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“While policies, governance structures, data and digital tools co-enable reforms, it is healthcare professionals who bring quality strategies to life in practice – guided by the insights, needs, and expectations of the people and communities they serve.” (Fonseca et al 2025) At the end of last year, I was drawn to a paper in the European Journal of Public Health by Válter Fonseca and colleagues from WHO: Quality of care in an era of global challenges: A transformational vision for the WHO European Region and beyond. The paper proposes a bold reframing of quality of care, one that moves decisively beyond traditional, compliance-driven models. What particularly caught my attention was its strong focus on leadership and its clear relevance to patient safety. The authors argue that leadership at all levels is essential to catalyse the transformation required: shifting from fragmented expert silos to integrated care pathways, and from guideline adherence alone to patient-centred, continuously improving systems. The paper reflects on how the concept of quality has expanded over recent decades to encompass safety, effectiveness, efficiency, equity, and people-centredness. Yet it also makes a persuasive case that many quality approaches still fall short, too often prioritising service volume and process compliance over outcomes, coherence, and purpose across complex health systems. Grounded in a review of major global reports - including WHO Regional Office for Europe’s Taking the Pulse of Quality of Care (2024), which highlights persistent disparities across European countries, the paper underscores why incremental change is no longer enough. To address this, the authors propose three key enablers for sustainable quality reform: 1. people, leadership, and a drive for change; 2. data and transparency; and 3. innovative solutions and tools. Together, these enablers point to a simple but powerful message: quality health systems are built on empowered professionals, trustworthy data, and responsible innovation. Leadership, learning, and culture enable safer, more integrated care; data and transparency support accountability and trust; and digital solutions can accelerate progress when ethically guided and designed around people. Importantly, the paper does not stop at vision. It offers concrete country examples from across the WHO European Region, showing how these ideas are being put into practice, with active support from the WHO Regional Office for Europe and its Athens Quality of Care and Patient Safety Office. I found the paper stimulating and focused on real world practice. Its emphasis on competencies, leadership support, motivation, and co-design resonates strongly with patient safety work. I was particularly struck by the authors’ reminder that “quality of care cannot be separated from the quality of health systems as a whole” and by their reframing of quality not as a technical add-on, but as a core principle underpinning health system effectiveness, resilience, and equity. For anyone interested in leadership, patient safety, and meaningful quality improvement, this paper is well worth the read.

I was just listening to a podcast interview between Dr Rangan Chatterjee and Matthew McConaughey (In the series 'Feel better, live more'). Matthew M. mentioned that he came from a highly resilient family. If someone fell over, his mother would tell them to get right back up straight away and carry on. He added that he thought that while this resilience was generally a good thing, there should be (what he called) a 'loophole' in it so that there was time to learn why they have fallen over to begin with. Was there a crack in the pavement that needed to be avoided? That way, it wouldn't happen again in the future. This made me think about whether there really was a conflict between resilience in organisations and the need to learn from failure. What do you think??

The NHS has too few staff to prepare for a pandemic surge, while its ageing buildings and social care’s weak ‘resilience and capacity’ would also undermine its response, NHS England has warned. A new NHSE submission to the Covid-19 public inquiry says funding pressure from 2010 has undermined the health service’s “resilience” and that “resilience and capacity issues in social care are national issues which must be addressed from the centre”. The document was posted unnoticed on the inquiry website last month. No current or former NHSE leaders have so far given evidence to the inquiry. It is the first time NHSE has clearly set out that understaffing and underinvestment compromised the service’s readiness to deal with the pandemic. Referring to the NHS’s ability to create “surge capacity [with] flexible staff and equipment which can be pivoted into different roles”, it goes on: “It is only possible to train staff to work more flexibly into different roles/environments if they can be freed up to attend training and refreshers. “This requires ‘surplus’ staff numbers on rotas, which is not currently possible in relation to many staffing groups across the NHS.” Read full story (paywalled) Source: HSJ, 3 October 2023

Two in three UK doctors are suffering “moral distress” caused by the enfeebled state of the NHS and the damage the cost of living crisis is inflicting on patients’ health, research has found. Large numbers are ending up psychologically damaged by feeling they cannot give patients the best possible care because of problems they cannot overcome, such as long waits for treatment or lack of drugs or the fact that poverty or bad housing is making them ill. A new survey found that 65% of doctors overall, including nearly four in five (78%) GPs and more than half (56%) of hospital doctors, have experienced “moral distress” as a direct result of situations they have encountered working in the NHS. Seeing patients with malnutrition or hypothermia, or stuck on trolleys in A&E corridors asking for help or forced to choose between heating their home or getting a prescription dispensed are among the events triggering their distress, medics said. “There’s barely a doctor at work in the NHS today who doesn’t see or experience this distress on a daily basis,” said Prof Philip Banfield, the leader of the British Medical Association. The NHS is “impossibly overstretched”, has thousands of vacancies for doctors and has a quarter fewer doctors a head of population than Germany, he added. “In practice that means we can almost never give the standard of care we would want, only ever the care we can manage. That takes its toll, as we see here,” Banfield said. Read full story Source: The Guardian, 28 December 2023

Here's a recent interesting blog post on leadership under pressure https://www.med-led.co.uk/2019/08/19/under-pressure/