ISQUA17-2839COLLECTIVE LEADERSHIP AND SAFETY CULTURES: DEVELOPING AN ALTERNATIVE MODEL OF LEADERSHIP FOR HEALTHCARE TEAMS

Abstract

Objectives: The traditional hierarchical leadership model is clearly failing in healthcare, the evidence for this being the references to poor leadership and dysfunctional accountability mechanisms in almost every investigation report into serious or fatal incidents. In response, this research programme draws on emerging theories of collective leadership (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). In contrast to traditional approaches that focus development on the individual as leader, the approach in this programme of work is on developing the team as a dynamic leadership entity with each member of the team being accountable for the performance of the team as a whole. In this phase of the research we describe the development of a suite of interventions to support collective leadership in healthcare teams. Methods: This 5-year programme of research designs and implements leadership interventions with 4 team types within a group of eleven hospitals and tests the impact of these interventions on staff performance and patient safety. The overall aim is to support quality and safety cultures through the development of a new model of healthcare leadership that is associated with effective team performance. The main research questions addressed in this paper are: What are the common leadership needs identified by healthcare teams? Do leadership development needs differ according to team type? What interventions are needed to support the development of a collective leadership approach within teams? Results: Common needs emerged across the different team types, although these varied somewhat depending on the stage of development of the teams. Role clarity and understanding was a common requirement. Trust, communication and shared goals were also considered key components for collective leadership. Efficient utilisation of performance data to drive improvement, including regular feedback and structured opportunities for learning from poor performance emerged as critical aspects for a safety culture. How and where the team learns was an additional consideration and one that poses challenges to conventional approaches to leadership development. Conclusion: Traditional approaches to developing healthcare leaders are no longer fit for purpose. Effective healthcare delivery is highly dependent on multidisciplinary teamwork drawing on the expertise of each discipline or team member and pooling this expertise to collectively diagnose and treat patients. Traditional hierarchical leadership models have done little to encourage accountability for collective team performance and as such, present obstacles to the development of safety cultures. Training designated leaders to do the job of leading does not guarantee the performance of the team as a whole. This study has demonstrated the potential for a team-based collective approach to developing the leadership capacity of the team as a whole, co-designing interventions that are fit for purpose and responsive to the performance challenges faced by teams in their everyday clinical practice. Such an approach supports collective accountability and enhances patient safety.