Health and social care professional standards need to be updated to advance leadership and action for environmental sustainability and planetary health.

BACKGROUND: Human health is inextricably linked to planetary health. The desire to nurture and protect both concurrently requires the mitigation of healthcare-associated environmental harms and global initiatives that support sustainable lifestyles. Health leadership is important to bring adequate attention and action to address planetary health challenges. Health professionals are central to this endeavour, but the will and energy of a few will not be adequate to address this urgent challenge. STUDY: We present an appraisal of the current UK health professional standards, frameworks and curricula to identify content related to planetary health and environmental sustainability. RESULTS: No current UK health professional standard provides statements and competencies to guide practising and trainee health professionals to focus on and advance the sustainability agenda within their clinical practice and across wider healthcare systems. CONCLUSION: Update of health professional standards is needed to ensure that health professionals in every specialty are supported and encouraged to lead the implementation of environmentally sustainable practices within the health sector and advocate for planetary health.

Generic professional capabilities hub: developing leadership and management skills in trainees.

High quality leadership is key to delivering high standards of patient care. For many reasons, doctors in training are not currently well represented in leadership positions and struggle to access opportunities to develop these skills. As a key cohort within the medical workforce, using existing present opportunities within clinical training programmes would allow them to engage in leadership development and support them to lead on projects within their trusts and make sustainable changes within their own organisation.Within our anaesthetic department, we designed the Generic Professional Capabilities Hub (GPC hub)-a framework that aims to address some of the barriers to engagement in clinical leadership. Involvement in the GPC hub can be at three different levels, which allows for flexibility around other training needs. Currently, there are seven workstreams within the framework, with trainees being involved through symposia attendance, leading on projects linked to the hub or becoming a trainee workstream lead. We share our learning from setting up this framework, the benefits it brings to trainees and departments, initial evaluation results and our next steps which include regional roll out to four other anaesthetic departments.

Evaluating the impact of a national strategic leader development programme for UK doctors: myth-busting, mind-changing, mood-enhancing.

BACKGROUND: The drive towards engaging UK doctors in clinical leadership and management has involved many initiatives at various levels. METHODS: This paper reports on the findings of an in-depth evaluation of a national medical leadership programme for doctors in the late stages of specialty or general practitioner (GP) training or have just become consultants or GPs. RESULTS: The evaluation clearly demonstrates the impact of this programme and the benefits for the individuals and organisations involved, particularly around stimulating a shift in mood and a major mindset shift in what medical leadership is (and is not) and what they can achieve as medical leaders. The programme structure and activities allowed participants to learn from a range of senior decision-makers about policy and strategic developments and processes. However, the evaluation also highlighted that some pervasive myths still exist around medical leadership and management which, if not addressed, will hamper efforts to fully engage doctors in taking on strategic leadership roles. CONCLUSION: Clinical leadership programmes are valuable, but must be carefully managed to extract the full value from them.

Medical leadership and management in the United Kingdom.

OBJECTIVE: This article aims to outline the historical development of medical leadership in the United Kingdom (UK), present recent advances, and discuss professional development and future prospects. CONCLUSIONS: With increasing involvement of medical professionals in top managerial roles in the UK over the last 30 years, leadership development initiatives have been growing steadily and there is increasing recognition of the need for leadership and management skills for doctors. Such skills can help to greatly improve patient care as well as enhance organisational effectiveness and productivity. The central involvement of professional bodies such as the UK Faculty of Medical Leadership and Management, and the establishment of medical fellowship schemes, have provided a solid foundation for a new generation of aspiring medical leaders but there is still a long way to go to achieve a higher degree of professionalism for clinical leadership in the UK. The evidence base is weak such that integrated efforts by clinicians and management academics have much to offer in achieving the vision of socially responsible, clinically relevant and research informed medical leadership training.

Evidence, culture and clinical outcome.

Leadership is the most influential factor in shaping organisational culture. Using evidence to inform decisions about clinical care is the norm, but its use in determining the optimal leadership culture, climate and systems is less apparent. In the wake of well publicised clinical and service failings, and in the face of a substantial financial challenge, it would seem sensible for the NHS to put evidence into practice if the lives of staff and standards of care are to be improved as we would wish. The Faculty of Medical Leadership and Management, the King's Fund and the Center for Creative Leadership conducted a comprehensive review of literature published in the last ten years, of the evidence relating healthcare leadership to clinical outcome. The review demonstrated that the quality of healthcare experienced by patients is inextricably linked to the climate, culture and support experienced by staff.

Defining the structure of undergraduate medical leadership and management teaching and assessment in the UK.

Medical leadership and management (MLM) skills are essential in preventing failings of healthcare; it is unknown how these attitudes can be developed during undergraduate medical education. This paper aims to quantify interest in MLM and recommends preferred methods of teaching and assessment at UK medical schools. Two questionnaires were developed, one sent to all UK medical school faculties, to assess executed and planned curriculum changes, and the other sent to medical students nationally to assess their preferences for teaching and assessment. Forty-eight percent of UK medical schools and 260 individual student responses were recorded. Student responses represented 60% of UK medical schools. 65% of schools valued or highly valued the importance of teaching MLM topics, compared with 93.2% of students. Students' favoured teaching methods were seminars or lectures (89.4%) and audit and quality improvement (QI) projects (77.8%). Medical schools preferred portfolio entries (55%) and presentations (35%) as assessment methods, whilst simulation exercises (76%) and audit reports (61%) were preferred by students. Preferred methods encompass experiential learning or simulation and a greater emphasis should be placed on encouraging student audit and QI projects. The curriculum changes necessary could be achieved via further integration into future editions of Tomorrow's Doctors.

Doctors who become chief executives in the NHS: from keen amateurs to skilled professionals.

OBJECTIVES: To investigate the experiences of doctors who become chief executives of NHS organizations, with the aim of understanding their career paths and the facilitators and barriers encountered along the way. DESIGN: Twenty-two medical chief executives were identified and of these 20 were interviewed. In addition two former medical chief executives were interviewed. Information was collected about the age at which they became chief executives, the number of chief executive posts held, the training they received, and the opportunities, challenges and risks they experienced. SETTING: All NHS organizations in the United Kingdom in 2009. RESULTS: The age of medical chief executives on first appointment ranged from 36 to 64 years, the average being 48 years. The majority of those interviewed were either in their first chief executive post or had stepped down having held only one such post. The training and development accessed en route to becoming chief executives was highly variable. Interviewees were positive about the opportunity to bring about organizational and service improvement on a bigger scale than is possible in clinical work. At the same time, they emphasized the insecurities associated with being a chief executive. Doctors who become chief executives experience a change in their professional identity and the role of leaders occupying hybrid positions is not well recognized. CONCLUSIONS: Doctors who become chief executives are self-styled 'keen amateurs' and there is a need to provide more structured support to enable them to become skilled professionals. The new faculty of medical leadership and management could have an important role in this process.