BMJ Leader最新文献

{"title":"Potential carbon savings in the management of shoulder dislocations through allied health professional-led patient pathways: an observational study using audit data.","authors":"Gemma Shearer, Simon Nicole, Ben Bowling, Jawaad Saleem, Nasri Zreik, Cloe Hubbard, Duncan Tennent, Linda Hindle, Manraj Phull, Tim W R Briggs, William K Gray","doi":"10.1136/leader-2025-001228","DOIUrl":"10.1136/leader-2025-001228","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":"277-284"},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leadership in the mirror: Discovering dyslexic leadership as a strategic asset in healthcare integration.","authors":"Joel Simon Phillips","doi":"10.1136/leader-2025-001279","DOIUrl":"10.1136/leader-2025-001279","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Aim: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Findings: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":"331-336"},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary care has a voice: let's use it.","authors":"Ashifa Trivedi, Martha Martin, Zahra Yasen, Tanvir Alam, Claire Fuller, Nick Harding, Nikita Kanani, Mayur Lakhani, Anthony McKeever, Rich Withnall","doi":"10.1136/leader-2024-001141","DOIUrl":"10.1136/leader-2024-001141","url":null,"abstract":"","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":"319-323"},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing role of tenure in academic medicine: a national survey of faculty affairs deans.","authors":"Maya Iyer, Doug Macdowell, Reshma Jagsi, Nancy D Spector","doi":"10.1136/leader-2026-001590","DOIUrl":"https://doi.org/10.1136/leader-2026-001590","url":null,"abstract":"<p><strong>Background: </strong>Tenure has traditionally signified academic freedom, job security and scholarly independence at US medical schools, yet the proportion of faculty in tenure-track positions has declined markedly in recent decades.</p><p><strong>Methods: </strong>To assess tenure's contemporary relevance, particularly for academic medical leaders, we conducted a national survey of senior faculty affairs deans at US medical schools from September to November 2025.</p><p><strong>Results: </strong>Of 139 faculty affairs deans contacted, 78 (56%) responded. Most respondents were physicians in clinical departments (n=44, 56.4%) and over half were not tenured or worked at institutions without tenure systems (n=43, 55.1%). Faculty affairs leaders viewed that tenure was slightly or not at all important for deans (n=42, 54%), clinical department chairs (n=57,73%) and themselves (n=45, 58%), but remained very important for basic science department chairs (n=56, 72%). Two-thirds believed it is important for medical schools to offer tenure, citing academic freedom, recruitment and retention value and its importance for basic scientists. Qualitative themes highlighted that tenure may confer leadership credibility, though leadership experience itself was viewed as more important.</p><p><strong>Conclusions: </strong>While tenure is still perceived as valuable in specific contexts, particularly for basic science department chairs, modern academic medicine may consider evolving tenure systems and requirements for tenure in leadership roles so that the pathways to leadership better reflect the diverse missions, expertise and contributions required to advance academic health centres.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of promoting 'Only order what you need' and ceasing pharmacy-initiated managed repeats in a large general practice.","authors":"Laura Smith, Helen Kingston, Richard Podmore, Chloe Jenvey, Daniel Tucker","doi":"10.1136/leader-2025-001286","DOIUrl":"10.1136/leader-2025-001286","url":null,"abstract":"<p><strong>Background: </strong>Prescribing is responsible for over half of carbon emissions in primary care.Strategies to reduce unnecessary medication use are therefore important in supporting the delivery of a net-zero National Health Service (NHS).</p><p><strong>Methods: </strong>We ceased to accept pharmacy-managed repeat prescriptions and undertook a patient education campaign to order only the medication they needed.</p><p><strong>Results: </strong>The intervention was associated with a saving of £165 957 and 5350 fewer prescribed items over a 7-month period. This equated to estimated emissions savings of 96 421 kgCO2e.</p><p><strong>Conclusions: </strong>A well-planned campaign to move away from pharmacy-managed repeat prescriptions to patient-initiated requests can reduce prescribing costs and support the NHS journey to net zero.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":"296-298"},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflections on grassroots leadership in planetary health.","authors":"Jennifer McNesfield","doi":"10.1136/leader-2025-001306","DOIUrl":"10.1136/leader-2025-001306","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Conclusion: </strong>Readers are invited to examine the opportunities in their professional spaces for positive change in the face of the climate and ecological crises.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":"342-345"},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting kindness through media increases patient satisfaction in an emergency department: a simple intervention to uplift patients and lower stress.","authors":"David A Fryburg, Stacey Mueller, Alicia Pilarski, Jennifer L Rabaglia, Jonathon D Truwit","doi":"10.1136/leader-2025-001314","DOIUrl":"10.1136/leader-2025-001314","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Objective: </strong>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?</p><p><strong>Methods: </strong>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').</p><p><strong>Results: </strong>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 <i>differences</i> 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.</p><p><strong>Conclusions: </strong>Viewing KM in this ED is associated with a positive shift in patient perception of their care experience.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":"268-276"},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four pillars of sustainable food services in healthcare: a practical approach for healthcare leadership.","authors":"Fiona Parascandalo, Iliya Khakban, Casey Qian, Elizaveta Zvereva, Amy Ford, Russell de Souza, Myles Sergeant","doi":"10.1136/leader-2025-001299","DOIUrl":"10.1136/leader-2025-001299","url":null,"abstract":"","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":"307-310"},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From clinical expertise to leadership capability: a challenge to generic and multidisciplinary leadership programmes in support of tailored leadership development.","authors":"Amanda H Goodall, Natasha Maw","doi":"10.1136/leader-2025-001263","DOIUrl":"10.1136/leader-2025-001263","url":null,"abstract":"<p><strong>Background/aim: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":"337-341"},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145878793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nursing followership: a concept analysis.","authors":"Wafaa ALQadrie, Ali Saleh","doi":"10.1136/leader-2025-001274","DOIUrl":"10.1136/leader-2025-001274","url":null,"abstract":"<p><strong>Purpose: </strong>The researcher aims to analyse the concept of nursing followership to identify its defining attributes, antecedents and consequences, as well as to explore its relevance and impact on clinical settings.</p><p><strong>Methods: </strong>This concept analysis was conducted using Walker and Avant's (2005) analysis framework. PubMed, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases searches were carried out from 1980 to 2025. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were used.</p><p><strong>Findings: </strong>Effective followership is defined as a role wherein nurses are actively engaged in care processes, capable of having advanced critical thinking and decision-making skills and proficiently communicative with their colleagues and team leaders alike for the purposes of eventually facilitating the achievement of the team goals and objectives. Nursing followership key attributes are active engagement, independent critical thinking, effective communication, adaptability and commitment to shared goals. The organisational culture, leadership styles, role clarity, recognition and reward systems, communication channels and training and development opportunities are the antecedents of nursing followership. The consequences of nursing followership include improved team dynamics, increased job satisfaction and enhanced patient care and professional development. These consequences also extend to strengthening organisational commitment and resilience in the nursing workforce.</p><p><strong>Conclusion: </strong>Nursing followership plays a crucial role in promoting teamwork, professional empowerment and achieving better patient care outcomes. It is therefore essential to incorporate followership into nursing education and practice, and to implement strategies that eventually support the development of effective followership competencies on behalf of nurses.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":"246-254"},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145858134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}