There is accumulating evidence for the value of collective and shared approaches to leadership. However, relatively little research has explored collective leadership in healthcare and thus, there is a lack understanding of the mechanisms that promote or inhibit the practice of collective leadership in healthcare teams. This study describes the development of an initial programme theory (IPT) to provide insight into the mechanisms underpinning the enactment of collective leadership. This IPT was informed by a multiple-method data collection process. The first stage involved a realist synthesis of the literature on collective leadership interventions in healthcare settings (n = 21 studies). Next, we presented initial findings to receive feedback from a realist research peer support group. Interviews with members of teams identified as working collectively (n = 23) were then conducted and finally, we consulted with an expert panel (n = 5). Context-mechanism-outcome configurations (CMOCs) were extrapolated to build and iteratively refine the programme theory and finalise it for testing. Twelve CMOCs were extrapolated from these data to form the initial programme theory and seven were prioritised by the expert panel for focused testing. Contextual conditions that emerged included team training on-site, use of collaborative/co-design strategies, dedicated time for team reflection on performance, organisational and senior management support, inclusive communication and decision-making processes and strong supportive interpersonal relationships within teams. Mechanisms reported include motivation, empowerment, role clarity, feeling supported and valued and psychological safety which led to outcomes including improvements in quality and safety, staff and patient satisfaction, enhanced team working, and greater willingness to share and adopt leadership roles and responsibilities. This study has identified preliminary support for the contexts, mechanisms and outcomes underpinning the practice of collective leadership. However, it must be noted that while they may appear linear in presentation, in reality they are independent and interlinked and generative of additional configurations. This paper contributes to the nascent literature through addressing an identified gap in knowledge by penetrating below the surface level inputs and outputs of an intervention to understand why it works or doesn’t work, and for whom it may work.

中文翻译：

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确定团队集体领导的背景、机制和结果：建立现实主义的计划理论


越来越多的证据表明集体和共享领导方法的价值。然而，探索医疗保健领域集体领导的研究相对较少，因此，对促进或抑制医疗团队集体领导实践的机制缺乏了解。本研究描述了初始程序理论（IPT）的发展，以深入了解支持集体领导制定的机制。该 IPT 是通过多种方法的数据收集过程得出的。第一阶段涉及对医疗保健环境中集体领导干预的文献进行现实主义综合（n = 21 项研究）。接下来，我们提出了初步研究结果，以接收现实主义研究同行支持小组的反馈。然后对被确定为集体工作的团队成员 (n = 23) 进行访谈，最后，我们咨询了专家小组 (n = 5)。推断上下文-机制-结果配置（CMOC）来构建和迭代完善程序理论并最终确定其以进行测试。根据这些数据推断出 12 个 CMOC，以形成初始计划理论，专家小组优先考虑了 7 个 CMOC 进行重点测试。出现的背景条件包括团队现场培训、协作/共同设计策略的使用、团队对绩效进行反思的专门时间、组织和高级管理层的支持、包容性的沟通和决策过程以及团队内强有力的支持性人际关系。 报告的机制包括激励、赋权、角色明确、感觉支持和重视以及心理安全，这些机制带来的结果包括质量和安全的改进、员工和患者的满意度、增强的团队合作以及更愿意分担和承担领导角色和责任。这项研究确定了对集体领导实践的背景、机制和结果的初步支持。然而，必须指出的是，虽然它们在呈现上可能看起来是线性的，但实际上它们是独立且相互关联的，并且生成额外的配置。本文通过深入研究干预措施的输入和输出的表层以下，以了解干预措施为何有效或无效以及它可能对谁有效，从而解决已知的知识差距，从而为新兴文献做出贡献。