Healthcare leadership has a paradox at its heart. We select, promote and celebrate leaders for their certainty, the confident diagnosis, the decisive plan, the unwavering strategic vision, yet we ask them to operate in environments of irreducible complexity. We reward knowing in a job that consists largely of ‘not knowing.’
Over the last decade, compassionate leadership has rightly become the dominant answer to what ails our systems. The evidence that compassion improves staff wellbeing, engagement and care quality is well established (1). I am not here to argue against it. I am here to argue that it is insufficient, and that on its own it can quietly do harm.
Compassion governs how leaders relate to people. Epistemic humility governs how they relate to the limits of their own knowledge. The disciplined recognition that what we know is partial, provisional and frequently wrong. Ethicists have recently described this as a relational practice (2): an active stance of treating other people as sources of knowledge we do not hold. Our clinical encounters demand it. So, I want to suggest, does leadership.
Here is the uncomfortable claim: compassion without epistemic humility turns paternalistic. ‘I care about you’ can easily slide into ‘I know what is best for you.’ The caring leader who is certain does not need to ask the team what they see, because caring has already supplied the answer. Warmth becomes the velvet glove on the same old hierarchy.
Where my certainty failed
I can recall two specific career defining moments, where my care-driven certainty backfired. A decision I made for a patient and for a team out of genuine compassion, made quickly and confidently, backfired. I missed inviting in genuine challenge. I lacked information and the team felt they were not able to speak up.
What stayed with me was the silence around it. Colleagues later told me they had seen the problem coming. They said nothing, not because they didn’t care, but because my certainty had left no doorway for their doubt. My compassion was real. It was also, functionally, a way of closing the conversation.
What epistemic humility looks like
Epistemic humility is not hand-wringing indecision, and it is not false modesty performed in the boardroom. It is a set of observable behaviours.
First, say ‘I don’t know’ in public & mean it. Uncertainty voiced by the most senior person in the room is permission. It converts the meeting from a performance of agreement into a genuine exchange of information.
Second, ask before telling. Multidisciplinary can fail not for lack of structures but for lack of genuine curiosity across professional boundaries. The question ‘what am I missing?’ asked of the junior member of staff as sincerely as of the medical director, is probably the cheapest intervention in healthcare, and the least used.
Third, reward changed minds. If people are only celebrated for being right, they will defend positions long after the evidence has left. Recent work in clinical settings shows that humble leadership improves attitudes to error disclosure precisely through psychological safety (3): people speak up about mistakes when leaders model that being wrong is survivable. Intellectual vulnerability role modelled well, can promote safety culture everywhere else.
The bravest sentence in leadership
The all-knowing leader was always a fiction. Every silenced voice is a data point lost, a risk unflagged, a better option never tabled. The systems we lead are too intricate for any single mind, however senior, however caring, to hold.
Compassion asks leaders to open their hearts. Epistemic humility asks them to open something harder: their conclusions. We need both. A leader who cares deeply and doubts wisely creates the conditions in which multidisciplinary teams actually function as teams, and in which patients are treated as partners in knowledge rather than recipients of certainty.
So here is a challenge for your next executive meeting, board round or ward huddle. Before you give your view, ask the room: ‘What am I missing?’ Then, and this is the hard part, wait long enough to be told. The bravest sentence in healthcare leadership is not ‘follow me.’ It is ‘I might be wrong.’
References
- De Zulueta PC. Developing compassionate leadership in health care: an integrative review. J Healthc Leadersh 2015;8:1–10. doi: 10.2147/JHL.S93724
- Muyskens K, Ang C, Kerr ET. Relational epistemic humility in the clinical encounter. J Med Ethics 2025. doi: 10.1136/jme-2024-110241
- Santos LCP, Goodwin W, McArthur M. Impact of humble leadership on attitudes to error disclosure: the mediating role of psychological safety and safety climate in Australian veterinary practices. BMJ Leader 2025. doi: 10.1136/leader-2024-001149
Author
Maiedha Raza
Maiedha is a GP, appraiser, and Associate Professor in Medical Education, and the owner of Maraz Healthcare, where she leads teaching on compassion in clinical practice. She is passionate about embedding empathy and compassionate care at the heart of healthcare education and everyday patient interactions.
Declaration of Interests
No interests to disclose.