Distributed leadership patterns and service improvement: evidence and argument from English healthcare

This article focuses on the pattern and impact of change leadership in complex, pluralistic, public sector settings, and specifically in English healthcare. The argument draws on evidence from ten comparative cases, exploring links between leadership patterns and organizational outcomes. Our analysis builds three themes. First, a pattern of widely distributed change leadership is linked to delivering improvements in service outcomes. Second, professional/managerial hybrids are shown to perform crucial lateral facilitation activities, adapting and extending their roles to suit their organizational context. Third, a foundation of good pre-existing relationships underpins the capacity of distributed leadership to implement service improvements. Conversely, poor relationships and conflicts erode the concerted capacity of distributed change leadership. The key contribution of this article thus concerns the establishment of links between situated patterns of distributed leadership, and service improvement outcomes, based on the cumulative effects of actors – managers and clinical hybrids – at different organizational levels.