Collective Leadership and Safety Cultures

Project Outline

The ‘Collective Leadership and Safety Cultures’ (Co-Lead) programme is a five-year research project that aims to develop and test the impact on patient safety cultures of collective leadership for healthcare. 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.

The Co-Lead programme’s approach is to develop the team as a dynamic leadership entity.

A key challenge for healthcare organisations is developing and supporting cultures that ensure the delivery of continuously improving high quality, safe and compassionate healthcare and place strong emphasis on leadership. 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. The seven hospital groups, with their emphasis on networks delivering integrated, safe care provide a receptive research environment. This programme of research is responding to two key priorities for the IEHG and HSE:

1. Leadership development
2. Improving quality and patient safety

We explored the impact of the implementation of the resources across four heterogeneous healthcare teams, ranging in size from small cross-organisational teams to large unit-based teams in large urban teaching hospitals. The intervention was successfully implemented in all four cases. We found that the intervention promoted a positive internal team environment, fostered the recognition that partnership is required for effective patient care and a more collective mindset was reported. 

“I think it’s actually just sitting in the room with everybody and getting that opportunity to speak to each other. You just don’t – you just don’t get it.”

“We learned quite a lot from each other. I suppose maybe a better appreciation of people on the team”

The provision of structured intervention materials to support and promote inclusivity and interdisciplinary working was strongly linked to enhanced empowerment, motivation and a shared sense of responsibility for team performance. 

“I think it was that sharing of experience which doesn’t really happen outside – haven’t really happened outside Co-Lead to my experience, in the sense that it was really a unique cross-discipline meeting point”

The intervention’s collective focus, aimed at highlighting expertise on the team, helped to dissolve the barriers between professions on teams and enhanced psychological safety. Through creating a culture of psychological safety, participants developed interpersonal trust, felt better equipped to share leadership, were more open to voicing opinions, and senior leaders were more willing to listen and seek input. 

“People really did enjoy the sessions and would come out – you know, a little bit rejuvenated and thinking “oh, there’s so much we can do” and feeling very positive”

“It just kind of helped to feel part of the team I think and to be driving something that wasn’t my own, it was on behalf of the team, makes you feel part of the team”

The materials have been utilised and continue to be utilised by many different types of teams across the health system.