Background: This paper describes research conducted with Big hART, Australia's most awarded participatory arts company. It considers three projects, LUCKY, GOLD and NGAPARTJI NGAPARTJI across separate sites in Tasmania, Western NSW and Northern Territory, respectively, in order to understand project impact from the perspective of project participants, Arts workers, community members and funders. Methods: Semi-structured interviews were conducted with 29 respondents. The data were coded thematically and analysed using the constant comparative method of qualitative data analysis. Results: Seven broad domains of change were identified: psychosocial health; community; agency and behavioural change; the Art; economic effect; learning and identity. Conclusions: Experiences of participatory arts are interrelated in an ecology of practice that is iterative, relational, developmental, temporal and contextually bound. This means that questions of impact are contingent, and there is no one path that participants travel or single measure that can adequately capture the richness and diversity of experience. Consequently, it is the productive tensions between the domains of change that are important and the way they are animated through Arts practice that provides sign posts towards the impact of Big hART projects.

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QUEENSLAND HEALTH as an organisation has been under a great deal of pressure in recent times. On 26 April 2005, the Queensland Government announced an independent review of Queensland Health?s administrative, workforce and performance management systems. The review was established in response to public concern over the safety and quality of the public health system following events that took place at Bundaberg Hospital, particularly the appointment and practices of Dr Jayant Patel. Associated with the Patel case were issues of bullying and intimidatory behaviour at the workplace. In response to the recommendations of the review, Queensland Health embarked upon a major reform program. One of the strategies for driving reform highlighted by the Queensland Health Systems Review final report, September 2005 was leadership development. Strong leadership was identified as vitally important to both drive the reform process and improve workplace culture.

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