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National Health Service (NHS) failures at Mid-Staffordshire, Shrewsbury and Telford, and East Kent reached the same conclusion: leaders who fail to listen and understand put patients at risk. The NHS response has been to promote compassionate leadership. Yet, compassion often entails emotional merging, which can blur boundaries and lead to fatigue. By contrast, empathic leadership and curiosity-driven perspective-taking, rather than emotional merging, offers a promising new way forward. Yet no practical method exists to teach empathic leadership. To fill this gap, we aimed to develop heuristics ('rules of thumb') for empathic leadership and create a course to teach them. 21 healthcare leaders attended a structured workshop. Using established heuristic development and curriculum design methods, participants generated, refined and prioritised heuristics for empathic leadership, then co-designed a training course to teach them. The group produced 35 heuristics and prioritised 12, including 'Listen first, speak last', 'Say sorry', and 'Walk the shop floor'. A one-day interprofessional empathic leadership course was then co-designed, featuring experiential learning, role play and implementation planning. We identified and prioritized heuristics for empathic leadership and produced a course to teach them. The short course may support healthcare leaders to strengthen empathic leadership in practice.
Healthcare integration demands leaders who can navigate complex multi-organisational environments, yet understanding of how cognitive diversity contributes to leadership effectiveness remains limited. Dyslexia, a specific learning difference affecting how the brain processes language, is often viewed through a deficit lens despite emerging evidence of cognitive advantages, including enhanced pattern recognition and systematic problem-solving. To reflect on my personal journey of discovering how dyslexic cognitive patterns functioned as strategic assets in healthcare integration leadership, challenging deficit-based assumptions about neurodivergent leadership capabilities. This Leadership in the Mirror reflection draws on a qualitative intrinsic case study conducted during my MSc in Healthcare Leadership. The study involved semi-structured interviews with eight leadership team members across three NHS organisations, complemented by reflective analysis and team effectiveness measures using the Affina Team Journey questionnaire. Thematic analysis revealed patterns in how dyslexic traits influenced leadership practices and team outcomes. Four interconnected themes emerged: structured enablement (creating clear frameworks that enabled rather than constrained team development), reflective integration (using systematic analysis to bridge organisational boundaries), safe progress (building psychological safety through structured approaches), and measured transformation (enabling sustainable change through thorough planning). Team effectiveness improved across multiple dimensions, with role clarity increasing from 3.6 to 4.4 and inter-team working from 3.5 to 4.1 (on 5-point scales where 4.0+indicates effective team functioning). Traits commonly viewed as dyslexic limitations-systematic processing, need for structure, methodical analysis-proved to be leadership capabilities that enhanced team effectiveness in complex healthcare integration contexts. This challenges traditional deficit-based approaches to neurodivergent leadership development and suggests that cognitive diversity may be essential for navigating healthcare transformation challenges outlined in the 2025 NHS 10 Year Health Plan.
Effective leadership is critical to the success of complex multidisciplinary healthcare organisations. As the organisation emerged from the global pandemic, Mayo Clinic recognised a need to transform its traditional, linear care model into a dynamic, platform-based approach to support its strategy. This required a new leadership model that could support and equip leaders with the skills needed to drive patient-centred healthcare transformation from within. To develop and validate a new leadership competency framework capable of supporting future-ready leadership. A multiphase, evidence-based approach was employed: (1) a visionary interview, goal setting and literature review; (2) focus groups with 23 leaders from across the organisation; (3) iterative competency framework development; and (4) a validation study involving a stratified sample of 129 physician leaders who rated competencies on importance and differentiation, and a qualitative verification by key stakeholders. Five core competencies with 23 behaviours were identified. The validation analysis established all behaviours as important for differentiating leadership performance. Stakeholder review confirmed the competencies were actionable and applicable across leadership roles at all levels. The Leads Self, Leads Others, Inspires Others, Forward Thinking and Engages Others (abbreviated LLIFE) competency model positions a healthcare organisation to advance leadership excellence in a rapidly evolving healthcare environment that requires comprehensive transformation. It aligns with strategic goals, embeds values-based behaviours and supports continuous development, establishing a model that other healthcare institutions may learn from and adapt.
Leadership is often conceptualised within stable healthcare systems, yet its most revealing moments arise when those systems fracture. Humanitarian and emergency care environments-marked by uncertainty, scarcity and cultural complexity-strip leadership of formal scaffolding and expose its human foundations. This reflective narrative explores how leadership understanding was reshaped through humanitarian deployments, with particular attention to psychological safety, humility, adaptability and empowerment, and considers how these behaviours translate into everyday healthcare leadership practice. Using narrative reflection and experiential synthesis, the author draws on de-identified critical incidents from humanitarian deployments in Bangladesh, Myanmar, Afghanistan and Lebanon. These experiences are examined through established frameworks of psychological safety, compassionate leadership, cultural humility and experiential learning-not as empirical case studies, but as sites of transformative professional learning. Across diverse crisis settings, effective leadership emerged less from hierarchy or technical authority than from relational presence and shared vulnerability. Four inter-related behaviours consistently shaped practice: cultivating psychological safety by modelling uncertainty; practising humility to recognise and elevate local expertise; adapting creatively when protocols and resources failed and deliberately transferring agency to others to enable sustainable leadership capacity. These behaviours fostered trust, sustained morale and built capability that endured beyond individual missions. The leadership qualities forged in humanitarian crises are not exclusive to extreme contexts. They offer transferable insights for emergency departments, multidisciplinary teams and healthcare systems operating under sustained pressure. This reflection suggests that leadership in high-stakes environments is fundamentally a human practice-grounded in connection, trust and shared responsibility.
Leadership has become an essential component of medical professionalism; yet, China lacks leadership competency models grounded in physicians' clinical realities. This study aimed to develop a context-specific leadership competency model for Chinese oncologists, aligning international frameworks with local healthcare priorities. A three-round modified Delphi study was conducted between June and October 2024. The process began with a preliminary model comprising 6 domains and 30 competency items, derived from a scoping review and the National Health Service Medical Leadership Competency Framework. 40 oncology-related experts evaluated both the six proposed domains and the 30 competency items in round 1 using 9-point Likert scales and open-ended feedback. In round 2, experts screened the suggestions from round 1 through binary (yes/no) evaluations. The resulting refined list was subjected to a final rating in round 3, again using 9-point Likert scales to establish consensus. Quantitative data (mean scores, SD, percentage agreement) and thematic analysis of qualitative feedback were used to iteratively refine the model across rounds. Experts reached consensus on a final leadership competency model comprising 6 domains and 40 specific competencies. The highest-rated competencies included integrity, continuous personal development, healthcare quality management, learn and apply new technologies and ensur patient safety. New competencies, not present in the initial model, also emerged-such as clear expression, empathy, influence on the public, familiarity with end-of-life care, health economics evaluation and vision building-capturing the evolving expectations of oncologists as communicators, collaborators and system improvers in a rapidly changing healthcare environment. The resulting competency model reflects the multidimensional nature of oncologist leadership, encompassing professionalism, teamwork, service improvement and social responsibility. It offers a practical framework for leadership development and assessment in oncology and provides methodological guidance for building physician leadership competency models in other medical fields.
Disabled staff are significantly underrepresented and face limited career opportunities within healthcare. This pilot study aimed to assess the feasibility and effectiveness of an internal positive action programme for disabled staff focusing on healthcare leadership, involving sessions from executive directors, combined with self-leadership through selected podcasts. In 2024, a course designed for disabled staff with a total of 10 leadership workshops was delivered by executive directors and matched with 10 self-leadership podcasts, supported by a reflective workbook. The programme's recruitment and retention were measured, as well as undertaking an embedded mixed methodology with quantitative and qualitative analysis to understand the effectiveness of the programme. A total of 14 participants signed up for the programme from different disciplines and levels in healthcare. No participants dropped out of the programme. Self-reported scores on leadership, the ability to navigate the organisation and requesting reasonable adjustments were all shown to have improved after the leadership programme. Key takeaways for participants included better understanding of change management, advocacy, networking, new career pathways and the complexity of the National Health Service (NHS) system. Executive directors within provider organisations could take the lead on local and tailored positive action programmes, potentially improving disability leadership within the NHS.
Onboarding inefficiencies in student-run healthcare organisations can lead to unclear role expectations, inconsistent knowledge transfer and disruptions in leadership transitions. This quality improvement (QI) initiative evaluates the implementation of a standardised operating procedure (SOP) within Street Medicine Detroit (SMD), a medical student-run clinic, to improve onboarding and leadership continuity. A QI initiative was developed to create an SOP based on retrospective surveys from past leaders, identifying key organisational challenges. Post implementation surveys assessed the SOP's impact on onboarding effectiveness, role clarity and preparedness. The project followed a Plan-Do-Study-Act cycle to guide the intervention and evaluate outcomes. The SOP improved new leader onboarding by reducing reliance on board members, increasing clarity of training materials and enhancing preparedness to lead from day 1. Leaders trained with the SOP reported fewer unanswered questions and greater self-reliance. Survey results indicated significant improvements in clarity and role understanding, with new leaders preferring to reference the SOP over informal knowledge transfer. The findings suggest that SOPs are an effective tool for improving operational efficiency and leadership transitions in student-led healthcare organisations. This intervention also integrated QI education, fostering leadership skills and systems-based thinking. The study highlights the applicability of this model to other healthcare settings. The implementation of an SOP at SMD successfully addressed long-standing onboarding inefficiencies, providing a scalable solution to improve leadership transitions. This model can be applied to other student-run clinics and healthcare organisations, enhancing both organisational efficiency and medical education.
While leadership effectiveness has been linked to occupational well-being among healthcare workers (HCWs), the relationship of specific leadership behaviours with mental health outcomes such as depression and anxiety remains less clear. To address this gap, we investigated associations between perceived effective leadership behaviours and symptoms of depression and anxiety in a large cohort of faculty and staff employed within an urban healthcare system. Anonymous online surveys were distributed to medical faculty and staff at a large urban healthcare system in New York City. The surveys included demographic questions, the Mayo Leadership Index to measure perceived leadership effectiveness and validated mental health assessments (Patient Health Questionnaire-2 (PHQ-2), Generalised Anxiety Disorder-2 (GAD-2)). Multinomial logistic regression was used to examine associations between leadership effectiveness (standardised as a z-score) and mental health outcomes. Survey response rates were 26.1% (1482/5684) for staff and 43.5% (1635/3761) for faculty. The final sample with completed data included 2335 participants (62% above the age of 40, 45% White, 65% female; 46% staff and 54% faculty, including physicians/providers and researchers). Each SD increase in leadership index score was associated with 31% lower odds of anxiety (p<0.001), and 47% lower odds of comorbid depression and anxiety (p<0.001). These findings underscore the potential role of leadership effectiveness in the mental health of HCWs. Organisational strategies that strengthen leadership effectiveness may be critical components of broad efforts to enhance well-being and promote mental health in the healthcare workforce.
This study examined how relational leadership and role attribution were perceived by key professionals (eg, physicians, nurses, managers, board members) in the crisis management teams of one academic medical centre. Furthermore, we explored the role of hierarchy and power dynamics when crisis management took over responsibility. The research design was qualitative-interpretive with the use of Relational Leadership Theory. We followed an abductive and iterative research approach using observations, document analysis and semi-structured interviews as main methods. Physicians occupied all key leadership roles in the crisis management structure, with their suitability for these positions unquestioned. Role attribution was shaped by formal expertise and informal networks, based on long-standing relational ties.Within the physicians' group, perceptions of each other's leadership abilities varied, with specific crisis competencies linked to individual traits. Despite the hierarchical, command-and-control presentation, much of the work occurred through emergent deliberative processes and informal networks. Power dynamics were continuously negotiated between professional groups, revealing tensions between hierarchical authority and collaborative crisis management. Drawing on healthcare professionals' experiences during the COVID-19 pandemic, this study demonstrates that effective crisis management extends beyond formal training and established hierarchies. Our findings show how relational leadership practices and power dynamics shape collective crisis responses, highlighting the importance of adaptive, relational leadership for strengthening organisational resilience and responsiveness.
Under-representation of women in senior academic medicine positions fails to mirror the over-representation of women entering medical schools. More women medical professors are needed as leadership role models to facilitate gender equity in the curriculum, research and medical services for national well-being. We seek to understand this gender gap in India by highlighting gender disparities in a premier Indian medical school and by advocating multi-level interventions in academic medicine. We statistically analysed documentary data of all faculty ranks from 2004-2005 to 2022-2023 at the All India Institute of Medical Sciences, New Delhi to illustrate women faculty's representation in different disciplines (clinical, paraclinical and surgical) and leadership positions. First, we used trend analysis to project the time to gender parity across ranks. We then adopted cross-tabulation analysis to calculate the relative odds of women faculty holding academic ranks and leadership positions compared with their male counterparts. The findings revealed significant gender inequities across all faculty ranks. The total percentage of women faculty in 2004-2005 was 24.2% compared with 27.5% in 2022-2023. Leadership positions also showed significant gender disparity (χ2=18.20, p<0.0001115) as women occupied 16% of senior roles in the last two decades. The overall trend indicated a decline in the proportion of women in senior academic medical leadership roles over time. This study highlights persistent gender disparities over 20 years for women faculty's career trajectories in academic medicine. We propose six multilevel recommendations for gender parity in academic medical leadership in India.
To use a lived-experience account of stillbirth and subsequent pregnancy to examine how maternity care systems respond to trauma, reveal structural and relational failures in maternal health services and propose principles for more just, compassionate leadership in maternity care. Despite advances in clinical knowledge, maternal outcomes in the UK have plateaued, with widening inequities by ethnicity, deprivation and other intersecting forms of exclusion. Maternal trauma, including stillbirth and miscarriage, is frequently minimised, poorly recognised in policy and measurement frameworks and inadequately supported in routine care. Personal experience of stillbirth and subsequent pregnancy exposes how systems that appear evidence-based and guideline-driven can fail to provide continuity, psychological safety and trauma-informed support at women's most vulnerable moments. This reflective paper integrates first-person narrative of stillbirth, subsequent pregnancy and encounters with maternity and primary care services with professional insight from clinical and leadership roles. The reflection is informed by existing evidence on maternal outcomes, perinatal mental health, intersectionality and global trends in women's health and rights. The narrative is used as an analytic lens to explore how leadership, culture and structures in maternity care shape women's experiences and outcomes. The reflection identifies recurrent gaps: silencing of women's voices, inadequate bereavement and mental health support, fragmentation of care and limited recognition of trauma across the maternity pathway. It highlights structural injustice in maternal health, including inequities by race, poverty and migration status, and the marginalisation of outcomes such as stillbirth and early pregnancy loss in key indicators. It proposes leadership practices that are relational, trauma-informed and equity-focused, including embedding lived experience in governance, investing across the preconception-to-postpartum continuum and prioritising culturally safe, psychologically safe care. Leadership in maternity care must move beyond metrics and guidelines towards models grounded in humility, listening and justice. By centring lived experience, recognising trauma and addressing structural inequities, leaders can begin to rebuild trust, honour loss and reshape maternity systems to better serve women, babies, families and future generations.
Preventing patient harm is a core ethical responsibility in healthcare. While support for patients and families after adverse events has improved, formal support for clinicians involved in serious medical errors, referred to in the USA as 'caregivers' remains inconsistent. This study reports the qualitative findings from a mixed-methods US study exploring healthcare leaders' perspectives on medical errors and caregiver support. The quantitative phase (n=81) found that only 64% of organisations had a caregiver-support programme and over one-third of leaders could not confirm such support existed. These results informed 19 in-depth interviews analysed thematically to identify perceived barriers and enablers to support. Healthcare leaders who participated in the quantitative phase were recruited for semistructured interviews. Transcripts were coded independently by multiple researchers and synthesised through iterative consensus using thematic analysis. Five themes emerged: (1) impact of leadership, (2) embedded in the culture, (3) supportive response, (4) utilisation of existing infrastructure and (5) self-imposed barriers. Leadership engagement, organisational culture and stigma were central in shaping caregiver recovery after medical error. Findings highlight the need for a 'compassionate just culture', defined here as an organisational approach that integrates accountability, empathy and restorative practices to support all parties after harm events. Quantitative and qualitative insights underscore the urgent need for trauma-responsive, co-designed caregiver support systems that address both individual and structural contributors to distress. Healthcare leaders play a pivotal role in ensuring compassionate, non-punitive support following medical errors. Strengthening these systems can enhance workforce well-being, organisational trust and patient safety.
This study investigates the non-negotiable criteria employed by C-suite information leaders when evaluating digital health innovation projects. We conducted a qualitative interview study with 17 executives serving in C-suite information leadership roles. Participants represented not-for-profit US health systems that varied in size, geographic location and mission. Semistructured interviews were conducted using a topic guide developed by the research team. Transcripts were analysed deductively with iterative refinement to identify recurrent themes. Three non-negotiables consistently emerged across interviews: (1) strategic alignment with organisational mission, (2) clinician buy-in and workflow integration and (3) regulatory, privacy and security compliance. These criteria functioned as baseline requirements and organisational safeguards, determining whether innovations advanced to further consideration. Findings suggest that C-suite information leaders operationalise digital innovation decisions through implicit filters that extend beyond financial considerations. In particular, leaders emphasised 'return on benefit' as an evaluative lens that accounts for time savings, workforce sustainability, patient outcomes and community benefit in addition to financial return. This framing reflects the non-profit identity of many health systems and aligns with calls for multidimensional evaluation of digital health initiatives. Strategic alignment, clinician buy-in and compliance represent non-negotiables in digital health innovation decision-making. The addition of return on benefit highlights the need to broaden evaluative frameworks to capture patient-centred and workforce-oriented outcomes.
Despite growing attention to diversity in academic medicine, gender and racial disparities persist in medical school leadership. This study examined how advanced academic qualifications, such as graduate degrees and additional certifications, intersect with these disparities in Canadian medical school leadership positions. We conducted a cross-sectional analysis across 17 accredited Canadian medical schools, categorising faculty by qualifications, medical school leadership roles and academic rank. Data sources included institutional faculty directories, LinkedIn and Scopus. Race and gender were inferred using NamSor. We used the χ2 tests and effect size reporting for analyses. Across qualification levels, gender and racial disparities in leadership and academic rank remained evident. Men and White faculty were disproportionately represented in senior roles, particularly among MDs who also held additional graduate degrees such as a master's or PhD, where disparities were most pronounced. In contrast, women and racialised faculty were more frequently found in mid-level or junior roles, even when holding multiple advanced degrees. These findings indicate that additional credentials alone do not mitigate inequities in academic advancement. Our findings suggest that while advanced qualifications may enhance access to leadership roles, they do not close gender and racial gaps. These persistent disparities highlight the need for systemic reforms and targeted policies to ensure equitable leadership opportunities in academic medicine.
Leadership appointments in academic medicine are often judged by outcome: who was appointed, who was not and whether the institution appears satisfied with the result. Experience observing leadership searches suggests that the process by which leaders are selected may matter more than the eventual outcome, as it shapes trust, morale and institutional legitimacy. Search committees represent moments in which institutional values are tested under pressure. Committee composition, definitions of merit, recruitment practices, management of disagreement and communication all signal whether a process is genuine or performative. Opaque or inconsistent processes erode trust even when outcomes appear defensible. Transparent and disciplined processes, by contrast, can preserve legitimacy despite disagreement. Best practice includes defining the role and criteria in advance, ensuring representative and empowered committees, standardising evaluation processes, broadening recruitment meaningfully, communicating clearly and using external supports to strengthen rigour rather than create the appearance of it. Search committees do more than appoint leaders: they reveal how institutions understand fairness, power and themselves.
In the process of providing healthcare, our health systems significantly contribute to the climate and nature crises, which in turn threaten the health of populations under its care. The health sector has the potential to reduce its impact on planetary health while improving patient health and reducing costs. The author suggests that all healthcare workers have the opportunity to create positive change in their professional spaces by embracing grassroots leadership. The author reflects on their own journey into grassroots leadership within planetary health and outlines why it is a vital element of the healthcare sector's response to the climate and nature emergencies. Using the framework of the National Healthcare Service Leadership Model, the author describes and reflects on a real-life example of a grassroots movement for planetary health in their profession. Readers are invited to examine the opportunities in their professional spaces for positive change in the face of the climate and ecological crises.
In 2022, National Health Service (NHS) Forth Valley, Scotland was escalated to Level 4 under the NHS Scotland Support and Intervention Framework - triggering the highest level of oversight and engagement from the Scottish Government prior to statutory intervention. While many systems under such pressure default to compliance-driven responses, NHS Forth Valley took a different path: embracing a whole-system approach focused on leadership, culture, integration and governance. Within this, Transformative Simulation was embedded as a leadership method to support cultural and systemic renewal. A multi-professional, multi-sector delegation from the Association for Simulated Practice in Healthcare (ASPiH) visited NHS Forth Valley in early 2025 to observe simulation in practice as a leadership tool. Over two immersive days, we witnessed how simulation was used not only for education and training but also for engaging with emotionally charged challenges, enabling system-wide reflection and co-designing new models of care. Leadership behaviours observed during the visit were marked by humility, openness and courage. Senior leaders did not simply oversee change - they participated in simulations, listened deeply and responded actively. Simulation served as both a mirror and a mechanism: surfacing cultural dynamics, enabling cross-boundary collaboration and supporting healing after organisational trauma. Transformative Simulation emerged not as a short-term intervention but as a long-term leadership framework. NHS Forth Valley's response demonstrates that simulation, when embedded intentionally, can be a powerful lever for leadership, trust-building and transformation. Their story offers a hopeful vision of what becomes possible when leadership chooses connection over control.
Climate change is an escalating public health emergency, yet within the National Health Service (NHS) it remains marginal to board-level leadership and governance. Despite its direct implications for population health, service resilience and health inequalities, responsibility for climate action is often delegated away from strategic decision-making forums. This article draws on the author's experience as the NeXt Director (Non-Executive Director in Training) with a remit for future generations, including climate change and sustainability, on a newly established Integrated Care Board in England. Using a reflective leadership lens, the article examines how climate change was reframed from a peripheral sustainability issue into a core governance and risk concern. Practical strategies included embedding climate-related threats into formal risk registers, aligning climate action with population health and inequality priorities and integrating climate considerations into existing strategic and operational levers. Positioning climate risk within established governance structures shifted board-level engagement, normalised climate-informed questioning in strategic discussions and enabled early integration of climate considerations into population health, commissioning and resilience planning. These changes established climate change as a shared leadership responsibility rather than a siloed agenda. The article argues that NHS leadership models must evolve to address long-term, systemic risks such as climate change. Boards should treat climate change as a determinant of quality, safety and equity, embedding it within risk management, strategy and accountability frameworks to ensure system preparedness in an increasingly unstable climate.