Previous chapters (Chapter 13 and Chapter 17) explored the value of undertaking self diagnostic tools for reflection and personal development planning for appraisal. While preparing individuals to develop the skills for quality improvement, more distributed, collaborative and shared leadership models are required to engage all stakeholders on the front line of health and social care services. This is a very different approach to the view that ‘leadership’ as a concept can be taught, theoretically in classrooms, to a select few individual leaders who will be taught ‘how’ to direct others in the organisation to follow a certain direction. Often, people in senior positions or roles do not have the highest level of knowledge within the system that requires improvement or system change. However, they do have the power in their role to choose to reflect on their leadership style and to consider the impact of their behaviour on others, to either keep control or to devolve power to others. There is a dominant perspective from writers in the field of leadership suggesting that ‘knowledge’ will trickle down from the notional ‘top’ of the organisation and that leaders will set the tone and make the decisions (Thorpe et al., 2011). A Systematic Review of the Literature: A Report for the NHS Leadership Centre defined leadership development as “the building of the capacity of individuals to help staff learn new ways of doing things that could not have been predicted” (Hartley and Hinksman, 2003:10).