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
Open accessAbstract
Introduction: There is accumulating evidence implicating the role of leadership in system failures that have resulted in a range of errors in healthcare, from misdiagnoses to failures to recognise and respond to patient deterioration. This has led to concerns about traditional hierarchical leadership structures and created an interest in the development of collective ways of working that distribute leadership roles and responsibilities across team members. Such collective leadership approaches have been associated with improved team performance and staff engagement. This research seeks to improve our understanding of collective leadership by addressing two specific issues: (1) Does collective leadership emerge organically (and in what forms) in a newly networked structure? and (2) Is it possible to design and implement collective leadership interventions that enable teams to collectively improve team performance and patient safety? Methods and analysis: The first phase will include a social network analysis, using an online survey and semistructured interviews at three time points over 12 months, to document the frequency of contact and collaboration between senior hospital management staff in a recently configured hospital group. This study will explore how the network of 11 hospitals is operating and will assess whether collective leadership emerges organically. Second, collective leadership interventions will be co-designed during a series of workshops with healthcare staff, researchers and patient representatives, and then implemented and evaluated with four healthcare teams within the hospital network. A mixed-methods evaluation will explore the impact of the intervention on team effectiveness and team performance indicators to assess whether the intervention is suitable for wider roll-out and evaluation across the hospital group. Ethics and dissemination: Favourable ethical opinion has been received from the University College Dublin Research Ethics Committee (HREC-LS-16–116397/LS-16-20). Results will be disseminated via publication in peer-reviewed journals, national and international conferences, and to relevant stakeholders and interest groups.
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A hospital system co-designed a team-based leadership model in collaboration with healthcare teams and patients, using a range of qualitative methods, including in-depth interviews and online surveys.
“For example, a hospital system co-designed a team-based leadership model in collaboration with healthcare teams and patients, using a range of qualitative methods, including in-depth interviews and online surveys.”
From Establishing organizational AI governance in healthcare: a case study in Canada (2025) · cites this paper as [40]
Methods, Phase 2 (page unavailable) proposes co-designing a team-focused collective leadership intervention with healthcare staff and patient representatives, using workshops informed in part by interviews. But this is a protocol for planned work, not a report that the hospital system had already co-designed the model. The online survey described in Methods, Phase 1 (page unavailable) is for mapping leadership networks, not a qualitative co-design method. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe model, which emphasizes the shared distribution of leadership roles and responsibilities across team members, was successfully implemented within the hospital system.
“The model, which emphasizes the shared distribution of leadership roles and responsibilities across team members, was successfully implemented within the hospital system40.”
From Establishing organizational AI governance in healthcare: a case study in Canada (2025) · cites this paper as [40]
The Background defines collective leadership as distributing leadership roles and responsibilities among team members. But this is a study protocol, not a report of successful implementation: the Methods section says the intervention “will be implemented” and evaluated with selected teams. It does not establish that the model was successfully implemented across the hospital system. (LLM, conf=0.91)
Experimental — accuracy not yet measuredVarious qualitative research methods, such as surveys, interviews, and co-design workshops, can be instrumental in facilitating this collaborative process.
“Various qualitative research methods, such as surveys, interviews, and co-design workshops, can be instrumental in facilitating this collaborative process40.”
From Establishing organizational AI governance in healthcare: a case study in Canada (2025) · cites this paper as [40]
The Methods section (Phase 2; page not provided) proposes co-design workshops and says interview findings will inform the intervention’s co-design. The Methods section (Phase 1; page not provided) also describes a survey, but it is used to collect network data, not presented as a qualitative method facilitating co-design. The paper is a protocol, so it proposes these methods rather than demonstrating that they were instrumental. (LLM, conf=0.78)
Experimental — accuracy not yet measuredThese methods have also been shown to effectively support organizational change in healthcare.
“These methods have also been shown to effectively support organizational change in healthcare.”
From Establishing organizational AI governance in healthcare: a case study in Canada (2025) · cites this paper as [40]
The Background and Methods describe a co-designed collective-leadership intervention intended to improve healthcare teams, while the Discussion says collaborative design increases its likelihood of success. But this is a protocol for a future evaluation: the Discussion says the intervention could be scaled up only ‘should it prove successful,’ so the paper does not show that these methods effectively support organisational change. (LLM, conf=0.86)
Experimental — accuracy not yet measured
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Development of an integrative coding framework for evaluating context within implementation science
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Self-citationEstablishing organizational AI governance in healthcare: a case study in Canada
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- Authors
- McAuliffe, E., De Brún, A., Ward, M., O’Shea, M., Cunningham, U., O’Donovan, R., McGinley, S., Fitzsimons, J., Corrigan, S., & McDonald, N.
- Affiliations
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland
- University College Dublin (IE)
- Our Lady of Lourdes Hospital (IE)
- Trinity College Dublin (IE)
- ORCID
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2017-11
- Volume
- 7
- Issue
- 11
- Pages
- e017569
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC5695301
- OpenAlex
- W2766375218
- Cited by
- 38
- References
- 3
- Citations by year
- 2025: 3 · 2023: 2 · 2022: 5 · 2021: 10 · 2020: 8 · 2019: 3 · 2018: 7
- FWCI
- 8.46
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HighWire Press Open Archive (acceptedVersion)
- Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion, cc-by-nc-nd)
- Funders
- Health Service Executive
- Health Research Board
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Social Sciences › Psychology › Social Psychology › Team Dynamics and Performance
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Keywords
- shared leadership, safety culture, patient safety, team performance, co-designed intervention, hospital networks, social network analysis, healthcare leadership, team effectiveness, clinical deterioration, hierarchical leadership, hospital management
- MeSH terms
- Hospitals, Humans, Ireland, Leadership, Patient Care Team, Pilot Projects, Research Design, Safety Management, Patient Safety
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