Culture and collective leadership


We are working with the King’s Fund to produce resources to help NHS providers develop cultures that enable and sustain continuously improving, safe, high quality, compassionate care.

Several recent reports and reviews, including the Rose review, the report of the Mid-Staffordshire NHS Foundation Trust Inquiry and the Berwick review, point to the need for cultural and leadership change.

The Five Year Forward View (5YFV) states that achieving quality requires a 'caring culture, professional commitment and strong leadership'.  

The biggest influence on culture is the leadership in the organisation. Collective leadership - people empowered to lead in all areas at all levels - the key to creating cultures that will give NHS staff the freedom and confidence to act in the interests of patients, and will lead to sustainable, operational and financial performance. 

It will help to continually improve and redesign services and support organisations to develop the environments necessary to enable the new care models envisaged in the 5YFV to grow.

About the culture programme and resources

The culture programme provides practical support and resources to help trusts run culture and leadership programmes. The work is taking place in three phases:

  • Phase 1: Discover - diagnose your cultural issues
  • Phase 2: Design - develop your collective leadership strategy to address the issues
  • Phase 3: Deliver - implement any necessary changes

We're exploring and linking to existing resources and programmes of work, for example the implementation of the Carter review. Where these add value, we will build them into the programme. 

Pilot trusts and partners

To ensure the programme has lasting value for trusts we have been working with three pilot NHS trusts to develop, design and test all aspects of the resources.

The pilot trusts are:

  • Central Manchester University Hospital NHS Foundation Trust
  • Northumbria Healthcare NHS Foundation Trust
  • East London NHS Foundation Trust

We're also working with other trusts and partners interested in culture and leadership development. This ‘culture community’ is growing rapidly to share good practice and learn together.  We'll continue to update our resources based on feedback from providers.

To join our culture community please email

We're also exploring and linking to existing resources and programmes of work, for example:

What do culture, collective leadership and leadership strategies mean in the NHS?


An organisation’s culture can be defined as the values lived by its employees every day – these may not be the same as the stated values. The lived values can be seen by ‘the way we do things around here’. 

Collective leadership
Means a type of culture where staff at all levels are empowered as individuals and in teams to act to improve care within and across trusts - 'leadership of all, by all and for all'. This is in contrast to command and control cultures which are not conducive to achieving high quality care.

In these trusts:

  • everyone understands and embodies the vision and values
  • everyone has clear objectives and data on performance
  • there is an open, supportive and compassionate approach to people management and how all staff interact with each other day to day
  • there is a high level of staff engagement
  • learning and quality improvement are embedded
  • good team and inter-team working are standard

Collective leadership strategy
This is a demonstration of the board’s commitment to implementing collective leadership, eg changes to structures, systems, behaviours. 

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