BMJ Leader最新文献

Background: Founded in 1925 as a 'reverse Rhodes Scholarship', the Harkness Fellowship was designed to foster international collaboration through transatlantic academic exchange. Over a century, it has evolved into a leadership programme uniting mid-career professionals from nine countries and a range of professional backgrounds to improve health systems through a year of immersion in the USA. As the fellowship marks its centennial, we reflect on what its history reveals about leading and learning across borders.

Methods: This centennial reflection draws upon archival research, programme documentation, alumni interviews and individual case studies. The analysis synthesises historical shifts, strategic pivots and leadership development outcomes over the programme's 100-year history.

Results: Three core lessons emerged: (1) challenge assumptions-fellows consistently innovated by questioning entrenched practices and applying cross-cultural insights; (2) harness the power of fellowship-sustained relationships and a shared mission drive collaborative outcomes across borders and (3) embrace a multidisciplinary mindset-fellows from diverse fields have advanced more holistic approaches to healthcare reform. Real-world examples illustrate the fellowship's tangible impact and provide practical lessons for healthcare leaders across countries and sectors.

Conclusions: The Harkness Fellowship demonstrates that leadership in healthcare demands curiosity, humility and sustained collaboration. The fellowship's story is a reminder that the ability to learn across differences remains one of the most powerful tools for change. As the programme enters its second century, its relevance will rest on staying true to its core values: shared purpose, openness to difference and collaboration across borders to drive systemic change.

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

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

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

Participants: 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.

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

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

Results: 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.

Conclusion and relevance: 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.

Introduction: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Health professionals can play important roles in promoting planetary health, including by contributing to delivering environmentally sustainable healthcare. Interventions that promote planetary health may be more frequently and effectively implemented where leaders have knowledge, skills and values aligned with planetary health.

Aims: This study aimed to:Highlight synergies between health professionals' leadership competencies and planetary health principles.Elucidate how health professionals can meet their leadership competencies while simultaneously learning about and promoting planetary health.

Methods: Health professionals representing multiple professions engaged in discussions exploring how health leadership impacts planetary health. Discussants selected competencies from the Faculty of Medical Leadership and Management that align with the United Nations' Sustainable Development Goals and pertain to planetary health. The selected competencies were reworded to explicitly reference planetary health.

Findings: Two competencies in each of seven leadership domains were reworded to explicitly reference planetary health. Practical examples of how these competencies could be achieved while promoting planetary health were developed to guide learners, educators and those developing professional standards to incorporate a planetary health perspective.

Conclusion: A multiprofessional group identified how health leadership competencies and planetary health priorities can be addressed simultaneously in lifelong learning across all health professions, disciplines and levels of training.

Introduction: 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.

Objective: 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?

Methods: 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').

Results: 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.

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

Introduction: For the National Health Service (NHS) in England to reach the target of Net Zero by 2040, transformation of the attitudes and behaviours of healthcare staff across all levels to promote systematic change is required. An understanding of current attitudes and barriers to change is vital for healthcare leaders and sustainability professionals to identify how they can support and encourage staff to adopt these changes.

Methods: We invited staff from an NHS trust in England to participate in an online survey conducted between December 2024 and March 2025, to investigate NHS healthcare professionals' attitudes towards environmental sustainability, current behaviours and perceived barriers to sustainable healthcare practices.

Results: We received 154 responses from healthcare staff across all pay bands and grades, representing an array of disciplines. 94.8% of staff were concerned about climate change and the environment; 95.5% and 93.5% believe that NHS staff have a responsibility to be aware of, and minimise the impact of their work respectively; and over 80% were willing to make changes to their personal practice or engage in education and training. The most predominant perceived barrier to sustainable healthcare practices was found to be cost (72.1% of responses), with both time and staff attitudes being reported as perceived barriers by 69.5% of respondents.

Conclusion: Our results suggest that among the staff surveyed, while there is a high level of willingness to change practice, increased funding is needed to support these changes, especially where sustainability initiatives have longer term cost-savings. There is a desire for more education to encourage and empower staff, and to make changes to NHS practice and policy. There is also a need for more direct leadership to facilitate change and integrate sustainability into the everyday work of healthcare professionals, rather than placing it as an additional burden on already overstretched staff.

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

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.