It is clear that leadership behaviour of executives in healthcare is considered to be of prime importance (Burke 2006), with key elements such as strategy, structure and process being vital for team and organisational effectiveness (Yammarino et al, 2008). This research identified that the executives interviewed in a Northwest acute Trust were clear on what type of leadership behaviour is expected of them; seeing themselves as transformational, setting clear goals and expecting the best from their teams. They also identified elements of autocratic and transactional leadership behaviour were required frequently in the achievement of targets such as waiting times and productivity. There was an acute recognition of the tensions between Q&S and the target-driven approach required by commissioners and the current financial climate within the National Health Service. External drivers for Q&S included losing foundation trust status which may result in loosing independence and being placed under special measures by monitor and receiving financial penalties. It was acknowledged the commissioners of services have huge power and influence over the direction of where the organisation concentrates effort to influence policy which could also provide tension with the Q&S strategy. Finance and ‘doing more for less’ are constant themes, with competition to keep Q&S on the agenda. Q&S has a reputation for being problematic, many executives believed changing the organisational culture requires evaluation and effective engagement of staff. The aim of this paper is to analyse the complex relationships between leadership behaviour and Q&S. The experiences of executives provide insight into the Q&S agenda within Healthcare through change and dealing with complex issues including targets, motivation, behaviour, leadership, change and organisational culture.

quality & safety, Healthcare Environments, leadership behaviour