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This report presents National Health Service (NHS) leaders' views of priorities and approaches regarding sustainable development in the NHS. It was produced in close collaboration with the United Kingdom (UK) NHS Sustainable Development Unit (SDU), and it represents the first systematic picture of leadership views in the NHS. It also provides a commentary on ways forward. Analysis draws on results of a survey of 172 leaders of NHS organisations (primarily chief executives), 12 follow-up interviews, interviews with the SDU, and additional data and literature searches. A major conclusion is that almost all leaders consider sustainable development to be important for the NHS and that a focus on sustainability can most likely be aligned with delivering other corporate goals. Aligned incentives at all organisational levels and support for diversity are considered necessary to achieve sustainability, as well as relevant performance metrics. The main barrier is organisational culture.

Table of Contents

  • Chapter One


  • Chapter Two

    Online survey responses from 172 NHS leaders

  • Chapter Three

    Interviews with twelve NHS leaders

  • Chapter Four

    NHS sustainable development and leadership in a broader context

  • Chapter Five

    Achieving a more sustainable NHS

  • Appendix A

    Survey and Interview Methodology

  • Appendix B

    Survey Questions

  • Appendix C

    Interview protocol sent to interviewees

Research conducted by

The research described in this document was prepared for the UK National Health Service (NHS) Sustainable Development Unit (SDU) and conducted by RAND Europe.

This report is part of the RAND Corporation Technical report series. RAND technical reports may include research findings on a specific topic that is limited in scope or intended for a narrow audience; present discussions of the methodology employed in research; provide literature reviews, survey instruments, modeling exercises, guidelines for practitioners and research professionals, and supporting documentation; or deliver preliminary findings. All RAND reports undergo rigorous peer review to ensure that they meet high standards for research quality and objectivity.

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