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Scrutiny of NHS chief executive officers (CEOs) has tended to focus on the generally short tenure of their position. The implications of high turnover have been assessed but there has been limited research looking at CEOs who remain in post for long periods, whether in the same organisations or in multiple ones. This study by researchers from the University of Manchester draws on interview data collected in 2019 with 10 long serving CEOs in the English NHS, with an average tenure of 17 years. This paper focuses on the following research questions: How do long-term CEOs manage to create, develop, disrupt or maintain their organisation over an extended period? How do they manage the boundary between the organisation and external interests? How do these CEOs build and sustain their personal resilience in the face of internal and external imperatives? How do they exhibit their strategic competence, political astuteness and leadership roles?

Humility, transparency and urgency are the keys to successfully steering an organization – big or small – through the challenges that come your way. In this TED Talk, leadership expert, Amy Edmondson, provides clear advice and examples to help any leader rise to the occasion.

This interview in the Journal of Quality and Patient Safety highlights the career and motivations of Dr. Gordon Schiff, a leader in patient safety whose has focused his efforts on improving medication safety, diagnostic safety and the role of information technology in enhancing care.

The health and care system in the United Kingdom is facing a huge challenge, placing enormous pressure on health and care staff with unprecedented demands on leaders, wherever they work. These pages, from the King's Fund, aim to provide support to health and care leaders, whether you are working in the NHS, social care, public health or the voluntary and independent sector.

 The Jeddah Declaration on Patient Safety is founded on the principles that guided the 4th Global Ministerial Patient Safety Summit 2019, Jeddah, Kingdom of Saudi Arabia. It is a call for action on many fronts, and for many actors, at all levels of healthcare provision and delivery – from frontline, to organisational and policy arenas. The Declaration is founded on the underlying spirit that it is imperative to reflect on the effectiveness of current practices in light of the now mature patient safety evidence base of 20 years and to collectively move forward with a vision to sustainable and scalable implementation of patient safety solutions known to improve care delivery systems, patient outcomes and safety culture. The Declaration signals a strong collective and global commitment to shape truly safer systems for generations to come.

This month’s Letter from America looks at actions and strategies core to leading an organisation during unexpected enterprise-affecting crises. Letter from America is the latest in a Patient Safety Learning blog series highlighting new accomplishments in patient safety from the United States. “There's no such thing as the unknown—only things temporarily hidden, temporarily not understood.” James T. Kirk, Captain, Starship Enterprise. Star Trek, Season 1: The Corbomite Maneuver. Leading a large enterprise isn’t easy. Vision, compassion, humility, curiosity and adaptability are required attributes for those in charge to keep moving forward during times of relative calm or uncertainty. The stress and tragedy that accompanies catastrophic events can reduce the resolve and effectiveness of even the most accomplished leaders. Unprecedented large-scale situations, such as the Hurricane Katrina landfall or the September 11th terrorist attacks, reveal gaps in understanding that may not have been apparent before the disaster. These blind spots can dismantle the reserve of a leader and their team to culminate in poor decisions, inaction and organisational dysfunction. The COVID-19 pandemic is such an event. Rules are being mindfully adjusted to respond to the litany of process, clinical, financial and political disruptions healthcare workers must grapple with as they face the uncertain conditions of their patients, communities and themselves. It is incumbent on leaders to create stability by addressing these unknowns. Leaders within hospitals, social care organisations and within the public health spectra need to make immediate process adjustments to optimise effort, realise opportunities for improvement and learn to be resilient. They need to arrive at understanding while simultaneously managing challenges that emerge from the strained system to keep their enterprise on track. They need to do this by paying attention to safety culture, transformation and innovation, and will need tools and resources to do so. Leadership must build a culture to keep patients and workers safe. Leader’s communications and actions are core to the implementation of safe working conditions to provide the best care possible during a crisis. Yet, a Gallup poll of US healthcare workers found a lack of understanding of their organisation’s COVID-19 plan and lack of belief that safety policies in place will support their safe return to work. To address this gap, experts recommend leaders three steps to a better safety culture: use formal and informal mechanisms to explicitly communicate what the organisation is doing to keep staff informed and safe during the pandemic enlist their managers to implement policies, create opportunities to align the work of management and hold managers accountable to implement and sustain current practice and procedure talk to their people. Keeping an open dialogue through the use of established mechanisms such as ‘rounding’ can solicit insights and raise concerns to enhance the safety of teams and patients. Leadership must see opportunities to transform systems: COVID-19 has presented leaders with immense responsibility to act, adjust quickly as required and use those process changes to improve the overall system of care post-pandemic in preparation for the next unprecedented challenge. Geisinger Health System leaders in their article, 'How one health system is transforming in response to Covid-19' share the experience of designing their emerging COVID response to reliably innovate rather than only react. Leaders examined core system business concerns such as pharmacy and information technology by bringing together multidisciplinary groups that dismantled silos. Teams worked together using scenario planning to fully consider how restoring care processes, entering new work phases, preparing for the second wave and restoring financial viability would affect patients and employees. Leadership must use evidence and collective knowledge to adapt: The Journal of Public Health and Management Practice shares recommendations for leaders to meet COVID-19 stressors successfully. The article suggests leaders communicate well, be decisive, lead without hierarchy, remain proactive and take care of themselves to protect others. For example, to lead across a system seek expertise from a variety of organisational and environmental elements. Working with government officials, staff and peers can form collaborations, solidify shared purpose and distribute responsibility to serve a community well in crisis. Public health is a core partner in understanding how to guide, motivate and inspire change to enhance a collective response to COVID-19 and upcoming health threats. Clinicians in patient-facing leadership roles also exhibit these behaviours as their roles shift to manage crisis. The perspective of a New York cardiologist leading a COVID-19 infections disease service illustrates how the transfer of tacit knowledge around deliberate leadership observed daily while coordinating the service shaped his views on leadership and his ability to lead. Being emotionally available was a core characteristic that helped to express grief, exhibit vulnerability and openly share concerns, giving the experience the humanness it needed. This was important not only in his ability to mature as a leader but to demonstrate the empathy needed to get his team through the challenges at hand. James T Kirk knew how to lead. He sought consensus, learned from mistakes, yet acted as necessary to keep his crew safe, engaged and aligned with the organisational mission. He sought partners across the federation as needed. Kirk could be firm, decisive, yet empathetic. Have health leaders done similarly to protect staff, patients and the community, while gaining experience during COVID-19 to apply over time to enrich the care system at large and boldly go to a better, safer future?

This article, published by Forbes, is written by Chief Executive Officer and Founder of Jody Michael Associates, a company that specialises in executive coaching, leadership development and career coaching. It looks at 'gaslighting' in the workplace, outlining what it is, what it means and how to counter it. When gaslighting happens, by its very nature, it can be hard to spot. This can lead to good staff being lost, and in healthcare it can be a major patient safety issue. The article covers: the history of gaslighting signs of gaslighting an example of gaslighting how to move and and how to counter gaslighting in the workplace.