Table 3 Initial Programme Theory and supporting evidence
CMOC | Context | + Mechanism | = Outcome | Evidence |
|---|---|---|---|---|
1 | Team training on-site | • Shared understanding and appreciation of others • Confidence in enhanced knowledge and skills in collective leadership | • Greater staff satisfaction through enhanced interdisciplinary teamworking • Improvements in quality and safety • Enactment of shared leadership behaviours | |
2 | Team given permission/encouragement to self-manage and use co-design or collaborative approaches for improvement | • Empowerment and motivation through sense of shared responsibility for team performance | • Teams more innovative and adaptable, characterised by a culture of learning, collaboration and continuous quality improvement • Staff satisfaction • Patient satisfaction • Adoption and sharing of leadership roles and responsibilities | Interview data |
3 | Dedicated time to reflect on and discuss team operations | • Greater role clarity | • System improvements, such as improvements/greater efficiencies in team processes around patient care • Enhanced teamworking; increased productivity • Effective team communication • Greater involvement of frontline staff in decision-making | Interview data |
4 | Open, regular and inclusive communication and decision-making processes | • Enhanced trust and psychological safety • Sense of shared responsibility | • Effective communication, knowledge sharing and conflict management • Safety culture characterised by greater safety awareness and open discussion of issues • Team leaders willing to share leadership responsibilities and adoption of leadership responsibilities by team members | Interview data |
5 | Lack of organizational support/resources, senior clinical support, or a strong hierarchical culture | • Disempowerment • Lack of confidence in approach | • Avoidance of team working | |
6 | Strong, supportive interpersonal relationships (formal and informal) | • Motivation to support others due to shared burden/responsibility • Trust and confidence in others’ expertise | • Enactment of proactive helping behaviours (role blurring) that enhance team performance • Staff satisfaction and retention | Interview data |
7 | Collective leadership is practiced | • Understanding that partnership needed for effective patient care • Internalization of collective leadership concepts; shared sense of responsibility for team • Recognition and understanding of skills and expertise of others | • Patient satisfaction • Improvements in patient safety and care quality • Willingness to speak up • Senior colleagues more open and accessible • Inclusive and collaborative team working characterised by a ‘give and take’ approach |