Background/Aims Evidence of the impact and effectiveness of lean systems thinking in healthcare settings remains mixed. This study explores the impact of participation in a process mapping activity on employee engagement and distributed leadership in the NHS. Methods A qualitative study was undertaken using semi-structured interviews with nine employees within an NHS trust in the north east of England. Questions explored participants' experiences of process mapping. A thematic analysis was then carried out. Findings Following the implementation of process mapping, staff appeared more engaged and there was a closer relationship between teams and management. The end result of process mapping was increased employee engagement, greater team working, well-distributed leadership, increased job satisfaction and reduced stress levels. Conclusions Participation in process mapping can have a number of positive impacts, including improved team working, reduced staff stress levels and improved relationships between staff and management. Using process mapping could help NHS trusts to implement a more distributed method of leadership.