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Dear Patient: A practical guide to patient experience

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Dear Patient: A practical guide to patient experience

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About the author

Kunle Thomas is renowned for his expertise in patient experience and involvement, co-production, and health communications. For over two decades, Kunle has worked in consulting, project lead and senior managerial roles in diverse organisations, mostly within the National Health Service (NHS) in England. His NHS roles cuts across acute hospitals, ambulance service, mental health, specialist eye care, and commissioning services. Prior to joining the NHS, Kunle worked at the Commission for Patient and Public Involvement in Health (CPPIH), precursor to Healthwatch England, where he played a key role in the setting up and promotion of patient and public forums across England. Trusteeship of a Carers’ Support charity and lectureship at a London university were some of his previous roles.

Kunle’s qualifications include LLM Medical Law & Ethics from Kent Law School, University of Kent, England and MSc Public Relations from the University of Stirling, Scotland. Member of the Institute of Health and Social Care Management (IHSCM) and former member of the Institute’s regional council for London and the South East. Kunle also holds membership of the Chartered Institute of Public Relations (CIPR) and has spoken at patient experience conferences in the UK and abroad.

Kunle enjoys playing table tennis and tennis and loves creative writing, including poetry and lyrics.

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Dear Patient - A practical guide to patient experience

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Dear Patient - A practical guide to patient experience : Thomas, Kunle: Amazon.co.uk: Books

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Invisible Women shows us how, in a world largely built for and by men, we are systematically ignoring half the population.  It exposes the gender data gap – a gap in our knowledge that is at the root of perpetual, systemic discrimination against women, and that has created a pervasive but invisible bias with a profound effect on women’s lives.

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Imagine a world where your phone is too big for your hand, where your doctor prescribes a drug that is wrong for your body, where in a car accident you…

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About the Book – Rebecca Skloot

Her name was Henrietta Lacks, but scientists know her as HeLa. She was a poor black tobacco farmer whose cells—taken without her knowledge in 1951—became one of the most important tools in medicine, vital for developing the polio vaccine, cloning, gene mapping, in vitro fertilization, and more. Henrietta’s cells have been bought and sold by the billions, yet she remains virtually unknown, and her family can’t afford health insurance.

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The Immortal Life of Henrietta Lacks named by more than 60 critics as one of the best books of 2010.

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Drawing on decades of research, Brown shows that effective leaders are those willing to engage with vulnerability, hold honest conversations, build trust through consistent behaviours, and develop the resilience to rise after setbacks. For health and social care leaders—working in high‑pressure, emotionally demanding environments—these skills are essential.

The book offers practical tools for creating psychological safety, strengthening team confidence, navigating difficult conversations, and leading with compassion and clarity. It supports leaders to align decisions with core values, foster inclusive cultures, and model the emotional intelligence needed for safe, high‑quality care.

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A Must-Read for Health and Social Care Professionals

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A Must-Read for Health and Social Care Professionals

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Patrick Lencioni’s book offers a compelling framework for understanding and improving team dynamics—essential in health and social care environments where collaboration, trust, and communication directly impact outcomes.

Through a relatable leadership fable, Lencioni identifies five core dysfunctions that can undermine team performance:

1. Absence of Trust

2. Fear of Conflict

3. Lack of Commitment

4. Avoidance of Accountability

5. Inattention to Results

For professionals navigating multidisciplinary teams, complex care pathways, and emotionally demanding roles, this book provides:

Clear strategies to build trust and psychological safety

Tools to foster healthy conflict and open dialogue

A roadmap for shared accountability and purpose

It’s an essential read for anyone seeking to strengthen team culture, lead with clarity, and deliver compassionate, coordinated care.

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Teamwork 5 Dysfunctions | The Table Group

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organizational health, teams, teamwork, teambuilding, online assessment, team assessment, team effectiveness, team survey, team field guide, executive team, offsite facilitation, executive consulting, Lencioni keynote speaker, team video

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Nigel Risner’s book serves as a practical guide to communication, leadership, and personal impact in health and social care. Through an engaging “zoo” metaphor, readers identify their communication style (lion, elephant, dolphin, or monkey) and learn to adapt their approach for better connection.

Risner’s insights empower professionals to:

- Communicate confidently across diverse teams

- Lead authentically with emotional intelligence

- Navigate high-pressure environments with resilience and humor

This book is essential for anyone dedicated to making a meaningful impact in care.

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"Let My People Go Surfing" by Yvon Chouinard is a valuable read for leaders and managers in health and social care because it champions values-based leadership, ethical decision-making, and a culture of trust and empowerment. Chouinard’s story of building Patagonia around environmental and social responsibility offers powerful lessons in leading with purpose, fostering staff wellbeing, and embracing innovation. His emphasis on authenticity, sustainability, and adaptive thinking aligns closely with the challenges and aspirations of health and social care leadership, making the book both inspirational and practically relevant for those seeking to lead with integrity and impact.

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In this newly revised 10th anniversary edition, Yvon Chouinard--legendary climber, businessman, environmentalist, and founder of Patagonia, Inc.--shares the persistence and courage that have gone into being head of one of the most respected and environmentally responsible companies on earth. From his youth as the son o

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Simon Sinek’s Find Your Why: A Practical Guide for Discovering Purpose for You and Your Team is a hands-on companion to Start With Why, and it’s especially useful for health and social care leaders and managers who want to turn inspiration into action.

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Simon Sinek (Author), David Mead (Author), Peter Docker (Author) & 0 more

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Find Your Why: A practical leadership book to bring purpose to your team from the multi-million copy bestselling author of Start With Why

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Buy Find Your Why: A practical leadership book to bring purpose to your team from the multi-million copy bestselling author of Start With Why 1 by Sinek, Simon, Mead, David, Docker, Peter (ISBN: 9780241279267) from Amazon’s Book Store. Everyday low prices and free delivery on eligible orders.

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Simon Sinek’s Start With Why: How Great Leaders Inspire Everyone to Take Action is a foundational leadership book that offers powerful insights for health and social care leaders and managers.

Sinek emphasises that people are inspired by the reasons behind actions, which aligns with the mission-driven nature of health and social care. Communicating a clear and authentic purpose fosters trust among staff, patients, and stakeholders, which is essential in care environments. Additionally, a strong sense of purpose can reignite passion and commitment within teams facing stress and resource limitations.

The book aids leaders in articulating their values and vision, guiding change and aligning services with community needs.

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Start With Why: How Great Leaders Inspire Everyone to Take Action: Amazon.co.uk: Sinek, Simon: 9780241958223: Books

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Buy Start With Why: How Great Leaders Inspire Everyone to Take Action 1 by Sinek, Simon (ISBN: 9780241958223) from Amazon’s Book Store. Everyday low prices and free delivery on eligible orders.

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Professor Michael West’s Compassionate Leadership is a deeply impactful book for health and social care leaders and managers, and that's why we, the IHSCM, promote it in our workshops.

West draws on years of work with organisations like Health Education and Improvement Wales (HEIW) and The King’s Fund, making the book highly tailored to the realities of health and social care.

West argues that compassionate leadership is both a moral obligation and a strategic advantage, leading to better staff well-being, improved patient outcomes, and more resilient organisations.

This book emphasises the importance of collective leadership by combining compassionate leadership with teamwork, fostering nurturing cultures, and enhancing organisational effectiveness—essential for high-quality care.

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Compassionate Leadership – Swirling Leaf Press

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Professor Michael West’s new book on Compassionate Leadership in Health and Social Care has just been published (2nd July 2021) and can be found here for purchase.

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Viv Groskop’s Lift as You Climb: Women, Ambition and How to Change the Story is a bold, empowering read that offers health and social care leaders—especially women—a fresh perspective on ambition, leadership, and collective progress. Here's why it’s especially valuable in this field:

Empowering Female Leadership: The book tackles how women can pursue ambition without compromising authenticity or leaving others behind—a vital message in a sector where women make up a large portion of the workforce but are underrepresented in senior leadership.

Sisterhood and Solidarity: Groskop’s emphasis on lifting others as you climb encourages inclusive leadership, mentorship, and collaboration—key to building resilient, supportive care teams.

Navigating Workplace Challenges: Health and social care environments can be hierarchical and emotionally demanding. This book offers survival skills and confidence-building strategies to help leaders thrive without losing their values.

Redefining Success: Groskop challenges traditional notions of success and encourages leaders to define it on their own terms—especially relevant in care roles where impact often matters more than status.

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Part self-help guide, part master class in survival skills for life and work, Lift as You Climb examines what sisterhood looks like today, asks what you can do to make things better for other women and considers how to do that without disadvantaging yourself. It’s the ultimate confidence bible for women planning careers in an ever-changing and uncertain world. And it addresses one of the biggest issues women face in the workplace - how to be ambitious without losing your sense of self. It must be possible, right? This essential handbook is full of brilliant tips and invaluable insights on everything you need to know about making life better for yourself - without making it worse for others.

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Simon Sinek’s Together Is Better: A Little Book of Inspiration is a beautifully illustrated fable that delivers a powerful message for health and social care leaders and managers: real human relationships are the foundation of meaningful leadership. Here's why it's a valuable read in this context:

Relationship-Centred Leadership: The book’s core message—that strong relationships lead to trust, cooperation, and fulfilment—is directly applicable to care environments, where collaboration and empathy are essential.

Vision and Purpose: Sinek encourages readers to find and pursue a shared vision. In health and social care, aligning teams around a common purpose—such as improving lives—can be a powerful motivator.

Emotional Connection: Through metaphor and storytelling, the book taps into emotional intelligence, helping leaders reflect on how they inspire and connect with others.

Accessible and Uplifting: Its short format and inspirational tone make it ideal for busy professionals who need a quick dose of motivation and clarity.

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Together is better : a little book of inspiration : Sinek, Simon, author : Free Download, Borrow, and Streaming : Internet Archive

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Jane Sunley’s Purple Your People is a vibrant, practical guide that’s especially well-suited for health and social care leaders and managers who want to build thriving, people-focused organisations. Here's why it’s a standout:

People-First Philosophy: Sunley’s central message is that “happy people are the best people to have in your company”—a principle that aligns perfectly with the values of compassion, empathy, and well-being in care environments.

The Purple Plan: This simple, actionable framework helps leaders engage, develop, and retain talent—critical in sectors facing recruitment and retention challenges.

Boosting Organisational Reputation: Health and social care providers often rely on public trust and staff advocacy. Sunley’s strategies help leaders become “people magnets” by creating inspiring workplaces.

Flexible & Accessible: The book is designed to be dipped into, making it ideal for busy managers who need quick, effective solutions without wading through dense theory.

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The Little Book of Emotional Intelligence

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The Little Book of Emotional Intelligence

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The Little Book of Emotional Intelligence: How to Flourish in a Crazy World by Andy Cope and Amy Bradley is a lively, accessible guide that’s especially valuable for health and social care leaders and managers. Here's why it stands out:

Positive Psychology Meets Practical Leadership: Andy Cope’s background in happiness research and positive psychology offers tools for leaders to foster well-being in themselves and their teams—vital in emotionally demanding care environments.

Bite-Sized Wisdom: The book is designed to be digestible and engaging, making it ideal for busy professionals who need quick, actionable insights.

Focus on Flourishing: Rather than just surviving stress, the book encourages leaders to help their teams thrive—aligning with the goals of holistic care and staff development.

Emotional Intelligence Made Fun: Amy Bradley’s illustrations and the book’s upbeat tone make emotional intelligence approachable, helping leaders connect with the material on a personal level.

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The Little Book of Emotional Intelligence

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A SELF HELP MANUAL FOR HUMAN BEINGSThe Little Book of Emotional Intelligence is an immediate, outcome-focused primer on the important topic of EQ, which provides practical, no-nonsense life advice and takes a sideways look at a world which is complicated and overwhelming at times. Do you seem to spend half your life counting down the days ’til your next holiday? Does it sometimes feel like your life is being lived on fast forward, with little time for reflection or idle amusement? It’s time to stop kicking happiness into the long grass and get on with really living.Funny, colourful and profound, this book is a gripping manual for the human mind, enabling you to understand and control your emotions, communicate better, unpick limiting beliefs and finally get around to living a happier, more balanced life.

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Simon Sinek’s Leaders Eat Last is a powerful and insightful read for health and social care leaders and managers because it redefines leadership as a deeply human, empathetic, and biologically grounded responsibility. Here's why it’s especially relevant in these sectors:

Trust as a Foundation: Sinek explores how trust is built biologically and socially, emphasising that leaders must create environments where people feel safe. In health and social care, psychological safety is essential for both staff and service users.

Servant Leadership: The book champions the idea that true leaders serve others—mirroring the ethos of health and social care, where compassion and service are core values.

Circle of Safety: Sinek’s concept encourages leaders to protect their teams from external threats and internal dysfunction, fostering collaboration and resilience—critical in high-pressure care settings.

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In his previous book, Start with Why, Simon explained that for an organization to be successful, its leaders need to understand the true purpose of their organization-the WHY. In Leaders Eat Last...

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Daniel Goleman's Working with Emotional Intelligence is a compelling read for health and social care leaders and managers because it offers a transformative framework for leadership that goes beyond technical expertise. Here's why it resonates so strongly in these fields:

Empathy and Relationship Management: Goleman emphasises interpersonal skills like empathy, active listening, and conflict resolution—crucial for leaders managing diverse teams and vulnerable populations.

Self-awareness and Regulation: Leaders in health and social care often face emotionally charged situations. Goleman’s model helps them recognise their own emotional triggers and respond with composure and clarity.

Improved Staff Retention: Studies show that emotionally intelligent leaders foster environments where staff feel valued and supported. This reduces burnout and turnover, which are persistent challenges in care settings.

Adaptability and Resilience: Goleman’s framework equips leaders to navigate change and uncertainty—skills essential in a sector constantly evolving due to policy shifts, funding pressures, and public health crises.

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The secret of success is not what they taught you in school. What matters most is not IQ, not a business school degree, not even technical know-how or years of expertise. The single most important factor in job performance and advancement is emotional intelligence. Emotional intelligence is actually a set of skills that anyone can acquire, and in this practical guide, Daniel Goleman identifies them, explains their importance, and shows how they can be fostered. For leaders, emotional intelligence is almost 90 percent of what sets stars apart from the mediocre. As Goleman documents, it’s the essential ingredient for reaching and staying at the top in any field, even in high-tech careers. And organizations that learn to operate in emotionally intelligent ways are the companies that will remain vital and dynamic in the competitive marketplace of today -- and the future. Drawing on access to business leaders around the world and studies in more than 500 organizations, Goleman documents a reoccurring fact: in determining star performance in every field, emotional intelligence matters twice as much as IQ or technical expertise. Readers also discover how emotional competence can be learned. Goleman analyzes five key sets of skills and shows how they determine who is hired and who is fired in the top corporations in the world. He also provides guidelines for training in the “emotionally intelligent organization.”

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The Let Them Theory is a step-by-step guide, offering practical strategies for empowering teams, managing stress, and leading with compassion—making it a valuable tool for anyone in a caregiving role. It encourages leaders to stop trying to control others’ actions and instead focus on their own responses and boundaries. For health and social care leaders, this mindset helps reduce burnout, improve emotional resilience, and foster healthier relationships with staff, patients, and families.

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The Let Them Theory will be available from publishers in the following languages, formats, and dates. This table updated regularly…

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Trust: A powerful resource for leaders seeking to build trust-based cultures in health and social care.

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Trust: A powerful resource for leaders seeking to build trust-based cultures in health and social care.

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Jack R. Gibb’s Trust: A New View of Personal and Organizational Development presents a foundational theory for building trust within teams and organisations. Gibb argues that trust is the key to reducing defensiveness, improving communication, and unlocking creativity and collaboration.

This book is especially valuable because it:

Explains how trust impacts group dynamics, decision-making, and productivity.

Introduces the TORI framework—Trust, Openness, Realisation, and Interdependence—as a model for creating high-functioning, emotionally intelligent teams.

Offers practical tools for diagnosing and improving group performance by addressing core concerns like membership, data flow, and goal alignment.

Encourages leaders to model authenticity and vulnerability, fostering environments where others feel safe to contribute and grow.

This book supports IHSCM’s values of compassionate leadership and continuous development, making it a powerful resource for leaders seeking to build trust-based cultures in health and social care.

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Trust : a new view of personal and organizational development : Gibb, Jack R : Free Download, Borrow, and Streaming : Internet Archive

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Includes bibliographical references (p. 316-320)

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Surrounded by Idiots: A practical guide for leaders in health and social care who want to foster collaboration, confidence & clarity.

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Surrounded by Idiots: A practical guide for leaders in health and social care who want to foster collaboration, confidence & clarity.

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Surrounded by Idiots by Thomas Erikson introduces a simple but powerful framework for understanding personality differences using four color-coded behavior types: Red (Dominant), Yellow (Influential), Green (Stable), and Blue (Analytical)

This book is especially useful because it helps:

Improve communication by tailoring interactions to different personality types.

Enhance team dynamics through better understanding of colleagues’ strengths and stressors.

Build emotional intelligence and empathy—key traits for compassionate leadership.

Navigate conflict and change more effectively by recognizing behavioral patterns.

It’s a practical guide for anyone in health and social care leadership who wants to foster collaboration, reduce misunderstandings, and lead diverse teams with greater confidence and clarity.

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Surrounded by Idiots: The Four Types of Human Behaviour (or, How to Understand Those Who Cannot Be Understood) (Vermilion)

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Buy Surrounded by Idiots: The Four Types of Human Behaviour (or, How to Understand Those Who Cannot Be Understood) (Vermilion) 1 by Erikson, Thomas (ISBN: 9781785042188) from Amazon’s Book Store. Everyday low prices and free delivery on eligible orders.

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Atomic Habits: How small, consistent changes can lead to big improvements in personal effectiveness, team culture, and service delivery. 

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Atomic Habits: How small, consistent changes can lead to big improvements in personal effectiveness, team culture, and service delivery. 

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Atomic Habits by James Clear is a practical guide to building better habits and breaking bad ones. It’s especially useful for IHSCM leaders because it shows how small, consistent changes can lead to big improvements in personal effectiveness, team culture, and service delivery. Clear’s system helps leaders align habits with their values, create supportive environments, and lead change more sustainably—making it a valuable tool for leadership development.

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Atomic Habits: The life-changing million-copy #1 bestseller: Amazon.co.uk: Clear, James: 9781847941831: Books

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Buy Atomic Habits: The life-changing million-copy #1 bestseller 1 by Clear, James (ISBN: 9781847941831) from Amazon’s Book Store. Everyday low prices and free delivery on eligible orders.

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The Let Them Theory: A practical tool for anyone in health and social care leadership seeking to lead with clarity, calm, and confidence—especially in high-pressure environments.

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The Let Them Theory: A practical tool for anyone in health and social care leadership seeking to lead with clarity, calm, and confidence—especially in high-pressure environments.

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The Let Them Theory by Mel Robbins offers a simple but powerful mindset shift for leaders: stop trying to control others and instead focus on your own actions and responses. The book introduces two core principles—“Let Them” (release control over others) and “Let Me” (take ownership of your own behaviour)—which help reduce stress, improve relationships, and build emotional resilience.

This approach is especially valuable in:

Managing workplace dynamics without micromanaging

Navigating change and conflict with emotional intelligence

Strengthening boundaries while maintaining compassion

Fostering authentic leadership by focusing on personal agency

It’s a practical tool for anyone in health and social care leadership seeking to lead with clarity, calm, and confidence—especially in high-pressure environments.

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#1 New York Times Sunday Times
#1 A Life-Changing Tool Millions of People Can't Stop Talking About
#1 Amazon Bestseller
#1 Audible Bestseller

What if the key to happiness, success, and love was as simple as two words?

If you've ever felt stuck, overwhelmed, or frustrated with where you are, the problem isn't you. The problem is the power you give to other people. Two simple words― Let Them ―will set you free. Free from the opinions, drama, and judgments of others. Free from the exhausting cycle of trying to manage everything and everyone around you. The Let Them Theory

In her latest groundbreaking book, The Let Them Theory , Mel Robbins― New York Times The Mel Robbins Podcast a global sensation, Robbins explains why

Using the same no-nonsense, science-backed approach that's made The Let Them Theory The Let Them Theory Learn how to: The Let Them Theory

Written as an easy-to-understand guide, Robbins shares relatable stories from her own life, highlights key takeaways, relevant research and introduces you to world-renowned experts in psychology, neuroscience, relationships, happiness, and ancient wisdom who champion The Let Them Theory

Stop wasting energy on things you can't control
Stop comparing yourself to other people
Break free from fear and self-doubt
Release the grip of people's expectations

Order your copy of
Build the best friendships of your life
Create the love you deserve

The cover has been updated to include the name of co-author Sawyer Robbins. Customers may receive either version of the cover at random.
Pursue what truly matters to you with confidence
Build resilience against everyday stressors and distractions
Define your own path to success, joy, and fulfillment
. . . and so much more.

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The Let Them Theory: A Life-Changing Tool That Millions of People Can't Stop Talking About

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Buy The Let Them Theory: A Life-Changing Tool That Millions of People Can't Stop Talking About by Robbins, Mel, Robbins, Sawyer (ISBN: 9781788176187) from Amazon's Book Store. Everyday low prices and free delivery on eligible orders.

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A multi-centre, multi-professional evaluation of sustainability in quality improvement education

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A multi-centre, multi-professional evaluation of sustainability in quality improvement education

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This publication evaluates an educational toolkit that links concepts of sustainable healthcare with established quality improvement methodologies (the SusQI approach, available at www.susqi.org).

Spooner, R., Stanford, V., Parslow-Williams, S., Mortimer, F., Leedham-Green, K. (2022) “Concrete ways we can make a difference”: A multi-centre, multi-professional evaluation of sustainability in quality improvement education, Medical Teacher, DOI: 10.1080/0142159X.2022.2064737.

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Sustainability in quality improvement: redefining value & measuring impact

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Sustainability in quality improvement: redefining value & measuring impact

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This publication outlines a practical framework for quality improvement to shape a more sustainable health service, while improving patient outcomes.

Mortimer F, Isherwood J, Wilkinson A, Vaux E. Sustainability in quality improvement: redefining value. Future Healthcare Journal, 2018 Vol.5(2):88-93

Mortimer F, Isherwood J, Pearce M, Kenward C, Vaux E. Sustainability in quality improvement: measuring impact. Future Healthcare Journal, 2018 Vol.5(2):94-97

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ABSTRACT

Sustainability can be considered a domain of quality in healthcare, extending the responsibility of health services to patients not just of today but of the future. The longer term perspective highlights the impacts of our healthcare system on our environment and communities and in turn back onto population health. A sustainable approach will therefore expand the healthcare definition of value to measure health outcomes against environmental and social impacts alongside financial costs. We set out a practical framework for including these new dimensions in an already well-defined model of quality improvement. This has the potential to harness the growing quality improvement movement to shape a more sustainable health service, while improving patient outcomes. Early experience suggests that the new model may also provide immediate benefits, including additional motivation for clinicians to engage in quality improvement, directing their efforts towards high value interventions and enabling capture and communication of a wider range of impacts on patients, staff and communities.

Sustainability as a domain of quality in healthcare

The Royal College of Physicians (RCP) expanded on the Institute of Medicine's six domains of quality to include sustainability (Fig 1). The RCP recognised sustainability to be 'a characteristic of healthcare which must run through and moderate other domains' and stated that 'healthcare should be considered not only in terms of what can be delivered to an individual today, but also to the population in general and the patients of the future.'

Sustainability, as coined by the RCP, refers to the capacity of a health service to deliver healthcare over time, with consideration to future generations. With the increasing demand on the health service and an already large financial deficit, the major threat to health service sustainability is most often identified as financial. However, healthcare, as with all human activity, takes place within a social and environmental context, not just an economic one. Important social and environmental constraints exist alongside the well-publicised financial restrictions. These include declining family support for an ageing population and the legal requirement to reduce greenhouse gas emissions by 80% in line with the UK Climate Change Act 2008. In order for the NHS to survive, it must be able to anticipate and respond to changes across all three spheres.

Arguably, the health service has a responsibility to go beyond safeguarding its own sustainability and should contribute to the sustainability of wider society. There is increasing recognition that individual and population health depends on functioning ecosystems, strong social networks and economic opportunity even more than access to good healthcare. This has prompted a debate on the role of the medical profession in influencing policy relating to these wider social determinants of health, which include education, employment and political empowerment as well as daily living conditions (such as housing, air quality, diet and physical activity) and the impacts of destruction or depletion of natural environmental systems (causing, for example, soil erosion, droughts or flooding). In the UK, the Public Services (Social Value) Act 2012 obliges NHS bodies to consider how the services they commission and procure might improve the economic, social and environmental wellbeing of the area. The health service must balance its responsibility to meet immediate healthcare needs with the responsibility to actively promote health and prevent illness. At a minimum, services should seek to 'do no harm', ie minimise damage to the environmental, social and economic determinants of health caused by the delivery of care. Box 1 highlights the twin drivers for healthcare sustainability discussed in the paragraphs above: the practical and the ethical.

In fact, the goals of meeting immediate healthcare needs, conserving resources and promoting wider wellbeing are not necessarily in tension but may be mutually reinforcing, as highlighted in recent work by Nesta and the Health Foundation. Recognising that people need to feel connected to a thriving community as well as have their physical health needs addressed, they focus on person- and community-centred approaches to healthcare and present compelling evidence that these approaches lead to better outcomes and significant benefits for individuals, services and communities - estimating a £950 million saving per annum for the health service, with wider social savings eg employment outcomes, reduced social isolation, estimated at £4.5 billion.

Redefining value

Value in healthcare has been defined as outcomes relative to cost. As highlighted by Muir Gray, in the case of publicly funded health services, value is determined by how well the allocated resources are used to achieve outcomes not only for patients treated by a service but for all the people in need in the population. Therefore, achieving high value relies not just on maximising the efficiency with which interventions are delivered, but on avoiding underuse of high-value interventions in people with greater need and overuse of low-value interventions in people who will benefit less (Fig 2).

A sustainability perspective extends thinking on value in two ways. Firstly, it broadens the scope of 'cost' or 'resources', considering patient and population outcomes against a 'triple bottom line' of environmental, social and economic costs or impacts (Figs 2 and 3). This is important, as it provides a consistent framework for measuring and driving sustainable improvements in care. Secondly, it requires limits on resource use in all three categories to be set at sustainable levels, since even an otherwise high-value service will not be sustainable if available resources are exceeded over time. Determining a sustainable level of resource use may need to be done at a macro level (eg national and international targets for carbon reduction), but to be meaningful will also need to be translated to the level at which services are managed (eg a carbon budget for asthma care in a local area). Such pathway-level limits have not yet been defined for environmental and social resources, but people engaged in improving services can nonetheless consider the current level of resource use and the impact of proposed changes.

What does the inclusion of sustainability in quality and value mean for the process of quality improvement?

Gone are the days when patients were under the care of a single individual, whether physician, midwife or other. Healthcare is now a complex system with many staff and even organisations involved in the treatment of each person. Health professionals are therefore expected not only to provide excellent direct patient care, but to contribute to 'quality improvement', that is, the ongoing, systematic effort to improve patient outcomes and system performance. As a domain of quality, it follows that sustainability should be addressed as an integral part of quality improvement. Standard approaches to quality improvement will often enhance sustainability, through streamlining of processes and better targeting of clinical resources to achieve outcomes. However, explicit attention to all elements of the sustainable value equation will further highlight resource issues and encourage a more thoughtful and holistic approach to improving care for the whole population, hopefully driving progress towards a truly sustainable service.

In this section, we set out a simple approach for incorporating sustainability into mainstream quality improvement methodologies, which we have called the 'SusQI' framework. We identify four stages in the quality improvement process (setting goals, studying the system, designing the improvement effort and measuring impact) at which sustainability is usefully considered and make specific suggestions for its inclusion. The intention is to transform sustainability from a lofty aim into a practical component of everyday improvement efforts.

Embedding sustainability into everyday practice

To truly embrace sustainability into the healthcare culture we need to work towards including it in the education and training of healthcare professionals. Embedding the principles of sustainability in our education will normalise a culture of resource stewardship, wider thinking and planning for the future. The General Medical Council (GMC) recognises 'demonstrating the knowledge and skills to improve the sustainability of health systems' as one of three overarching learning outcomes for sustainability in medical education, referenced in their Outcomes for graduates document.

Recent reports such as the National Quality Board's Shared commitment to quality recognise sustainability as a domain of quality and reinforce the need to focus on building workforce capability to improve quality. Developing capability in quality improvement is integral to the new GMC Generic Professional Capabilities Framework, launched in May 2017, to the NHS Improvement Developing People - Improving Care national framework on improvement and leadership development and to the Academy of Medical Royal Colleges Quality improvement; training for better outcomes report. This is a tipping point in healthcare education with significant opportunity to influence how these recommendations are effectively implemented for the highest value impact.

Table 2 summarises how our proposed modifications could be included within standard quality improvement training and practice, highlighting the intended benefits at each stage. This provides a practical framework for the development of tools and learning resources which could be incorporated across mainstream training programmes - an approach that we are currently piloting in undergraduate and postgraduate settings in the UK.

The ideal quality improvement project might apply all four principles of sustainable practice to achieve measurable positive outcomes for patients and the triple bottom line. Currently, most projects already apply at least one of the principles, and encouraging teams to retrospectively evaluate their project using the SusQI framework (Supplementary file 1 [Case study 1]) could reinforce sustainable approaches and raise awareness of the new model.

Professional bodies and educational institutions could further encourage adoption of SusQI, for example by introducing new sustainability categories and awards at healthcare conferences and in journals, or through adaptation of existing quality improvement / leadership development programmes such as 'RCP Quality Improvement' and the RCP Chief Registrar scheme. Already, medical royal colleges such as the RCP and the Royal College of Psychiatrists are offering clinical fellows and scholars the opportunity to work at a regional and national level to study services and suggest and implement more sustainable practices.

Finally, there is a need for research to identify the most effective approaches to incorporating sustainability into quality improvement practice and to evaluate the impact on the outcomes achieved.

Conclusion

Sustainability is an important and legitimate domain of quality in healthcare, which calls for the redefinition of value to incorporate social and environmental costs.

Including the concept of sustainability and resource stewardship as part of quality improvement provides a practical way for healthcare professionals to respond to ethical challenges such as climate change and social inequalities, to which we all contribute through our use of resources, and which present an urgent and unequal threat to vulnerable communities worldwide.

A sustainability lens may also bring immediate benefits to quality improvement, including new motivation and energy for change, highlighting wastes and opportunities otherwise overlooked, encouraging whole-systems thinking and directing projects systematically towards the highest value improvements.

We propose a practical framework for embedding sustainability across quality improvement education, practice and research.

Author contributions

FM was main author and led on conception, design, data analysis and drafting. JI contributed to the design and drafting of this manuscript. AW contributed to data acquisition and analysis, drafting and critical review. EV contributed to design and critical review. All authors gave final approval of the manuscript and agreement to accountability.

Supplementary material

Additional supplementary material may be found in the online version of this article at http://futurehospital.rcpjournal.org :

S1 - Case study 1: retrospective sustainability review of a hospital-based QI project on smoking cessation.

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