Using a Constructivist methodology, combining elements of Fourth Generation Evaluation and Grounded Theory (Guba and Lincoln, 1989; Charmaz, 2014), this study explored the impact over time of the Delivering Better Care Leadership Programme, to better understand the factors that enabled or hindered subsequent changes. The study involved three Phases and data were collected longitudinally, primarily using interviews with a range of stakeholders. The study was underpinned by the ‘Senses Framework’ and ‘enriched environments’ (Nolan et al., 2006; Brown, 2005), and resulted in the development of the Five Cs’ substantive theory comprising: Context, Catalyst, Chronology, Conditions and Consequences. This theory, when used in conjunction with the Senses Framework, illuminates experiences and subsequent Consequences of participants, their teams and the wider organisation over time, and highlights the Conditions needed to create and sustain positive Consequences for participants and the wider Context. The importance of relationships emerged as being paramount. In order to create the Conditions, necessary for enriched environments, a number of enabling factors were identified, including support from colleagues, the promotion of autonomy, intrinsic motivation and drive, and opportunities for continual learning and development. On the basis of this study, the promotion of ‘relationship-centred leadership’ is suggested as a way forward for future initiatives. Implications for on-going leadership development programmes are considered, particularly in the challenging and complex landscape of the National Health Service (NHS), as are the contribution that the study makes to advancing knowledge. Methodologically, the study also argues for an expansion of the EA Matrix via the addition of two further dimensions: Evaluate and Embed Action. The study concludes that the Five C’s theory, allied with Senses Framework, provides a facilitation mechanism to foster relationship-centred leadership, which has the potential to further promote a compassionate, collective leadership culture, so vital for the NHS at this time
