassionate leadership is the means for achieving this -where everyone is given attention and listened to; staff seek to understand each other’s perspectives and opinions; people put themselves in each other’s position by empathising and caring; and everyone seeks to help their colleagues regardless of seniority.

Shared team leadership

There is considerable evidence that shared leadership in teams consistently predicts team effectiveness, particularly but not exclusively within healthcare15-17. There may be a formal hierarchical leader, such as the senior partner in a primary healthcare team or the ward manager in a hospital setting, but they enact their roles through ensuring all team members contribute their knowledge, skills, experience and abilities to the work of the team. Leadership shifts seamlessly in work processes depending upon who has the relevant expertise for the task in hand. Sometimes this might be the practice nurse; at other times, the practice manager. Such collective or shared team leadership is associated with better performance and is markedly different to team interactions where one or two people dominate discussion and decision-making while other team members sit silently or passively. Compassionate leadership in teams is enacted by modelling and encouraging all to listen to each other’s contributions, understanding the roles of other team members, nurturing a supportive caring environment, and developing an ethos in which team members support each other or back each other up, particularly when the work is demanding or unusually difficult.

Leaders working together across boundaries

Collective leadership also refers to leaders working together across boundaries, focused on how to support each other and how to sustain a collective leadership culture across the organisation (or system). This involves seeing leadership as not simply an individual capability or characteristic, but as collective. Leadership across an organisation exists collectively to ensure direction (what we are trying to achieve), alignment of efforts in service of that purpose, and commitment of all founded on high levels of trust and motivation18. Collective leadership as a concept, therefore, emphasises the function of that collective in nurturing and sustaining direction, alignment, and commitment.

In practice, what that also requires is that leaders work together to prioritise overall health and social care services, rather than focusing only on their own areas of responsibility. It requires leadership to encourage attentiveness to the outcomes for the people the system serves, not the narrow outcomes of their own service, potentially at the expense of the effectiveness of other parts of the system. 

For example, it is important that primary and secondary care services work together to ensure high-quality care for patients. If primary care services become more concerned with reducing workload and referring people to secondary care as a way of achieving that, it simply leads to secondary care being swamped by inappropriate referrals. And if secondary care consultants do not work with primary care staff to help develop both appropriate referral decision-making and post-treatment primary care management, patients’ needs are not well met. Collective leadership should be implemented beyond the boundaries of specific teams or organisations and beyond the personnel of specific organisations. 

Collective leadership is enabled by the behaviours that constitute compassion, of course – listening carefully to each other; understanding the other’s challenges; empathising with the other leader(s) or service providers; and always asking the question ‘How can we help?’. A collective leadership strategy emerges from a conscious and intelligent effort to plan for an integrated, collective network of leaders, distributed throughout the organisation or system and embodying shared values and practices19-21.

The aim of the strategy must be to create a leadership community in which all staff take responsibility for nurturing cultures of high-quality and compassionate care. The strategy requires all staff to prioritise the effectiveness of the organisation and sector in creating this culture, rather than focusing only on individual or team success. Every member of staff has the potential to lead at many points in time, particularly when their expertise is relevant to the task in hand. Conscious, deliberate attention must be paid to enabling people at every level within the organisation to adopt leadership practices that nurture the collective leadership cultures that the health and social care system requires. 

Leadership with the community 

Collective leadership describes how the whole health and social care system and the community can forge an interdependent network of organisations that work together to deliver high-quality care. Because health and social care organisations can no longer work in isolation to achieve the best possible care, their cultures must support interdependent working within and across the system. We saw this during the covid-19 pandemic with the health and social care sectors working more closely together; homeless people being housed in private hotels; over a million volunteers supporting the health service; and the development and distribution of vaccinations in a dramatically foreshortened time, as a result of collective leadership across boundaries.

Refugee health in Lebanon: GOAL partnership

There are over one million Syrian refugees living in Lebanon (making up 30% of the country’s population), with the majority living in Lebanon for over five years. Consequently, the country has high unmet mental health needs among refugees and the host population. Its government has offered only fragmented health policy responses. 

Designing effective mental health services requires collective and compassionate leadership, including the close involvement of Syrian refugees and Lebanese living with mental disorders. GOAL is a partnership set up by the National Mental Health Program of Lebanon, the London School of Hygiene and Tropical Medicine, ABAAD, St Joseph’s University of Beirut, War Child Holland, and Positive Negatives. GOAL applies a co-production approach, with key stakeholders centrally involved in the project design and implementation. The overall aim of GOAL is to support government and partners in strengthening the ability of health systems to meet the mental health needs of refugee and host communities affected by protracted displacement, focusing on Lebanon.https://www.lshtm.ac.uk/research/centres-projects-groups/goal

Bromley by Bow Centre

In London, the combined Bromley by Bow Centre and Health Partnership have developed various community engagement interventions, based on collective and compassionate leadership, intended to respond to locally identified health needs and aspirations. They have developed new relationships between patients and professionals and new ways to do consultations, manage the workload, and support patients in managing their own health. Their innovative approaches represent a shift from a service provider model, to a model based on identifying, supporting, and growing community assets and capabilities. 

They have created ‘East Exchange’, an initiative which builds community resourcefulness and resilience through bringing together hundreds of local people to collaborate, matching individual and community needs and capabilities. Through this and other projects, they support community innovation and nurture the capabilities of local people, especially of those who are socially isolated, have low skill levels, and/or are unemployed. https://bjgp.org/content/68/672/333


Well Communities
This is another innovative framework that enables collective leadership by supporting disadvantaged communities and local organisations to work together in improving health and well-being, building community resilience and reducing inequalities. The framework has been implemented in 33 London neighborhoods across 20 London boroughs. 

The vision is of empowered local communities, who have the skills and confidence to take control of and improve their individual and collective health and well-being. They are achieving this by developing a robust framework for community action for health and well-being that influences policy and practice, to enhance well-being and reduce health inequalities. Key to the approach are whole systems, holistic and assets-based working, community participation and action, community development and capacity building.

Well Communities builds and strengthens the foundations of good health and well-being by:

  • Increasing community participation and volunteering in activities that enhance health and well-being through a range of community engagement and development processes
  • Building individual and community knowledge, confidence, cohesion, sense of control and self-esteem, which underpin health and well-being
  • Stimulating the development of formal and informal community and social support networks, which are key to mental well-being and resilience
  • Providing a coherent framework for, integrating with and adding value to existing activities, ensuring value for money
  • Building individual, community and organisational resources to develop and deliver activities. 

http://wellcommunities.org.uk/

Consistent leadership styles and values

Collective leadership also refers to developing consistency in leadership cultures. Such cultures are developed when all or most leaders portray the same fundamental values or styles of leadership. Based on research evidence, this would most appropriately include authenticity, openness and honesty, humility, optimism, appreciativeness and, of course, compassion10.

Collective leadership at Wrightington, Wigan and Leigh NHS Foundation Trust: empowering dialogue 

The journey to staff engagement at Wrightington, Wigan and Leigh NHS Foundation Trust began 18 years ago as a joint initiative between senior managers and staff to increase mutual understanding and bridge hierarchical divides. 

Directors’ ‘walkabouts’ give them the opportunity to listen to staff at the frontline and give staff regular opportunities to talk directly to the senior team. This engagement is greatly strengthened by large-scale staff listening events led by the chief executive and other directors. Staff are asked three questions: what works well, what needs to improve, and what are the barriers to improvement? 

A team-focused practice of collective leadership is the ‘Pioneer Teams’ programme, with staff running their own listening events and implementing local changes to improve services. Teams are encouraged to come together for 15 minutes on a daily basis to determine priorities, provide updates, address problems and recognise and appreciate successes. They record their progress visually at a central point to keep the whole team updated.

The trust has seen major sustained improvements in staff survey scores, sickness absence levels and expenditure on temporary staffing, as well as many benefits for patients, including improvements in patient care. 

More information in an online video: http://bit.ly/1dB2fwO


Conclusion
In summary, collective leadership founded on the four compassionate leadership behaviours helps create cultures in which high-quality, compassionate care can be delivered by encouraging all staff to play a role in leading. 

This is fundamentally important in healthcare because mastery of quality and patient safety sciences and practices is everyone’s responsibility. It occurs where there are high levels of dialogue, debate and discussion about quality and safety across the organisation (top to bottom and end to end) to achieve a shared understanding about quality problems and solutions22-24. This is precisely what collective leadership implies. Similarly, all staff will feel safer and encourage, welcome, and explore feedback and treat complaints and errors as opportunities for system learning rather than as a prompt for blame. This collective openness supports learning from errors, near misses and incidents. 

Shared leadership in teams is a strong predictor of team performance16. Where multi-professional teams work together with an ethos of shared leadership, patient satisfaction is higher, healthcare delivery is more effective, there are higher levels of innovation in the provision of new and improved ways of caring for patients, lower levels of staff stress, absenteeism and turnover, and more consistent communication with patients25-28.

Leadership that ensures effective team and inter-team working (both within and across organisational boundaries) is essential if health and social care organisations are to meet the challenges ahead. Creating such cultures requires a conscious, collective approach to ensuring that the right leadership is in place to nurture the right values with the right behaviours. This can be achieved by implementing a compassionate and collective leadership strategy sustained now and for the long-term future. 

- Michael West is Professor of Organisational Psychology (Lancaster University Management School) and Visiting Fellow with the King’s Fund. See also this piece on compassion in the NHS from 2019., and find much more on compassion and leadership in our archive.

Extract is from West, M. A. (2021). Compassionate leadership: Sustaining wisdom, humanity and presence in health and social care. London: Swirling Leaf Press, with kind permission. Buy the book here. For your chance to win a copy, keep an eye on our Twitter feed.

Resources

Exercises/Discussion questions (to reflect on or discuss with a colleague)

  1. What is collective leadership?
    To what extent are all enabled to lead in your organisation, department or team? How could this be improved?
  2. To what extent is there shared team leadership in your team? What would have to change for team leadership to be better shared in your team? What can you do (alone or with others) to influence this?
  3. Where in your organisation do leaders work well together across boundaries, and where is it not happening? What would most help to transform the least effective into the most effective cross-boundary working? What can you do (alone or with others) to influence this?
  4. To what extent does the leadership in your organisation involve communities in the genuine co-design and co-ownership of health and social care services? How could this be improved and what can you do (alone or with others) to make a significant difference?
  5. How consistent are leadership styles and values across your organisation, in relation to authenticity, openness and honesty, humility, optimism, appreciativeness and compassion?

Questionnaires

Collective leadership – the health and social care systems of all four UK nations have a commitment to developing collective as well as compassionate and inclusive leadership. Here you can find a questionnaire already used successfully (in terms of reliability and validity) in NHS organisations. Either the complete measure or a shortened four item version (with just those items marked with an asterisk) can be used.  

  1. Leaders here prioritise overall patient/service user care, not just their own work area.* 
  2. Leaders across different departments work together to ensure high-quality overall patient/service user care. 
  3. Leaders here go out of their way to help each other across different departments to provide high-quality care. 
  4. Everyone in this organisation is expected to act as a leader in ensuring high-quality care.* 
  5. Team leaders encourage everyone to lead changes in order to improve the work we do. 
  6. We all play a leadership role in our teams in this organisation.* 
  7. We all listen to each other's views so we can best lead this organisation.* 
  8. Leadership in teams is shared rather than the responsibility of only one person. 

Websites

The Collective Leadership and Safety Cultures (Co-Lead) programme

This is a five-year University College Dublin research project that aims to develop and test the impact of collective leadership in healthcare on team performance and patient safety. Co-Lead’s approach develops the team as a dynamic leadership entity and is based on the premise that healthcare is delivered through teamwork, and teams should share responsibility and accountability for quality and patient safety. Co-Lead takes a systems approach, recognising healthcare as a complex system and identifying key points and levels of intervention as essential to enabling a collective leadership approach to create a change in culture. It is working with seven hospital groups, emphasising the importance of networks in delivering integrated, safe care. 

Health and Social Care Collective Leadership Strategy, Northern Ireland Northern Ireland introduced a collective leadership strategy for all of health and social care in 2017 with an emphasis on compassionate leadership, leadership being everyone’s responsibility, interdependent leadership (collaborative leadership across boundaries) and shared leadership in and across teams. Evaluations of progress have been undertaken using the Culture Assessment Tool. This inspirational initiative, led by Myra Weir, is helping to develop work contexts in health and social care that enable the core work needs of staff to be better met and promote staff voice, influence and innovation. 

The Collective Leadership Institute (CLI)

CLI empowers people at the individual level by building the competence for collective leadership and stakeholder collaboration, as well as dialogue expertise. Additionally, CLI builds competence at the systemic level by strengthening the collective capacity of collaborating actors to implement dialogic change and shift towards more co-creation. CLI offers capacity building through open courses, tailor-made courses, online learning, the Young Leaders for Sustainability programme and the training of facilitators.

NHS England/Improvement: Culture and Leadership resources

NHSE/I offers a comprehensive set of evidence-based and open-source tools to support health and social care organisations to develop a culture and leadership strategy. The tools focus on developing individual and collective leadership, emphasising the value of compassion. The process involves three stages for organisations to work through: discovery, design and implementation. This is being implemented by over 100 NHS organisations across the UK as well as by health and social care organisations in other countries. The materials can be found at this site:

The Compassionate Leadership Interview

Chris Whitehead interviews public, private and third sector leaders who have adopted compassionate and collective leadership approaches. This builds on Chris Whitehead’s book Compassionate Leadership that combines life experience, psychology and neuroscience for leaders seeking to learn how to create supportive workplaces. It is based on the observation that people thrive when they are involved and listened to, when they are growing and developing and when they are motivated by the vision of the organisation. 

New Local

New Local is an independent think tank and network with a mission to transform public services and unlock community power. Its recent report ‘Community Power: The Evidence’ is the first research to take a comprehensive view of what community power looks like – featuring examples from across the UK and internationally. It is also the first to collect and analyse existing evidence of the impact of community power. 

Videos

Collective leadership culture change in the NHS. Michael West explains that to continually improve health and social care, we must design collective leadership into NHS strategy – encouraging the participation and involvement of all NHS staff. (5 minutes 43 secs)

Graeme Currie, Warwick Business School, describes the notion of leadership as ‘distributed’ or ‘collective’. (5 minutes 33 secs)

Collective and compassionate leadership in public services - ‘Nurturing work cultures for people and performance’. Michael West speaks to leaders from the Northern Ireland Civil Service. (15 minutes)

A CCL perspective on collective leadership. Rachael Hanley-Browne, CCL’s Regional Director UK and Ireland, speaking at the Corporate Research Forum Spring Symposium in 2013 and arguing that leadership comes from the bottom, the middle and the top, but begins with leadership of self. (2 minutes 24 secs)

References and Further Reading

  1. Curtis, E. A., Beirne, M., Cullen, J. G., Northway, N., & Corrigan, S. (Eds.). (2021). Distributed leadership in nursing and healthcare: Theory, evidence and development. London: Open University Press.
  2. West, M. A., Lyubovnikova, J., Eckert, R., & Denis, J. L. (2014). Collective leadership for cultures of high-quality healthcare. Journal of Organizational Effectiveness: People and Performance, 1(3), 240-260.
  3. McAuliffe, E., De Brún, A., Ward, M., O’Shea, M., Cunningham, U., O’Donovan, R., McGinley, S., Fitzsimons, J., Corrigan, S., & McDonald, N. (2017). Collective leadership and safety cultures (Co-Lead): protocol for a mixed-methods pilot evaluation of the impact of a co-designed collective leadership intervention on team performance and safety culture in a hospital group in Ireland. BMJ Open, 7(11), e017569. 
  4. Eckert, R., West, M. A., Altman, D., Steward, K., & Pasmore, B. (2014). Delivering a collective leadership strategy. London: Center for Creative Leadership/The King’s Fund. 
  5. West, M. A., Steward, K., Eckert, R. & Pasmore, B. (2014). Developing a collective leadership strategy for health care. London: Center for Creative Leadership/The King’s Fund.
  6. Woods, S. & West, M. A. (2019). The psychology of work and organizations (3rd edition). London: Cengage.
  7. Bakker, A. B. (2011). An evidence-based model of work engagement. Current Directions in Psychological Science, 20(4), 265-269. 
  8. West, M., & Dawson, J. (2012). Employee engagement and NHS performance. The King's Fund. https://www.kingsfund.org.uk/sites/default/files/employee-engagement-nhs-performance-west-dawson-leadership-review2012-paper.pdf
  9. Dawson, J. (2018). Links between NHS staff experience and patient satisfaction: Analysis of surveys from 2014 and 2015. London: NHS England.
  10. West, M. A., Armit, K., Loewenthal, L., Eckert, R., West, T., & Lee, A. (2015). Leadership and leadership development in health care. London: Faculty of Medical Leadership and Management and The King’s Fund, Brussels: Center for Creative Leadership. 
  11. National Advisory Group on the Safety of Patients in England. (2013). A promise to learn - a commitment to act. Department of Health and Social Care.
  12. West, M. A., Topakas, A., & Dawson, J. F. (2014). Climate and culture for health care performance. In B. Schneider & K. M. Barbera (Eds.), The Oxford handbook of organizational climate and culture. (pp. 335-359). Oxford: Oxford University Press. 
  13. De Brun, A., Anjara, S., Cunningham, U., Khurshid, Z., MacDonald, S., O’Donovan, R., Rogers, L., & McAuliffe, E. The collective leadership for safety culture (Co-Lead) team intervention to promote teamwork and patient safety. International Journal of Environmental Research and Public Health, 17(22), 8673.
  14. McCauley, C. (2011). Making leadership happen. Greensboro, NC: Center for Creative Leadership.
  15. Aime, F., Humphrey, S., DeRue, D. S., & Paul, J. B. (2014). The riddle of heterarchy: Power transitions in cross-functional teams. Academy of Management Journal, 57(2), 327-352. 
  16. D’Innocenzo, L., Mathieu, J. E., & Kukenberger, M. R. (2016). A meta-analysis of different forms of shared leadership–team performance relations. Journal of Management, 42(7), 1964-1991.
  17. Carson, J. B., Tesluk, P. E., & Marrone, J. A. (2007). Shared leadership in teams: An investigation of antecedent conditions and performance. Academy of Management Journal, 50(5), 1217-1234. 
  18. McCauley, C., & Fick-Cooper, L. (2020). Direction, alignment, commitment: Achieving better results through leadership. Greensboro, NC: Center for Creative Leadership.
  19. Browning, H. W., Torain, D. J., & Patterson, T. E. (2011). Collaborative health care leadership. Greensboro, NC: Center for Creative Leadership. 
  20. Ham, C., Baker, G. R., Docherty, J., Hockey, P., Lobley, K., Tugendhat, L., & Walshe, K. (2011). The future of leadership and management in the NHS: No more heroes. London: The King’s Fund. 
  21. Ham, C. (2014). Reforming the NHS from within. Beyond hierarchy, inspection and markets. The King’s Fund. https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/reforming-the-nhs-from-within-kingsfund-jun14.pdf
  22. Chassin, M. R., & Loeb, J. M. (2013). High-reliability health care: Getting there from here. Millbank Quarterly, 91(3), 459-490.
  23. Dixon-Woods, M. (2019). How to improve healthcare improvement - an essay by Mary Dixon-Woods. British Medical Journal, 367, I5514.
  24. Liberati, E. G., Tarrant, C., Willars, J., Draycott, T., Winter, C., Kuberska, K., Paton, A., Marjanovic, S., Leach, B., Lichten, C., Hocking, L., Ball, S., & Dixon-Woods, M. (2020). Seven features of safety in maternity units: A framework based on multisite ethnography and stakeholder consultation. BMJ Quality & Safety.
  25. Lyubovnikova, J., West, T. H., Dawson, J. F., & West, M. A. (2018). Examining the indirect effects of perceived organizational support for teamwork training on acute health care team productivity and innovation: The role of shared objectives. Group & Organization Management, 43(3), 382-413. 
  26. Lyubovnikova, J., West, M. A., Dawson, J. F., & Carter, M. R. (2015). 24-karat or fool’s gold? Consequences of real team and co-acting group membership in healthcare organizations. European Journal of Work and Organizational Psychology, 24(6), 929-950. 
  27. West, M. A. & Lyubovnikova, J. R. (2013). Illusions of team working in health care. Journal of Health Organization and Management, 27(1), 134-142. 
  28. West, M. A., & Markiewicz, L. (2016). Effective team working in health care. In E. Ferlie, K. Montogomery & A. R. Pedersen (Eds.), The Oxford handbook of health care management. (pp. 231-252). Oxford University Press. 

See also:

1. Bolden, R. (2011). Distributed leadership in organizations: A review of theory and research. International Journal of Management Reviews, 13(3), 251–269.

2. Denis, J. L., Langley, A., & Sergi, V. (2012). Leadership in the plural. Academy of Management Annals, 6(1), 1-73.

3. Fitzgerald, L., Ferlie, E., McGivern, J. & Buchanan, D. (2013). Distributed leadership patterns and service improvement: Evidence and argument from English healthcare. The Leadership Quarterly, 24(1), 227-239.

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