Leadership

Actively engaging patients is essential for diagnostic excellence and patient safety.

To (1) identify and synthesise interventions facilitating patient and family engagement (PFE) across the diagnostic process, and (2a) assess patient involvement and (2b) equity considerations in their design or implementation.

This scoping review followed Arksey and O’Malley’s framework and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review) guidelines. An advisory panel guided the review. We searched Medline, Embase, CINAHL, PsycInfo and Northern Light for peer-reviewed literature and conducted grey literature searches using DuckDuckGo and targeted websites. Search terms focused on PFE and diagnostic error. Eligible interventions were published in English between January 1999 and July 2024 and supported PFE in at least one step of the National Academies of Sciences, Engineering, and Medicine (NASEM) diagnostic process. Narrative reviews, case studies and editorials were excluded. Interventions were mapped to the NASEM steps; data were extracted on patient involvement and equity.

Of the 11 630 studies screened, 250 were included, representing 260 interventions. Most (n=213; 85.2%) were from the grey literature, and patients were primary users (n=166; 63.8%). Interventions spanned all diagnostic process steps but were most common in treatment (n=122; 46.9%) and history taking (n=100; 38.5%), with few in referrals (n=10, 3.8%) and physical examinations (n=6, 2.3%). The evidence base was weak: grey literature interventions lacked high-quality studies, and among the 37 peer-reviewed studies, three were randomised controlled trials, each limited by small samples or high attrition. Only 63 interventions (24.2%) were designed with patients, and 48 (18.5%) incorporated equity.

PFE interventions exist across the diagnostic process, but few target referrals and physical examinations. The evidence remains weak, and current interventions cannot be considered effective. Future research should prioritise equity, patient involvement and rigorous evaluation.

The World Health Organization Surgical Safety Checklist (WHO-SSC) is a global tool designed to enhance teamwork and safety in operating rooms (ORs). Its use remains under-reported in the Eastern Mediterranean Region (EMR). This study aimed to assess WHO-SSC awareness, adoption, satisfaction with its implementation, barriers and its impact on healthcare professionals’ safety attitudes.

Using a validated questionnaire, a cross-sectional survey was conducted from 11 March to 18 June 2024, in hospitals across 12 countries in the EMR through face-to-face and online distribution. Healthcare professionals’ safety attitude was assessed using the modified operating-room version of the Safety Attitudes Questionnaire. A multiple logistic regression model was used for data analysis, reporting aOR with 95% CIs.

The study involved 3861 respondents, comprising 1348 surgeons, 1277 OR nurses and 1236 anaesthesiologists. Overall, 52.5% of respondents reported awareness of the WHO-SSC. Among those aware, adoption was highest in private and teaching hospitals and lowest in charity hospitals, with 56.2% expressing satisfaction with its implementation. Reported ‘always’ adherence to the checklist was 32% in elective surgeries, compared with 19% in emergency surgeries. The main barriers included a lack of training, time constraints, limited awareness and poor team communication. Overall, 61.4% of participants demonstrated a positive safety attitude. Positive attitudes were associated with older age, being from a low-income and middle-income country, and WHO-SSC awareness.

This study emphasises inadequate awareness and adoption of the WHO-SSC in the EMR. Strengthening training, institutional support and context-specific implementation strategies is essential to enhance surgical safety culture in the region.

Prescribed opioids are potent analgesics associated with high safety risks due to their adverse effects, drug-drug and drug-disease interactions and potential for dependency. To support the implementation of prescribing indicators for further interventions, this study examined the prevalence of different types of potentially hazardous opioid prescribing (PHOP) in general practices across England and investigated underlying factors and variation between practices.

We conducted a cross-sectional study focusing on adults (aged ≥18 years) at risk of triggering 17 PHOP indicators on 1 April 2021, involving 1358 general practices contributing to the Clinical Practice Research Datalink Aurum. PHOP prevalence was calculated by dividing the number of patients triggering an indicator by the total number at risk. Variation was assessed with intraclass correlation coefficients (ICCs), and multilevel mixed-effects logistic regression models identified associated factors, presented as adjusted ORs (aORs) with 95% CIs.

Among 3 121 852 patients observed, 361 505 (11.58%, 95% CI 11.54, 11.62) triggered at least one PHOP indicator, yielding an ICC of 0.07 (95% CI 0.06, 0.07). The prevalence of the 17 PHOP indicators ranged from 1.97% to 32.02%. Significant variability was noted across the 17 indicators, especially for persistent opioid prescriptions in patients with alcohol use issues (ICC 0.08, 95% CI 0.07, 0.09), chronic obstructive pulmonary disease or asthma (ICC 0.08, 95% CI 0.07, 0.09) and hypothyroidism (ICC 0.07, 95% CI 0.06, 0.07). Patients from the most deprived regions (aOR 1.28, 95% CI 1.22, 1.34) and the Northwest of England (aOR 1.73, 95% CI 1.66, 1.81) had a higher risk of PHOP.

The high prevalence of PHOP, particularly among the most socioeconomically disadvantaged populations, emphasises existing prescribing risks and the need for their appropriate consideration within primary care. The high variation between practices indicates potential for improvement through targeted practice-level intervention.

Transitioning into a new chief executive role within a large national health and social care provider prompted a period of systematic observation and deliberate reflection. Drawing on Schön’s concept of the reflective practitioner, I kept a journal during my first months to capture critical moments that tested my assumptions and revealed how organisational culture shapes leadership behaviour.

This autoethnographic account integrates observation, intentional listening and reflective journaling to explore how leadership meaning is constructed in everyday practice. Six anonymised vignettes are presented, spanning board discussions, governance meetings and frontline encounters. Each vignette illustrates tensions such as silence vs intervention, urgency vs empathy and authority vs collaboration, analysed through frameworks including adaptive, situational and collective leadership, as well as psychological safety, motivation and organisational culture.

The reflections show that leadership is not confined to formal authority but emerges in presence, tone and everyday interactions. They demonstrate how listening, humility and adaptive behaviour foster psychological safety and collective leadership. While situated in health and social care, the insights are transferable to leaders at all levels and across sectors facing complexity and uncertainty.

Shared decision-making (SDM) is a cornerstone of patient-centred care, yet it has been underused in radiology.

To translate research into innovative strategies to empower radiology leaders to apply SDM and outline the cultural and structural changes required for meaningful integration into clinical practice.

This article synthesises case examples and evidence across imaging scenarios, evaluates emerging innovations and highlights leadership levers that can embed SDM as a core practice in radiology.

Leadership interventions can transform radiology’s contribution to SDM. Cases such as incidental pulmonary nodules, breast MRI in familial risk and Li-Fraumeni syndrome illustrate how radiologists can engage directly in preference-sensitive decisions. Key strategies include improving access to imaging data, using patient-friendly summaries, expanding opportunities for direct communication and incorporating patient-reported outcome measures, patient-reported experience measures and artificial intelligence (AI)-driven tools to support patient understanding. Barriers such as workflow demands, medicolegal uncertainty and lack of incentives can be addressed through leadership-driven reforms.

Radiology plays a central role in care pathways, offers clinical and technical expertise and increasing patient-facing innovation. Leaders who embed SDM into training, workflows and systems can enhance radiology as a model of cutting-edge, patient-centred care. Clear actions include training, protected time, incentives, strategic application of AI and transformational leadership.

Mentorship and sponsorship play pivotal roles in career development, yet disparities in access to these opportunities persist among medical trainees. This report describes a structured alumni engagement programme for pulmonary, critical care and sleep medicine fellows, aimed at fostering mentorship, professional development and equitable career opportunities.

Conducted within a university-based fellowship programme, the intervention comprised seven themed virtual sessions featuring alumni from diverse career trajectories, including academia, industry and private practice.

Thematic analysis of session transcripts identified ten key themes across four domains: career development, personal fulfilment, professional relationships and adaptability. Postsession feedback indicated high participant satisfaction, with 53% of fellows reporting subsequent mentorship or career opportunities with alumni.

Limitations include the small sample size, short follow-up period and lack of full characterisation of baseline features.

This initiative highlights the scalability and potential impact of alumni engagement on career development, emphasising the importance of mentorship and sponsorship. Broader implementation could enhance networking opportunities across medical disciplines, addressing long-standing disparities in access to professional growth resources. Future studies should focus on longitudinal outcomes to assess the influence of such programmes on trainees’ career trajectories. This innovative model offers a replicable framework to strengthen professional networks and support leadership development among trainees.

To identify the range of internal specialist management expertise providers in the NHS and explore their blending with external organisations to address complex organisational challenges.

Ongoing quantitative and qualitative research (e.g. interviews) and a national networking event and workshop organised by the University of Bristol with NHS partners.

There is a diverse NHS ecosystem of what we term internal consultancies where strategic benefits can result from combining their contextual insight with the specialist skills of external providers. Effective blending can build sustainable management capacity, deliver better value and reduce over-reliance on external consultants.

There is a need for coordinated action across policy, procurement and workforce development to support a network of internal consultancy/expertise and its periodic blending with other partners, including external organisations.

Mattering, defined as making a difference and feeling significant to others, is endorsed by the US Surgeon General as an essential component of a healthy work environment. This concept is particularly relevant for healthcare leaders whose workforce face challenges such as burnout and turnover due to the demanding nature of the healthcare work environments. Research on mattering within the context of work environments can provide valuable insights into how mattering can be understood in relation to employees’ work experiences.

This scoping review aims to explore the concept of mattering within the work environment to identify key concepts and relationships between mattering and work-related factors.

A comprehensive search was conducted across PubMed, ERIC, CINAHL, EMBASE, Business Source Complete and PsycINFO for peer-reviewed studies that investigated mattering at work.

The review included 33 articles covering a diverse range of work environments in seven different countries. Employees’ perceptions of mattering at work were influenced by their role and status, interpersonal relationships, peer and organisational support and societal impact. Several studies reported significant relationships between mattering and employee well-being, job satisfaction and organisational culture.

Employees’ perceptions of their significance and the importance of their work are shaped by interpersonal, societal and organisational interactions. To foster healthy work environments, healthcare leaders can examine these interactions and prioritise employee mattering. Future research should build on these findings by exploring mattering within the healthcare work environment, measuring healthcare worker mattering and developing interventions to enhance mattering and well-being.

In their 2024 editorial, Yassaie and Garman called on health professionals to be planetary health leaders. Responding to their call for articles, this submission reflects my COVID-19 ‘planetary health’ epiphany during the Australian lockdowns while curating sustainable healthcare and climate change education submissions.

As a global collective, we could have learnt much from the pandemic. Despite our broken relationship with Nature, during lockdown, most of us spent considerable time in Nature. This should have heightened our awareness of our interdependence with our natural environment. The United Nations has asked us to Make Peace with Nature and be the #GenerationRestoration in the 2021–2030 Decade of Restoration.

My COVID-19 epiphany happened while curating sustainable healthcare education articles for a medical education journal. An article reflecting Indigenous perspectives introduced me to Natural and First Laws. My newfound awareness of Indigenous communities’ deep spiritual connection to and stewardship of Country or Land changed the lens with which Planetary Health was integrated across our curriculum.

This ‘epiphany’ also led to advocacy for advancing planetary stewardship in health professions education, such as the development of a Consensus Statement on Planetary Health and Education for Sustainable Healthcare, and contributing to the revision of the Australian Medical Council’s Accreditation Standards.

Individually and collectively, as health professionals and health professions educators and as #GenerationRestoration, current and yet unborn generations of all ‘beings’ are relying on us to be inclusive eco-ethical leaders and planetary stewards.

Student leadership plays a crucial role in the development of planetary health education. The Planetary Health Report Card (PHRC) is an established model of student-led initiative that is advancing planetary health education internationally.

In this collection of personal reflections and informal discussions from 12 members of the PHRC’s leadership team, we share a narrative analysis of the unique perspectives of student leaders working to advance planetary health education. The aim of this piece is to explore the value of student leadership in the development of Education for Sustainable Healthcare.

Students have a unique leadership role in this space, bringing a shared passion and collective responsibility for action while balancing academic studies and having finite course durations in which to enact change. Challenges exist in engaging other students and changing faculty perspectives; nevertheless, participation in this work is identified as both rewarding and personally fulfilling through international networking, working relationships and collective empowerment.

Student leadership is a strong and necessary driver in the development of planetary health education and can be rewarding for those involved. However, student time must be respected; more work is required to break down negative perceptions and barriers to this work.

Hospital pharmacists play vital roles in patient care, with career satisfaction influenced by work environment, career advancement opportunities and personal aspirations. Addressing these factors in Japan is essential to attract and retain hospital pharmacists. This study aimed to identify factors associated with hospital pharmacists’ satisfaction with their current careers in Japan.

A nationwide cross-sectional questionnaire survey was distributed through the Japanese Society of Hospital Pharmacists website, journal and newsletter. Responses were collected from 14 June to 31 July 2024, using Google Forms. Ordinal logistic regression analysis was applied to evaluate the association between career satisfaction and individual-related factors, including background, work style and environment.

Of the 712 respondents, 710 provided consent for analysis. Pharmacists in their 30s, 40s and 50s reported significantly higher career satisfaction than those in their 20s (OR: 2.311, 95% CI: 1.323 to 4.038; OR: 2.148, 95% CI: 1.128 to 4.092; and OR: 2.077, 95% CI: 1.048 to 4.116, respectively). Conversely, mid-level and senior managerial roles and certifications were associated with lower satisfaction (OR: 0.354, 95% CI: 0.200 to 0.627; OR: 0.258, 95% CI: 0.158 to 0.421; and OR: 0.668, 95% CI: 0.478 to 0.934, respectively).

Structured mentorship programmes, financial support for advanced training and systems to reduce workload and improve flexibility could enhance career satisfaction among hospital pharmacists in Japan.

Pharmaceutical manufacture, delivery and use produces an estimated 10%–55% of national healthcare greenhouse gas emissions. Addressing pharmaceutical supply chain emissions is essential to mitigating healthcare’s climate impact. Our research aimed to explore the constraints to pharmaceutical supply chain climate action and how planetary health leadership can overcome these challenges.

We conducted 21 narrative interviews with representatives from pharmaceutical companies and industry and health system stakeholders. Interviews explored perspectives on climate action across pharmaceutical supply chains. Analysis was informed by argumentative discourse analysis, enabling the identification of key storylines.

Climate action across pharmaceutical supply chains is sporadic and insufficient to achieve health system climate goals. Critical constraints to climate action include (a) structural constraints, particularly complex, fragmented, global supply chains as well as limited renewable energy infrastructure in some countries where supply chains operate and (b) conceptual constraints, the ‘patient-profit-planet dilemma’, where climate action is perceived to conflict with patient well-being and financial considerations.

Planetary health leadership can help overcome these constraints in three key ways. First, planetary health leadership can help reconceptualise healthcare delivery, and the role of pharmaceuticals, to align patient and planetary well-being while meeting financial pressures. Second, planetary health leadership can mobilise collective climate action across pharmaceutical supply chains, reframing climate change as a shared problem and challenging issues of transparency, competition and blame. Third, planetary health leadership can challenge wider systems that constrain climate action, leveraging the economic and political power of pharmaceutical supply chains to drive global decarbonisation efforts.

Planetary health leadership must confront considerable constraints to embed planetary health considerations across pharmaceutical supply chains. Leaders in this space must be willing to go against the status quo and challenge entrenched norms and systems to enable wider spread and support for sustainable healthcare delivery.