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Anyone seeking to influence another is a potential leader. Within higher education, determining what an institution should undertake on sustainability can be daunting. Sustainability leaders face labyrinthine, multifaceted sub-cultures, influencers and viewpoints across staff, students, government, business and alumni all with an opinion on whether, how and in what order of priority sustainability should be taken forward. In this paper we take on this challenge by synthesising and critically evaluating core principles and working models for influencing and leading for sustainability in higher education. We identify a series of eight challenges affecting delivery of sustainability and seek to understand how conceptual models and principles in sustainability decision-making and leadership could address these. We draw on the experience of both authors, in tandem with comments from workshop and leadership training programme participants who attended the Environmental Association for Universities and Colleges (EAUC) Leadership Lab training in the UK, as well as reflections arising in a detailed case study from the University of Edinburgh. We bring key insights from theory and practice for the benefits of individuals or teams seeking to influence and persuade key decision-makers to embrace the sustainability agenda.

The main purpose of this paper is to document the first author's experience of using institutional ethnography (IE) to “take sides” in healthcare research. The authors illustrate the points with data and key findings from a study of cardiovascular disease prevention.

The authors use Dorothy E Smith's IE approach, and particularly the theoretical tool of “standpoint”.

Starting with the development of the study, the authors trouble the researcher's positionality, highlighting tensions between institutional knowledge of “prevention” and other locations where knowledge about patients' health needs materialises. The authors outline how IE's theoretically and methodologically integrated toolkit became a framework for “taking sides” with patients. They describe how the researcher used IE to take a standpoint and map institutional relations from that standpoint. They argue that IE enabled an innovative analysis but also reflect on the challenges of conducting an IE – the conceptual unpicking and (re)thinking, and demarcating boundaries of investigation within an expansive dataset.

This paper illustrates IE's relevance for organisational ethnographers wishing to find a theoretically robust approach to taking sides, and suggests ways in which the IE approach might contribute to improving services, particularly healthcare. It provides an illustration of how taking a patient standpoint was accomplished in practice, and reflects on the challenges involved.