English National Health Service (NHS) Trust Hospital board members are collectively responsible for ensuring high-quality care and organisational performance. Integrated performance reports support boards by tracking key performance indicators, supporting quality improvement and providing assurance to NHS England. Statistical Process Control (SPC) charts can support leaders to distinguish signals (special cause variation) from natural fluctuations in data (common cause variation). The Making Data Count (MDC) Programme has effectively increased the use of SPC methodology in NHS Trusts. This study explored board members' experiences of MDC and SPC, and SPC use in public board meetings. 14 semistructured interviews were conducted with executive directors and non-executive directors across five NHS Trusts. 13 board meetings were observed, and quantitative data were coded and extracted to evaluate if SPC outputs supported assurance and decision-making. Board members generally expressed positive views towards the MDC Programme and SPC, recognising their value as a supporting tool to monitor interventions, guide investigations and highlight performance issues. Board members noted insufficient training and instances of inappropriate use or overuse of SPC charts. The observations showed that of the 99 statements made by board members, 71 (72%, 95% CI 62% to 88%) were supported by a relevant SPC chart. Unsupported or unverifiable claims made by executive directors were more likely to be statements of improvement (p=0.054). Six decisions were made for further investigative work, and all six were supported by an SPC chart. MDC SPC charts are seen as a helpful tool, and their outputs are used reasonably effectively in a board environment. However, consistent and repetitive training is necessary to optimise SPC use and prevent misuse or overuse. Training may only partially prevent misuse of SPC charts due to managers' tendency to try to demonstrate improvement to other staff members.

In 2022, National Health Service (NHS) Forth Valley, Scotland was escalated to Level 4 under the NHS Scotland Support and Intervention Framework - triggering the highest level of oversight and engagement from the Scottish Government prior to statutory intervention. While many systems under such pressure default to compliance-driven responses, NHS Forth Valley took a different path: embracing a whole-system approach focused on leadership, culture, integration and governance. Within this, Transformative Simulation was embedded as a leadership method to support cultural and systemic renewal. A multi-professional, multi-sector delegation from the Association for Simulated Practice in Healthcare (ASPiH) visited NHS Forth Valley in early 2025 to observe simulation in practice as a leadership tool. Over two immersive days, we witnessed how simulation was used not only for education and training but also for engaging with emotionally charged challenges, enabling system-wide reflection and co-designing new models of care. Leadership behaviours observed during the visit were marked by humility, openness and courage. Senior leaders did not simply oversee change - they participated in simulations, listened deeply and responded actively. Simulation served as both a mirror and a mechanism: surfacing cultural dynamics, enabling cross-boundary collaboration and supporting healing after organisational trauma. Transformative Simulation emerged not as a short-term intervention but as a long-term leadership framework. NHS Forth Valley's response demonstrates that simulation, when embedded intentionally, can be a powerful lever for leadership, trust-building and transformation. Their story offers a hopeful vision of what becomes possible when leadership chooses connection over control.

This study investigates the non-negotiable criteria employed by C-suite information leaders when evaluating digital health innovation projects. We conducted a qualitative interview study with 17 executives serving in C-suite information leadership roles. Participants represented not-for-profit US health systems that varied in size, geographic location and mission. Semistructured interviews were conducted using a topic guide developed by the research team. Transcripts were analysed deductively with iterative refinement to identify recurrent themes. Three non-negotiables consistently emerged across interviews: (1) strategic alignment with organisational mission, (2) clinician buy-in and workflow integration and (3) regulatory, privacy and security compliance. These criteria functioned as baseline requirements and organisational safeguards, determining whether innovations advanced to further consideration. Findings suggest that C-suite information leaders operationalise digital innovation decisions through implicit filters that extend beyond financial considerations. In particular, leaders emphasised 'return on benefit' as an evaluative lens that accounts for time savings, workforce sustainability, patient outcomes and community benefit in addition to financial return. This framing reflects the non-profit identity of many health systems and aligns with calls for multidimensional evaluation of digital health initiatives. Strategic alignment, clinician buy-in and compliance represent non-negotiables in digital health innovation decision-making. The addition of return on benefit highlights the need to broaden evaluative frameworks to capture patient-centred and workforce-oriented outcomes.

Emergency departments (EDs) are high-pressure environments prone to staff burnout, emotional fatigue and interprofessional tension. In early 2024, a serious interpersonal conflict at Labuan Hospital's ED-set against the backdrop of COVID-19 legacy stress-exposed deeper issues in team trust, inclusion and psychological safety. Recognising that punitive or disciplinary approaches would not address the root causes, departmental leadership opted for a relational and culturally grounded healing response. The Labuan Emergency Medicine Games (LEM-G) was a month-long initiative designed to restore ukhuwah-a sense of brotherhood and belonging-through inclusive, team-based engagement. Around 100 staff from across roles (doctors, nurses, assistant medical officers, attendants, drivers) were randomly assigned to three symbolic teams: Red Phoenix, Yellow Fury and Jurassic Green. Together, they participated in 'The Quest for the Ibnu Sina Cup'-a series of low-cost, diverse activities including physical challenges, quizzes, creative design and online games like PlayerUnknown's Battlegrounds (PUBG). Ibnu Sina (Avicenna), a Persian physician-philosopher, was chosen as a symbol of healing, unity and excellence. LEM-G helped rebuild psychological safety-a shared belief that individuals can express themselves without fear of retribution-while flattening hierarchies and reigniting workplace joy. Feedback collected via WhatsApp, informal debriefs and direct staff input pointed to increased morale, engagement and cross-disciplinary connection. The intervention sparked spontaneous follow-up activities and left a sustained cultural imprint. When leadership is human-centred, inclusive and culturally attuned, even small interventions can catalyse profound transformation in team dynamics and emotional well-being.

Physician parents experience challenges during their transition to parenthood and their return to work. We expanded a Parental Wellness Programme (PWP) to Department of Medicine faculty physicians and evaluated its impact on physician well-being. The programme supported new physician parents through peer mentorship and financial resources. Through internal marketing, expectant and new parent faculty were encouraged to self-enrol and were supported until 12 months following the child's birth (up to an 18-month period). Participants enrolled between October 2021 and September 2022. The programme included a US$500 feeding/lactation reimbursement and pairing with a parental wellness advocate (PWA), a physician with parenting experience. Anonymised participant surveys were voluntary and conducted at programme entry, and at 6 months and 12 months following the child's birth to assess return-to-work experience, lactation, burnout and programme impact. A final feedback survey was sent after all participants completed the programme. The programme supported 67 participants (82% women). 53 participants responded to the baseline survey, of whom 85% were junior faculty/early career. At baseline, 85% of respondents planned to breastfeed; 88% at 12 months (n=25) reported breastfeeding. Participants indicated a desire for connection, support and resources at baseline; follow-up surveys confirmed that the programme provided these supports. By 12 months, 76% received individualised PWA support, 88% used the feeding/lactation reimbursement and 92% self-reported improved well-being on return to work. All respondents indicated they would recommend the programme to colleagues. Participant comments highlighted challenges with parental leave coverage, and time and space for lactation. We demonstrated the scalability of a novel PWP that successfully supported early career and junior faculty during a difficult transition period. Feedback indicated ongoing system-based challenges and a need for institutional culture change.

The health sector contributes 8.5% of US greenhouse gas (GHG) emissions and 4.4% of global GHG emissions. Health professionals are in a powerful position to advance mitigation and adaptation climate solutions, yet there is weak consensus about allaying concern and encouraging optimism and motivation in the research. In reviewing Climate and Health Tool (CHANT) data (2020-2024), authors explored these questions: (1) How are concern, optimism and motivation to act on climate change related? (2) What do respondents report motivates and demotivates action on climate and health? (3) How does concern and optimism relate to motivating and demotivating climate action? 6823 health professionals responded to the tool. Females (84%), non-US respondents (8%) and late-career nurses were most concerned about climate change. Nurses and females were most motivated to act. Optimism about prevention and preparation was higher among nurses-particularly late-career nurses. Most frequently identified motivators were 'clean air and water' (78%), 'the future' (75%) and 'health impacts' (73%). Most frequent demotivators included 'I don't know what to do' (37%), 'I am overwhelmed' (37%) and 'It is too complex' (34%). Results of the CHANT indicate health professionals are concerned and motivated-yet not optimistic. Amplifying motivating messaging, educating and simplifying climate mitigation or adaptation activities may encourage action among health professionals regardless of optimism.Leaders have opportunities to harness health professionals' motivation to act on climate change in the interest of health. By leveraging motivators and decreasing barriers, health leaders might inspire further climate action across health professions.

The relationship between the natural environment and health outcomes has garnered significant attention in recent years. However, few studies have explored whether the benefit of nature visibility can be translated into measurable clinical outcomes in inpatient settings, such as length of stay. This retrospective observational study investigated the impact of nature visibility from the patient's window on length of stay. Patients were sampled from two intermediate care units in Sussex, and the nature visibility from their window was classified into three predefined categories. A generalised linear model was used to analyse length of stay, while controlling for potential confounding factors. The final analysis included 459 patients. Nature visibility was a significant predictor (p=0.016) of an inpatient length of stay. However, seasonality (p=0.438) did not impact the effect of nature visibility on length of stay. Hospital location (p=0.020) and discharge age (p<0.001) had a significant impact, but sex (p=0.940), room type (p=0.619) and window view restrictions (p=0.756) did not have a significant impact on length of stay. The results demonstrated an ~8.7% decrease in length of stay for every increase in nature visibility category, regardless of the season. The study findings emphasise the value of non-pharmaceutical interventions in patient recovery and contribute to the idea of patient-centred care.

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.

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. 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. 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. 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.