I was asked to participate in an inaugural healthcare leadership forum 2040 hosted by my state health service this month. It was great to hear from a diverse group of voices across the organisation.
My co-panel and I were asked two questions to guide the afternoon discussion :
What will health services look like in 2040?
How will health leaders need to adapt ?
I don’t think any conversation about the future of healthcare can proceed without fundamental discussion about how we are going to recruit, support, develop, invest in and crucially retain our most valuable asset in healthcare, our people. This is essential because we now have good evidence that it impacts the quality and safety of the patient care we deliver.
We have increasingly stretched healthcare systems enabling burnout, moral injury and attrition of our healthcare workforce.
I was allowed one image to assist my presentation and thank artist Drew Sheneman for allowing me to share his work for this purpose. 
This is one of the most powerful images I’ve seen in the past two years. A healthcare worker, fortunately in PPE, holding together the fabric of our healthcare system and arguably fabric of society through a global public health crisis. All the while barely hanging on themselves, hanging on by the threads.
After several years working, reading and increasingly developing my understanding and skillset to assist my contribution to the challenges that lie ahead, I travelled to Stanford WellMD in California earlier this year to participate in their Chief Wellness Officer programme and learn from world leaders and experts in this area. Dr Tait Shanafelt formerly of Mayo clinic and his colleagues at Stanford WellMD have nearly two decades of evidence-based expertise in this area.  Notably I had read much of literature we discussed but I was more interested in their real world, on the ground experience, of actioning evidence and also to meet colleagues facing similar challenges and doing this work across the world.
In 2020 this group asked healthcare workers what they needed from their leaders as they prepared to face a global pandemic 
These were to :
Care for me
Fundamentally people need to feel seen, met, heard and safe at work.
Similar work in the UK by the King’s Fund with nurses and midwife produced the ABC framework , something I can definitely get on board with as an emergency physician. This work identified the importance of Autonomy, Belonging and Contribution for the workforce. 
Fortunately we are moving on from the era of distress and the focus on healthcare worker individual resilience as the “problem” toward more of a systems thinking approach to solutions and mitigation. The Stanford conceptual model of professional fulfillment requires a strategic approach addressing efficiency of systems and process, fostering a culture of wellbeing in addition to providing tools, skills and supports for teams and individuals. [5,6]
It strikes me that this is very much akin to the safety and quality movement in healthcare a few decades ago. Naming, blaming and shaming individuals has progressed to appreciation in the complex, uncertain, ever changing and stretched health care environment where systemic and human factors interplay.
This forum however was focussed on leadership and indeed leadership is a key part of this equation.
When we measure leadership, and I argue we can and should measure it, it has been shown the quality of this leadership impacts physician and other healthcare worker burnout and satisfaction. [ 7-9 ]
Building on this work in 2021 the Stanford group authored a paper describing the future requirement for what they have termed wellness-centred leadership 
The describe three major elements to this approach :
Care for people always
Commitment to building individual and team relationships
For a deeper dive into this construct listen to my podcast conversation with Dr Daniel Murphy MD from Stanford WellMD 
I would add to this an urgent need to develop and equip our leaders with the requisite skills, tools and crucially supports in addition to providing quality feedback on performance. They are exhausted too.
Leadership is a privilege but the first rule of leadership is you must have the means to take care of yourself to enable you to keep showing up to do this work for others.
I was speaking to a good friend and colleague recently, a clinician now working in industry, who was discussing her leadership scores for the past quarter, feedback received and how she planned to work with her team constructively to build her own and their skills moving forward, and crucially how she was being supported to do this work.
Whilst last week was a discussion about leadership for 2040 and we know change takes time, the need for action is now. The work started yesterday, it continues today and tomorrow.
It’s a time frame I can certainly commit to for next stage of my career.
 Shanafelt T, Ripp J, Trockel M. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA. 2020;323(21):2133–2134. doi:10.1001/jama.2020.5893
 Physician Well-being 2.0: Where Are We and Where Are We Going?
Shanafelt, Tait D. Mayo Clinic Proceedings, Volume 96, Issue 10, 2682 - 2693
 Dyrbye LN, Major-Elechi B, Hays JT, Fraser CH, Buskirk SJ, West CP. Relationship Between Organizational Leadership and Health Care Employee Burnout and Satisfaction. Mayo Clin Proc. 2020 Apr;95(4):698-708. doi: 10.1016/j.mayocp.2019.10.041. PMID
 Shanafelt TD, Gorringe G, Menaker R, Storz KA, Reeves D, Buskirk SJ, Sloan JA, Swensen SJ. Impact of organizational leadership on physician burnout and satisfaction. Mayo Clin Proc. 2015 Apr;90(4):432-40. doi: 10.1016/j.mayocp.2015.01.012. Epub 2015 Mar 18. PMID: 25796117.
 Shanafelt TD, Makowski MS, Wang H, et al. Association of Burnout, Professional Fulfillment, and Self-care Practices of Physician Leaders With Their Independently Rated Leadership Effectiveness. JAMA Netw Open. 2020;3(6):e207961. doi:10.1001/jamanetworkopen.2020.7961
 Shanafelt T, Trockel M, Rodriguez A, Logan D. Wellness-Centered Leadership: Equipping Health Care Leaders to Cultivate Physician Well-Being and Professional Fulfillment. Acad Med. 2021 May 1;96(5):641-651. doi: 10.1097/ACM.0000000000003907. PMID: 33394666; PMCID: PMC8078125.