Introduction: The creation of person-centred cultures in health care settings is understood as a pre requisite to the provision of person-centred practice. Such cultures need systematic facilitation by health care leaders. While there are few empirically informed theoretical models for person-centred leadership and many organisations internationally, educate leaders in how to transform cultures to become more person-centred, there is lack of consensus on how person-centred leadership can be developed and no high quality, multi-centre evaluations of their effectiveness or impact. Before such evaluations can be undertaken an agreed curriculum is necessary. Only by having this can the fidelity of a leadership programme, subject to evaluation, be maintained. Methods: This study sought to gain international expert consensus on a curriculum for person-centred leadership using a modified Delphi method. Delphi studies employ anonymous and confidential survey methods to ensure expert consensus can be achieved without the interference of influential voices or group coalitions. They typically include two or more rounds with controlled feedback between rounds. We developed curriculum components by undertaking a literature review to identify programmes and theoretical models for person-centred leadership alongside a mapping of current person-centred leadership programmes being delivered by members of an international community of practice committed to the development of person-centred practice. We recruited experts using snowball recruitment. In round 1 we focused on seeking consensus on 16 curriculum components and 6 pedagogical delivery principles and offered the opportunity to comment on the phrasing or clarity of any components or propose additional components. Results: Round 1 resulted in consensus of ≥70% for all components. All bar one had consensus of ≥80%. In round 2 consensus was achieved for all components (≥80% and a mode of 5). Discussion: Using a modified Delphi study approach we have developed an internationally critiqued curriculum framework for person- centred leadership programmes, specific enough to ensure the fidelity of future programme delivery whilst providing sufficient flexibility for appropriate cultural modification within any complex intervention evaluation study. Research is now needed to evaluate the impact of engagement with this curriculum on healthcare leaders’ self-views; enacted leadership behaviours and practices; health care cultures and other relevant patient and staff outcomes.

Person-centred cultures are increasingly recognised as essential to the delivery of compassionate, safe, and effective healthcare. While Lean Six Sigma (LSS) is widely adopted as a process improvement methodology, its application is often critiqued for lacking alignment with relational or values-based care. This study aimed to test the transferability of three previously developed Programme Theories (PTs), generated through realist inquiry in a public hospital setting, within a large private acute hospital. Realist-informed adjudication workshops were conducted with interdisciplinary staff who had completed university-accredited training in LSS. Structured workbooks, visual artefacts, and thematic synthesis were used to identify how context–mechanism–outcome configurations (CMOCs) held, shifted, or evolved in the new setting. All three PTs were confirmed, with six CMOCs refined, and eight new configurations generated. Key refinements included the role of strategic intent, informal improvement communities, and intrinsic motivation. These findings suggest that values-based mechanisms underpinning person-centred LSS are not confined to public systems and may be equally active in private settings. The study confirms the explanatory strength of the original PTs while contributing new insights into their adaptability. It offers practical guidance for healthcare leaders seeking to embed person-centred improvement approaches across diverse systems, regardless of sectoral funding or governance structures.