An exploration of how the concept of the ‘well led’ hospital trust is defined and understood by NHS staff across a range of organisational managerial levels.

Abstract The aim of this PhD study was to gain greater understanding of staff experience of being well led within a NHS Hospital Trust rated ‘well led’ by the Care Quality Commission (CQC), to better understand the potential contribution leaders could make to improve quality of patient care. A qualitative case study method was utilised to explore staff experiences in the ‘well led’ Trust. A theoretical framework was developed to underpin the methodological process, incorporating components of learning organisational theory (Argyris 1995 & Senge 1990) and an interpretive grounded theory approach was applied (Charmaz 2006). Four main themes were identified: • A sense of ‘family’, particularly a focus on shared values and behaviours that prioritised both patient and staff wellbeing. • A strong preference for a distributed leadership model that was balanced against a need for a hierarchical model. • A learning approach was balanced against a robust commitment to sanction behaviours outside the values of the organisation. • A clear ambition to build resilience and embed these values to sustain the ‘well led’ approach in the face of significant financial pressures and work force challenges. Many of the principles of learning organisation theory, identified by Argyris (1992) & Senge (1990), were visible across all four themes. However, there were also some important differences. In particular, there were challenges related to the organisational requirement to balance strategies to both promote staff commitment, as well as compliance. Furthermore, there were similar challenges linking parallel, but disparate models of distributed and hierarchical leadership. The findings identified both the features of a well led NHS Trust and also some challenges. These new insights contribute to our current understanding of ‘well led’ Trusts, which can be used to improve Trust level leadership more broadly in the NHS, and also provide a framework for further research in this area.