Leadership

On 30 June 2025, the healthcare world lost Dr Lucian Leape, widely regarded as the father of the modern patient safety movement. His 1994 paper ‘Error in Medicine’ reframed medical errors as symptoms of flawed systems rather than individual failings.1 Five years later, the Institute of Medicine’s To Err Is Human report, which Dr Leape helped shape, galvanised a national reckoning with patient safety.2 Through the Lucian Leape Institute, and beyond its formal structure, he championed five transforming concepts: transparency, integrated care platforms, patient and family engagement, restoration of joy in work and medical education reform.³

As Schiff and Shojania observed, the patient safety movement has achieved undeniable cultural gains, yet demonstrating measurable reductions in harm remains elusive.4 Although dentistry shares medicine’s ethical imperative to ‘first, do no harm’, the profession was largely absent from early patient safety discussions...

Acute deterioration refers to a sudden, clinically important change in a person’s physiological, cognitive, behavioural or functional state.1 It includes early and sometimes subtle changes that may precede critical events if not recognised and responded to promptly,2 including, but not limited to, changes in respiratory rate, heart rate or rhythm, blood...

Patient safety remains...

Coaching is increasingly used to benefit doctors’ professional development. This scoping review summarises the current state of the evidence relating to workplace leadership coaching for qualified doctors.

A rapid scoping review was conducted, informed by Joanna Briggs’ Institute guidelines, with protocol designed a priori. Medline, Embase and APA PsycInfo were searched for relevant articles. Search results were screened for inclusion in duplicate. Data were synthesised descriptively and thematically, mapping the existing research and identifying knowledge gaps.

A total of 5307 articles were screened, and 94 met the inclusion criteria. 15 (16%) articles were classified under ‘leadership training needs assessments’, 15 (16%) under ‘evaluations of leadership development interventions with coaching’, 18 (19%) under ‘evaluations of leadership coaching interventions’, 1 (1%) specifically evaluated a team leader coaching training programme, 37 (40%) were commentaries, 1 (1%) was a research protocol and 7 (7%) were reviews.

The studies were positive about the role of coaching in medical leadership development and as a skill for doctors to develop. The use of the term ‘coaching’ was often conflated with the term ‘mentoring’. Most intervention articles mentioned coaches’ qualifications or training. Only three used coaches with internationally recognised accreditation qualifications, and the majority used ‘faculty coaches’.

Most of the coaching components of leadership interventions, reviews and commentaries included in our review were considered successful. Coaching appears to be increasingly requested as an intervention for leadership development and identified as a training need for medical leaders.

This article challenges the dominance of multidisciplinary and often generic leadership development programmes in healthcare. Drawing on nearly a decade of experience with the Executive Masters in Medical Leadership (EMML) at Bayes Business School—a physician-only programme—we argue that profession-specific education is not just preferable but essential.

This paper reflects on our experience designing and delivering the EMML, combined with a review of evidence on physician personality traits, professional responsibilities, and the historical development of generic management education. We examine the theoretical and practical case for tailored leadership development that recognises professional differences.

Physicians possess distinct personality traits, undergo uniquely extensive training, carry exceptional legal and professional responsibilities, and operate within a fundamentally different professional culture than other healthcare workers or general managers. We do not believe that this is adequately recognised in the National Health Service. Our experience and EMML learning outcomes data demonstrate that physician-only programmes create psychological safety, build lasting professional networks, and deliver learning outcomes that generic, multidisciplinary courses are unlikely to replicate.

Professional differences demand profession-specific education. The NHS champions diversity in race, gender and background. It is time to recognise cognitive, professional and situational diversity with equal vigour.

To evaluate the trends in sex and race/ethnicity demographics of department chairs at US medical schools over 45 years.

This was a longitudinal retrospective analysis of the Association of American Medical Colleges database.

The study analysed the sex and race/ethnicity of department chairs in US medical schools.

Department chairs were classified by sex and self-reported race/ethnicity. Data from 1977 to 2022 were used to evaluate changes in the demographic composition of leadership roles over time.

Identifying as female and/or as part of an under-represented in medicine group.

The outcome measures were demographic (ie, sex, race and ethnicity) trends among department chairs.

The analysis depicted under-representation of women and racial minorities in department chairs. A notable increase was noted in the number of Asian, Black or African American, and Hispanic or Latino department chairs. However, this was outnumbered by the number of white individuals in leadership positions.

The end of affirmative action is expected to jeopardise the progress made and has the potential to perpetuate the lack of diversity in the department chair positions.

One of the compelling reasons for healthcare leaders to nurture a kinder organisational culture is that kindness buffers stress by creating connection. As stress affects both patients and staff and increases negativity, burnout, distrust and incivility, the impetus for fostering kindness is much greater than just being nice.

We have been deploying kindness media (KM)—short form videos depicting acts of kindness and caring—in healthcare. Seeing KM reduces stress and uplifts patients and staff in non-critical settings.

The emergency department (ED) is a particularly stressful environment. In the ED, patients’ personal stressors are amplified by wait times, anxiety and illness.

The goal of this observational study was to assess the impact of KM in a level 1 trauma ED. Two questions were addressed. Did KM affect how patients felt? Did viewing KM affect patient satisfaction with their care?

KM was displayed on waiting area televisions. Questions were added to the patient experience survey (Press Ganey (PG)) to assess if patients watched KM and, if yes, how it made them feel. We report PG topbox scores (percentage of responses as ‘very good’).

3176 survey responses were included in the analysis. Of these, 361 patients (11%) reported that they had watched KM. Of the 361 patients, 54% reported feeling more positive.

In general, patients who watched KM had significantly higher top box scores across care-related questions stratified by waiting time satisfaction. For example, the top box percentage differences for ‘overall rating of care’ were 9%–27% higher in KM viewers (all p<0.001). Similar results were observed for multiple other questions, including ‘Likelihood to recommend our ED’ and ‘I was treated with respect and dignity’. KM partially offset the negative impact of waiting time.

Viewing KM in this ED is associated with a positive shift in patient perception of their care experience.

Streamlined healthcare pathways can have advantages in terms of a more efficient service and better outcomes for patients, financial savings and lower carbon footprint. The aim of this study was to look at the potential carbon savings associated with streamlining clinical care pathways for people presenting to the emergency department (ED) with shoulder dislocation.

This was a retrospective analysis of routinely collected clinical data for the purposes of quality improvement. Data were collected for randomly selected patients recorded as attending the ED of a major trauma centre in England with a shoulder dislocation between 1 April 2022 and 31 March 2023. Data were collected relating to demographics, presentation, treatment received, imaging, hospital attendance and secondary complications. Care activities associated with the current pathways were linked to carbon emissions factors to identify areas for action. Where they existed, mitigation actions were then identified, and potential carbon savings calculated.

Data were collected for 154 (88.5%) of 174 patients attending ED with a shoulder dislocation during the study period. raumatic dislocation without fracture patients dominated (68.2%). Across all dislocation types, 92 (59.7%) patients were aged 15–34 years and 109 (70.8%) were male. 13 specific actions that could result in carbon emissions reduction were identified. If these actions were implemented, we estimate that there is potential to save 86.4 kgCO₂e per patient. For 2022/2023 across the whole of England (n=30 846 patients who presented to ED with a shoulder dislocation), we estimate that 2666 tonnes CO₂e could be saved enough to power 2426 homes with electricity for 1 year.

There is scope to substantially reduce the carbon footprint associated with ED attendances for shoulder dislocation. Efficient, streamlined pathways are needed if the National Health Service is to meet its commitment to net-zero carbon emissions by 2045.