2025/04/29 by Reginald Edward · 1 voice
Business, Management and Accounting · #Competitive and Knowledge Intelligence #Quality and Management Systems
paper · pdf · doi:10.1111/anae.16629
I write in response to von Ungern-Sternberg and Becke-Jakob's timely and courageous editorial on toxic leadership in anaesthesia departments [1]. As a specialist anaesthetist who has worked across health systems in both the UK and Australia, I found the piece to be not only resonant but also painfully familiar. The behaviours described – bullying, favouritism, passive-aggression and emotional detachment – are not abstract threats; they are lived realities for many clinicians navigating hierarchical and culturally siloed environments. My journey, like many international medical graduates, has been marked by a paradox: receiving formal recognition through specialist qualifications, only to be undermined subtly or overtly based on my origin. I have witnessed leaders who thrive not through inspiration or service, but through control, silence and gatekeeping. Titles and achievements are brandished as shields, but rarely as tools for elevating others. This editorial rightly questions the prevailing assumption that clinical excellence equates to leadership competence. I have seen highly skilled clinicians promoted into roles for which they had neither training nor temperament, replicating toxic mentorship models they once endured. What is often dismissed as ‘just how things are’ is in fact a culture of fear that stifles innovation, isolates dissenters and sabotages excellence. In Australia, the intersection of cultural bias and toxic leadership is particularly insidious for international medical graduates and clinicians from minority backgrounds. Speaking up can cost careers. Remaining silent corrodes one's sense of professional integrity. The barriers listed – cognitive dissonance, emotional defensiveness, hierarchical structures – form a closed feedback loop that immunises leadership from accountability. The idea of mutual respect becomes hollow when power is asymmetrical, and retaliation is real. The editorial's call for ethical leadership grounded in respect, accountability and community is inspiring. Yet, these principles must be operationalised. I echo the recommendation for 360° feedback systems, but would stress the need for external oversight, particularly in departments where leadership has remained unchecked for years. Internal feedback without external validation risks becoming performative rather than transformative. Moreover, we must reconsider how leadership is selected. Emotional intelligence, psychological safety and cultural humility must be part of the leadership lexicon – assessed, taught and expected. Our systems currently reward self-promotion over self-reflection. That must change. Lastly, institutions should publish anonymised data on complaints, mediation outcomes and leadership evaluations. Transparency is not a threat to trust; it is its foundation. The editorial ends with a reminder that we are here for patients, not personal gain. I would add we are also here for one another. A system that values only outcomes but not the people who deliver them is neither ethical nor sustainable. Let this editorial be a catalyst – not for conversation alone – but for courageous, structural change.