There is an increasing body of evidence that poor leadership can contribute to system failures and errors. In a health setting, this can result in a range of errors, such as misdiagnoses or the failure to recognize and respond to patient deterioration. Research has found that effective leadership in a clinical setting is associated with improved quality and safety.
The traditional hierarchical leadership model is clearly failing in healthcare. It is becoming increasingly evident that the interdependencies in healthcare require more collective leadership approaches, and that there is a need to reconsider the content, teaching methods, and learning outcomes of leadership programmes. There is a need for a more inclusive approach to leadership, one that is typified by shared responsibility and accountability and a focus on collective impact rather than individual achievement.
Collective leadership is not the role of a formal leader, but the interaction of team members to lead the team by sharing in leadership responsibilities. It is not a characteristic of an individual person, but involves the relational process of an entire team, group, or organisation. West et al. distinguish collective leadership cultures as follows:
“In collective leadership cultures, responsibility and accountability function simultaneously at both individual and collective levels. They breed regular reflective practice focused on failure, organisational learning and making continuous improvement an organisational habit. By contrast command and control leadership cultures invite the displacement of responsibility and accountability onto a single individual, leading to scapegoating and a climate of fear of failure rather than an appetite for innovation.” 
The Co-Lead programme is based on the premise that healthcare is delivered through teamwork and teams should share responsibility and accountability for quality and patient safety. Enabling this to happen requires an understanding of what leadership supports these teams need in order to continuously improve quality and patient safety. The programme follows 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.
 West, M., Lyubovnikova, J., Eckert, R. and Denis, J-L. (2014), “CL for cultures of high quality health care", Journal of Organizational Effectiveness: People and Performance, Vol.1 Iss 3 pp. 240-260