The reforming appeal of distributed leadership

Abstract

With a systematic literature review, this article examines the significance of distributed leadership in healthcare, assessing the extent to which it reflects a consistent set of values, meanings, practices and outcomes. It identifies key mediating factors and their importance in enabling or constraining distributive leadership processes. The findings indicate that clinicians without formal leadership titles are inspiring change and driving improvements, although countervailing pressures are limiting this in practice. Distributed leadership is evident in the way that clinical teams function, and more could be made of this for the modernisation of healthcare. At present, this potential tends to be constrained, and subject to competing interpretations that reflect distinct occupational identities. Greater attention could be given to educational and developmental programmes that claim space for distributed influence among current and aspiring leaders, and for enabling arrangements that can help ‘ordinary leaders’ to feel less vulnerable and more confident about this aspect of their practice. Established approaches to leader development could be usefully refocused to prioritise collective processes and refine relational abilities, ideally with more inclusive, joint venture initiatives that bring formal and informal leaders together for mutual learning and effective engagement.