Abstract
Leaders in today's NHS face the unenviable task of reconciling rising demand, frozen resource allocation and increasing accountability. As the NHS itself stands at the nexus of an unstable political and socioeconomic landscape, its future success relies largely on its ability to nurture excellence, to encourage open communication within and across health-care teams, and to inspire its workforce through exemplary leadership and followership. Key to these endeavours are clinicians on the 'shop floor', whose daily interactions with patients and staff help to shape prevailing culture and drive progress through quality improvement and leadership initiatives. This article considers how transactional analysis can be incorporated into professional development to help doctors develop insight into and optimize the use of different communication styles. The authors propose that a working knowledge of the transactional analysis ego state model can enhance effective communication, leadership and followership within and across health-care teams, with a view to optimizing patient outcomes and workforce interactions.