We have witnessed the impact of organisational culture on quality of care, safety, and organisational effectiveness in the NHS. Prominent failures such as Mid Staffordshire highlighted that a good organisational culture is a necessary condition for organisational strategy to succeed, and leadership is the preeminent influence factor for organisational culture.

Leadership culture must be understood as the product of collective actions of formal and informal leaders acting together for organisational success. It is not simply the number or quality of individual leaders that determine organisational performance, but the ability of formal and informal leaders to pull together in support of the organisation’s goals.

We believe that collective leadership in health care is necessary for overcoming challenges that the NHS now faces. Collective leadership means the distribution and allocation of leadership power to wherever capability, expertise and motivation sit. The responsibility of leadership is shared by each and every member of the organisation.

A collective leadership culture requires new mindsets, not just new skills. These take time to develop. Many health care organisations have focused their development efforts only on individual leader competencies. For sustainable change, they need to advance both individual and collective leadership mind-sets. Making the shift to collective leadership in an organisation requires strategic implementation.

Developing and implementing an effective collective leadership strategy comes in three phases:

Discovery, Design, and Delivery.

  • The Discovery phase involves collecting data and intelligence about the strategy, vision, mission, future challenges, political context and opportunities for the organisation. This process enables organisations to identify the leadership capabilities required to face the future and the gap between current and required future capabilities.
  • The Design phase involves identifying required leadership capabilities for individual and collective leadership and the means to acquire, develop and sustain those capabilities.
  • The Delivery phase involves elements from organisational and individual leadership development alike, targeting culture, systems and processes, as well as leadership development in synchrony.

While the process of developing collective leadership starts at board level, all staff across the organisation will need to be involved in this endeavour with their respective expertise, contributing to the collective leadership process.

Collective leadership offers huge opportunities for creating cultures of continually improving, high quality, and compassionate care. But it requires courage, persistence and professionalism from all leaders (informal and informal) to fully realise its potential. The complete dedication of the board and leadership team to empower all staff as leaders, and trust in the process of collaboration in the organisation as the foundation for its leadership culture are keys to success.

We believe that the challenges that face health care organisations are too great and too many for leadership to be left to chance or to piecemeal approaches. Through working together with health and social care organisations and in consultation with patients, we can develop leadership strategies that will ensure the NHS confidently faces the future and delivers the high quality, compassionate care that is its mission.

Additional Contributing Authors:

Michael West, PhD, joined The King’s Fund as a Senior Fellow in November 2013. He is Professor of Work and Organisational Psychology at Lancaster University Management School, Senior Research Fellow at The Work Foundation and Emeritus Professor at Aston University. He was formerly Executive Dean of Aston Business School. He graduated from the University of Wales in 1973 and received his PhD in 1977. He has authored, edited and co-edited 20 books and has published more than 200 articles for scientific and practitioner publications, as well as chapters in scholarly books. He is a Fellow of the British Psychological Society, the American Psychological Association (APA), the APA Society for Industrial/Organisational Psychology, the Higher Education Academy, the International Association of Applied Psychologists and the British Academy of Management. He is a Chartered Fellow of the Chartered Institute of Personnel and Development. Michael is an Academician of the Academy of Social Sciences. His areas of research interest are organisational cultures, collective leadership, team and organisational innovation and effectiveness, particularly in relation to the organisation of health services. He lectures widely, both nationally and internationally, on the results of his research and on his solutions for developing effective and innovative organisations.

Katy Steward, PhD, is an Assistant Director in Leadership Development at The King’s Fund. She joined the Fund in 2006 and has more than 20 years’ experience working in the public and private sector. Before joining the Fund she worked at Monitor on governance and leadership as Head of Governance Policy. Katy has worked extensively in change management and organisational effectiveness. She has a PhD in engagement, culture and communication and following this worked as a consultant at KPMG, and was Vice President at Citigroup. She has implemented new structures, teams and processes, working at board level and below to define roles, change strategies, and develop leaders and cultures. Before coming to the NHS she worked for two years on government change programmes, including with the House of Commons and with the University for Industry. She is a qualified coach and enjoys running action learning sets. She has a strong interest in board leadership and its impact on culture and governance. At The King’s Fund she directs the Board Leadership programme and works with boards she set up with the Foundation Trust Governors Association. She also runs the New Medical Director programme.

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