Background: The concept of distributed leadership has been addressed in previous research, but few studies link their analysis to current and comparative empirical studies on processes and conditions enabling or hindering the development of distributed leadership. This specific study aims to identify and analyze mechanisms that enable or hinder the development of distributed leadership among employees in eldercare.

Methods: This is a case study based on six specific workplaces in eldercare in Sweden in different ways aiming to work toward an organization that emphasizes trust and distribution of power. A realistic evaluation framework was used to understand the different workplace program theories regarding distributed leadership. Key mechanisms and how they interact with contextual factors in each case were analyzed. Comparative analyses were performed, identifying key processes in terms of realizing distributed leadership.

Results: Analyzing the program theories in the respective cases showed that they have different orientations influenced by different motives for distributed leadership, which also interact with how distributed leadership was manifested and realized. The results point specifically to the importance of the mechanism formalization processes, participatory approaches to implementation, vertical sense-making, and horizontal sense-making for the development of distributed leadership.

Conclusions: The result points to that regardless of the path for achieving distributed leadership adopted by the various workplaces studied, the common denominator for those succeeding in distributing leadership is the development of a relational agency based on shared visions, a shared understanding of roles, and responsibilities, a learning approach and a dialogue-oriented relationship between management and employees. Another critical aspect is having sufficient resources to make taking on more responsibilities attractive.