Understanding mechanisms and outcomes in multidisciplinary leadership development: a mixed-methods evaluation

BACKGROUND: The Oxford Health: Health Systems Development Programme was co-designed to strengthen multidisciplinary leadership capacity and address staff morale, engagement and autonomy. This study aimed to evaluate the mechanisms and outcomes of the programme. METHODS: Twenty-two participants completed the one year programme, which included six full-day workshops. We conducted a mixed-methods evaluation mapped to Kirkpatrick's framework. Pre-programme and post-programme self-assessments using an adapted Medical Leadership Competency Framework Questionnaire (MLCFQ) were analysed using Wilcoxon signed-rank tests with Bonferroni correction. Post-programme questionnaires, free-text responses and reflective essays (n=15) were analysed using reflexive thematic analysis. RESULTS: Workshops were highly rated for relevance and experience. There were statistically significant improvements in two MLCFQ domains: managing services and setting direction (p=0.02). Psychological safety, legitimised vulnerability and structured reflection were identified in qualitative data as central mechanisms for change. Participants reported increased leadership self-efficacy, systems-thinking and confidence in speaking up. Behavioural transfer included deliberate cultivation of psychological safety and broader ranges of approaches to leadership. Reported organisational impacts included increased staff voice, team cohesion and early service-level improvements. CONCLUSIONS: This evaluation demonstrates credible evidence of behavioural transfer and early organisational influence. Strengthened longitudinal evaluation and predefined service-level metrics are required to assess sustainability and objective impact.