Strengthening Collective Leadership in High-Pressure Environments

Leading with Purpose in Times of Pressure

Leadership in healthcare is never easy. For organisations like the Welsh Ambulance Services University NHS Trust (WAST), the stakes are uniquely high. Every decision made by leaders has a direct impact on patient care, staff wellbeing, and the wider health system. With demand for services rising year on year, leaders are required to balance urgent patient needs with system-wide pressures, regulatory requirements, and government expectations.

In such a high-pressure environment, leadership cannot be left to chance. It requires intentional development, collective responsibility, and alignment with strategic priorities. Recognising this, WAST embarked on a journey to strengthen the capability, cohesion, and impact of its most senior leaders.

Why Collective Leadership Matters

Traditional leadership models often focus on the individual. Yet in complex systems like healthcare, no single leader can carry the weight alone. Collective leadership, where leaders work together with shared responsibility, trust, and alignment, creates resilience and enables organisations to adapt to challenges more effectively.

For WAST, this meant starting at the very top. The Executive Team recognised the need to build greater self-awareness, align behaviours with the Service’s strategic priorities, and enhance their collective leadership to better meet the needs of patients, stakeholders, and employees.

Our Approach: Executive Team 360

To support this transformation, we partnered with WAST to deliver the Executive Team 360, a research-driven process designed to provide evidence-based insights into leadership behaviours. Importantly, the process was fully aligned with Our WAST Way, the Trust’s evolving framework for compassionate, inclusive, and collective leadership.

Through a combination of 360-degree feedback, facilitated workshops, and collective action planning, the Executive Team gained clarity on their strengths, identified priority development areas, and committed to concrete actions. This journey not only enhanced individual growth but also strengthened the team’s cohesion and collective impact.

The Results

“The Executive Team 360 has been invaluable in helping us build self-awareness, not just as individual leaders but as a collective leadership group. The initial assessment gave us clarity on where we stood and what needed to change, while the facilitated workshop created the space to engage with the feedback openly and agree meaningful actions together. “Repeating the process in 2025 showed us how far we have progressed and gave us confidence that our development is on the right track. This programme has strengthened our cohesion, improved our leadership behaviours, and ultimately enhanced our ability to lead the organisation in what is an incredibly challenging environment.”

Angie Lewis, Director of Culture Change,

Welsh Ambulance Services University NHS Trust

By repeating the Executive Team 360 in 2025, WAST was able to benchmark progress and evidence tangible improvements in leadership behaviours. The results highlighted stronger trust, greater psychological safety, and improved alignment with strategic goals—ultimately reinforcing the organisation’s ability to deliver safe, effective, and responsive care across Wales.

Read the full case study: Strengthening Collective Leadership at the Welsh Ambulance Services University NHS Trust

Book a DEMO to find out more about the Executive Team 360 at hello@realworld-group.com

Find out more about the Executive Team 360 here