Compassionate and inclusive medical leadership among senior doctors across Somerset NHS Foundation Trust: a mixed-methods analysis

OBJECTIVES: To explore the motivations, barriers and systemic challenges experienced by senior doctors' engagement with compassionate and inclusive medical leadership (CIML) within Somerset NHS Foundation Trust, and to identify evidence-based strategies to support sustainable leadership development. DESIGN: A sequential mixed-methods study integrating quantitative survey data with qualitative thematic analysis and postsurvey facilitated group discussions. SETTING: Somerset NHS Foundation Trust, a large integrated healthcare organisation providing acute, community, mental health, learning disability and GP services across Somerset. PARTICIPANTS: Senior doctors including consultants and specialty associate specialist and specialist (SAS)-grade doctors. Participants included 156 survey respondents and 39 participants in postsurvey group discussions. OUTCOME MEASURES: Identifying leadership challenges, motivations, recruitment barriers and systemic facilitators of CIML engagement. Validation of survey findings through stakeholder discussions grounded in NHS leadership principles. RESULTS: Of the 692 eligible participants, 156 responded (22.5%) and 39 (5.64%) participated in the postsurvey group discussions. Key barriers to leadership engagement included time constraints (28%), lack of administrative support (20%), poor work-life balance (15%) and non-transparent recruitment practices (35%), echoing national concerns regarding clinician burnout and structural inequities. Qualitative themes reinforced these findings, highlighting cultural and systemic challenges, especially for women and ethnic minority doctors. Stakeholder discussions underscored the need for structured mentorship, protected time and inclusive leadership pathways. CONCLUSIONS: Systemic reforms, including mentorship programmes, transparent recruitment processes, leadership induction and protected time for leadership development, are essential to fostering sustainable and inclusive medical leadership. Engaging senior doctors in co-produced leadership strategies may help strengthen engagement and support more inclusive leadership cultures.