TY - JOUR T1 - Leadership for careful and kind care JF - BMJ Leader JO - BMJ Leader DO - 10.1136/leader-2021-000451 SP - leader-2021-000451 AU - Dominique Allwood AU - Sreenivas Koka AU - Ryan Armbruster AU - Victor Montori Y1 - 2021/08/03 UR - http://bmjleader.bmj.com/content/early/2021/08/03/leader-2021-000451.abstract N2 - The fundamental role of healthcare organisations ought to be to care for patients. The care of patients is a human activity by which people with the capacity to care notice and respond well, with compassion and competence, to people who seek this care.1 This article describes how, instead, healthcare has industrialised care; with care degraded, care has become transactional. It has overwhelmed the capacity of both the people called to care and those that receive care, and has rendered care unsustainable.2 We propose that leaders can restore care by turning their organisations away from industrial healthcare and asserting their organisation’s purpose to enact careful and kind care. This article describes that turning away and invites healthcare leaders to pioneer it from within their organisations. First, we explain the pathologies of care and an alternative to them, and then what leaders might do to turn this new strategy into action.The public expects healthcare organisations to enable care by supporting the work of people responding to the problematic situations of their patients. Yet, healthcare organisations respond to their external environment and to the policies and structures—austerity, greed, poverty—that condition the kind of healthcare that clinicians give and patients receive.3 4 Extrinsic motivators encoded in healthcare policies determine what is measured,5 how organisations are benchmarked and how organisations behave.6 Organisations have prioritised improving their financial position and sustainability, monitoring performance, characterising flow, stemming demand and counting beds and appointment slots. Increasingly often, the core purpose of healthcare, to care, has become side lined or postponed as organisations focus on prioritising operational and financial goals and pursuing reputation-burnishing targets.In adapting to these determinants of industrial care, pathologies of care have emerged. These pathologies include hurry, blur, cruelty and burden (figure 1). As fewer resources are available to … ER -