Leadership

There is increased recognition that diagnostic errors disproportionately affect marginalised and underserved patient populations in the USA. However, evidence on diagnostic inequities in mental disorders is sparse and not well integrated into the overall diagnostic safety literature.

We systematically reviewed and narratively synthesised evidence on inequities in diagnosis of mental disorders, guided by the Diagnostic Process Framework developed by The National Academies of Sciences, Engineering, and Medicine.

We conducted a systematic review and a narrative synthesis. Medline, Embase, PsycInfo and CINAHL were searched for studies published between 2015 and 2024. Studies were eligible if they reported on inequities in the diagnosis of mental disorders and applied a quantitative, qualitative or mixed-methods design. Studies had to be peer reviewed, US based and published in English. The Mixed-Methods Appraisal Tool was used for quality appraisal. Data were analysed with a descriptive intent, and inequities were mapped into the diagnostic process.

20 studies of varying methodological quality were included. Though not the initial focus, autism spectrum disorder (ASD) emerged as the most studied mental disorder (n=17). Of the diagnostic errors identified, most fell into the category of delayed diagnosis. 11 factors emerged as contributors to diagnostic inequities. Limited health literacy among patients and caregivers was the leading cause of diagnostic error in symptom recognition. Insurance coverage issues delayed patient engagement with the healthcare system. Provider bias during clinical history-taking and interviewing was seen as a key cause of delays and misdiagnoses. Within diagnostic testing and interpretation, culturally inequivalent assessment measures might cause misdiagnosis and delayed diagnosis for Black/African American and Hispanic/Latino patients. The use of medical jargon and lack of qualified language interpreters during communicating the diagnosis were associated with diagnostic errors impacting patients with limited health literacy and low English language proficiency.

Diagnostic inequities in ASD and other mental disorders persist across US patient populations. Multiple factors such as parental health literacy, provider bias and limited access interact and impact the diagnostic process. Addressing these interconnected barriers is essential to ensure timely, accurate and equitable care.

CRD42024581271.

While the incidence of hospital adverse events appeared to be declining before 2019, the COVID-19 pandemic may have changed its course. This study aimed to evaluate adverse event incidence rates and trends during the pandemic and analyse differences in patient outcomes.

This retrospective electronic chart review included a random sample of adult patients admitted to four acute care hospitals in Calgary between 2017 and 2022. 18 adverse events and patient information were extracted. We calculated the observed and risk-standardised incidence rates of adverse events. Interrupted time series analysis was employed to determine the impact of COVID-19 on adverse events trends. Outcome differences were evaluated using mixed-effects logistic regression and negative binomial models.

Among 10 673 patient admissions, 2310 adverse events were identified, resulting in an incidence rate of 21.64 (95% CI 20.77 to 22.54) per 100 patient admissions, or 26.85 (95% CI 25.77 to 27.97) per 1000 patient days. After adjusting for patient characteristics, seasonal variations and overall trends, the adverse event incidence rate increased by 14% (incidence rate ratio (IRR) 1.14, 95% CI 1.01 to 1.29) during the COVID-19 pandemic. In multivariable mixed-effects models, adverse events were associated with significantly longer hospital stays (IRR 3.13, 95% CI 2.97 to 3.30), increased odds of 30-day readmission (OR 1.4, 95% CI 1.17 to 1.68) and in-hospital death (OR 1.72, 95% CI 1.43 to 2.08).

The incidence of adverse events was high but relatively stable in acute healthcare settings before the COVID-19 pandemic and increased during the pandemic. Strengthening healthcare resilience and prioritising patient safety initiatives are crucial as we transition into the post-pandemic era.

Artificial intelligence large language models (LLMs) are increasingly used to inform clinical decisions but sometimes exhibit human-like cognitive biases when facing nuanced medical choices.

We tested whether new chain-of-thought reasoning LLMs might mitigate cognitive biases observed in physicians. We presented medical scenarios (n=10) to models released by DeepSeek, OpenAI and Google. Each scenario was presented in two versions that differed according to a specific bias (eg, surgery framed in survival vs mortality statistics). Responses were categorised and the extent of bias was measured by the absolute discrepancy between responses to different versions of the same scenario. The extent of intransigence (also termed dogma or inflexibility) was measured by Shannon entropy. The extent of deviance in each scenario was measured by comparing the average model response to the average practicing physician response (n=2507).

DeepSeek-R1 mitigated 6 out of 10 cognitive biases observed in practicing physicians by generating intransigent all-or-none responses. The four biases that persisted were post hoc fallacy (34% vs 0%, p<0.001), decoy effects (44% vs 5%, p<0.001), Occam’s razor fallacy (100% vs 0%, p<0.001) and hindsight bias (56% vs 0%, p<0.001). In every scenario, the average model response deviated substantially from the average response of practicing physicians (p<0.001 for all). Similar patterns of persistent specific biases, intransigent responses and substantial deviance from practicing physicians were also apparent in OpenAI and Google.

Some biases persist in chain-of-thought reasoning LLMs, and models tend to produce intransigent recommendations. These findings highlight the role of clinicians to think broadly, respect diversity and remain vigilant when interpreting chain-of-thought reasoning artificial intelligence LLMs in nuanced medical decisions for patients.

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.