Dr Alwin Tan, GAICD, MBBS, FRACS, EMBA (Melbourne Business School)
Senior Surgeon | Governance Leader | HealthTech Co-founder | Founder of the Institute for Systems Integrity (ISI) | Harvard Medical School—AI in Healthcare | University of Oxford—Sustainable Enterprise | Bastas Academy for Healthcare Leadership – Triple Scholar

Institute for Systems Integrity (ISI)

Everyone wants to be called an inclusive leader.

Few leaders describe themselves as intimidating.

Few CEOs believe people are frightened to challenge them.

Few Chairs think their board suffers from groupthink.

Few senior clinicians believe hierarchy prevents junior staff from speaking.

And almost nobody says:

“My team has learned that disagreeing with me is dangerous.”

Yet the Australian evidence presents an uncomfortable contradiction.

The Diversity Council Australia's Inclusion@Work Index 2025–2026, based on a survey of 3,000 Australian workers, found that 59% considered their organisation inclusive and 56% their team inclusive—but only 35% described their manager as inclusive.

That manager figure has remained essentially stagnant since 2019.

So perhaps the leadership question for 2026 is not:

“DO YOU BELIEVE IN INCLUSION?”

It is:

“WHAT DO PEOPLE AROUND YOU EXPERIENCE WHEN THEY DISAGREE WITH YOU?”

Because inclusion is not a statement of values.

It is behaviour.

And behaviour leaves evidence.

Here is the playbook.

1. SPEAK LAST WHEN YOU CAN

The CEO enters the strategy meeting and says:

“I think Option A is clearly our strongest choice. What does everyone else think?”

What follows may look like consultation.

But the room has already been anchored.

Status matters.

People interpret the leader's opinion not merely as another contribution, but as information about the socially preferred answer.

So sometimes the most inclusive thing the most powerful person can do is withhold their opinion temporarily.

Ask:

“What are each of you seeing?”

“What concerns you?”

“What would you recommend if you didn't know what I thought?”

BOARDROOM

Before giving their own view on an acquisition, a Chair can ask each director independently:

“What concerns you most about this transaction?”

HEALTHCARE

Instead of the consultant announcing the diagnosis and then asking for views, ask:

“Before I tell you what I think, what are you seeing?”

The junior nurse may hold information nobody else has noticed.

TECHNOLOGY

Before the product leader declares an AI model ready for deployment, let engineering, clinical, safety and data teams independently identify failure modes.

IF YOU WANT INDEPENDENT THINKING, DO NOT GIVE PEOPLE THE ANSWER BEFORE ASKING THE QUESTION.

2. ASK FOR DISAGREEMENT — DO NOT WAIT FOR IT

Weak leaders ask:

“Does everyone agree?”

Strong leaders ask:

“WHO SEES THIS DIFFERENTLY?”

Better still:

“What evidence contradicts our preferred conclusion?”

“What assumption are we most likely to be wrong about?”

And perhaps:

“IF THIS DECISION FAILS IN SIX MONTHS, WHAT WILL WE WISH SOMEBODY HAD TOLD US TODAY?”

AMAZON

Amazon's operating philosophy provides a useful example.

Its leadership language explicitly invokes “Have Backbone; Disagree and Commit”—challenge the decision when necessary, then support the final direction once it has been made. Current Amazon role descriptions continue to frame this as fostering constructive dialogue, resolving conflicting views and driving decisions.

The important leadership lesson is not that every organisation should copy Amazon.

It is the underlying mechanism:

DISAGREEMENT SHOULD BE PART OF THE JOB, NOT AN ACT OF DISLOYALTY.

Challenge before the decision.

Clarity after it.

3. FIND THE QUIETEST VOICE

An invitation to speak is not the same as an ability to speak.

Look around your meetings.

Who always speaks first?

Who interrupts?

Whose ideas receive attention?

Whose contribution is ignored until somebody senior repeats it?

Who used to speak—

but no longer does?

Research in healthcare has demonstrated why this matters. Nembhard and Edmondson's study across 23 neonatal intensive-care units found leader inclusiveness predicted psychological safety and helped teams overcome some of the inhibiting effects associated with professional status.

AVIATION

Aviation learned that technical expertise alone does not guarantee safe decisions.

Crew Resource Management deliberately encourages questioning and challenge. FAA guidance describes an environment where crew members speak up with appropriate persistence, questions are encouraged and actions and decisions can be challenged.

The captain retains command.

The first officer retains a voice.

AUTHORITY REMAINS. INFALLIBILITY DOES NOT.

And remember:

Not everyone contributes best in a crowded meeting.

Some need writing.

Some need one-to-one conversation.

Some need time to reflect.

Equal access to voice does not require everyone to use the same voice.

4. SEPARATE CHALLENGE FROM DISLOYALTY

Someone says:

“I think you're wrong.”

Notice what happens inside you.

Do you immediately explain why they don't understand?

Remind them of your experience?

Question their attitude?

Defend your record?

Or become curious?

Try:

“TALK ME THROUGH WHAT YOU'RE SEEING.”

Then:

“What evidence supports that?”

“What am I missing?”

Challenge the argument.

Not the person's loyalty.

NASA — CHALLENGER

The Challenger disaster remains one of the most sobering examples of why this matters.

The Rogers Commission concluded that the launch decision-making process was flawed, including communication failures that resulted in incomplete and misleading information reaching decision-makers, conflict between engineering evidence and management judgement, and organisational structures that allowed safety problems to bypass key managers.

The Commission also found that NASA and Thiokol had failed to respond adequately to internal warnings and had progressively accepted recurring O-ring problems as an acceptable flight risk.

The broader lesson is devastatingly simple:

SOMETIMES THE ORGANISATION DOES NOT FAIL BECAUSE NOBODY KNEW.

IT FAILS BECAUSE SOMEBODY KNEW — AND THE SYSTEM COULD NOT HEAR THEM.

5. MAKE THE DECISION RIGHT EXPLICIT

Inclusive leadership does not mean every decision becomes democratic.

Before asking for input, tell people what kind of process they are entering.

Are you:

Informing?

Consulting?

Seeking a recommendation?

Seeking consensus?

Delegating the decision?

Or:

Listening before the leader decides?

Say it explicitly:

“I want everyone's perspective. I hold accountability for this decision, so after hearing the arguments I will make the final call.”

That is not less inclusive.

It is more honest.

AMAZON

“Disagree and Commit” captures part of this distinction.

Debate can be vigorous before a decision.

But once the decision right has been exercised, execution cannot remain trapped in permanent debate.

EMERGENCY MEDICINE

During a cardiac arrest, the team does not vote on every intervention.

Roles and authority need clarity.

But before and after the crisis, the system should remain open to challenge and learning.

So:

VOICE ≠ VOTE ≠ VETO ≠ DECISION RIGHT.

Confusing them does not produce inclusion.

It produces ambiguity.

6. BUILD THE RIGHT TO INTERRUPT THE SYSTEM

Do not depend entirely on courage.

Design mechanisms.

TOYOTA

Toyota's Production System provides a powerful example.

Its jidoka principle involves stopping when abnormalities are detected. Toyota describes the andon mechanism through which workers can alert the person in charge when abnormalities such as quality problems or delays occur.

Consider what this means culturally.

Production matters.

Throughput matters.

Cost matters.

Customers matter.

But the system deliberately creates a mechanism for the person close to the work to surface abnormality.

THE PERSON WITH THE SMALLEST TITLE MAY HOLD THE MOST IMPORTANT INFORMATION IN THE SYSTEM.

MINING AND CONSTRUCTION

The equivalent might be stop-work authority.

HEALTHCARE

It may be clinical escalation.

CYBERSECURITY

It may be incident escalation independent of normal management hierarchy.

AI

It should include clearly defined authority to pause deployment when material safety concerns emerge.

The lesson:

DO NOT BUILD A SYSTEM THAT REQUIRES HEROISM EVERY TIME SOMEBODY NEEDS TO SAY STOP.

Build the challenge into the architecture.

7. PROTECT THE PERSON WHO BRINGS BAD NEWS

This may be the hardest behaviour of all.

An employee tells you something uncomfortable.

You listen.

Thank them.

Say all the right things.

Now watch what happens during the next six months.

Are they still invited?

Still promoted?

Still trusted?

Still given opportunities?

Or does their “tone” suddenly become problematic?

Are they now:

Difficult?

Negative?

Not aligned?

Not a team player?

Retaliation rarely announces itself.

It can occur through exclusion, opportunity, reputation and access.

YOUR REACTION TO BAD NEWS TRAINS EVERYONE WATCHING WHETHER TO BRING YOU BAD NEWS AGAIN.

HEALTHCARE

A junior nurse repeatedly escalates deterioration after a senior clinician dismisses the concern.

What happens next matters enormously.

If persistence is treated as insubordination, every nurse watching learns something.

If it is treated as professional responsibility, they learn something else.

In high-consequence systems:

PSYCHOLOGICAL SAFETY CAN BECOME PHYSICAL SAFETY.

CONSTRUCTION

The same applies when a worker stops a job because they believe it is unsafe.

The real safety culture is not written only in the manual.

SOMETIMES IT IS WRITTEN ON THE SUPERVISOR'S FACE WHEN SOMEBODY USES THE STOP-WORK RULE.

8. CLOSE THE LOOP

This is where many organisations quietly destroy inclusion.

They ask.

Employees answer.

A survey is conducted.

A listening session occurs.

A concern is reported.

Then—

silence.

Months later leadership wonders why participation has fallen.

The answer may be simple.

People learned that speaking changes nothing.

Tell them:

“This is what we heard.”

“This is what we're changing.”

“This is what we're not changing.”

“And this is why.”

Even when the decision is no, explanation can preserve trust.

ASKING FOR VOICE WITHOUT CLOSING THE LOOP EVENTUALLY TEACHES PEOPLE NOT TO SPEAK.

This is why ISI proposes:

VOICE-TO-DECISION TRACEABILITY™

Can the organisation trace:

Concern raised

→ Concern received

→ Evidence considered

→ Decision-maker informed

→ Decision made

→ Rationale communicated

→ Action taken

→ Person protected

Boards routinely demand financial audit trails.

Why not an audit trail for consequential dissent?

9. ADMIT WHEN THE DISSENTER WAS RIGHT

Now comes the real leadership test.

New evidence appears.

The junior employee was right.

You were wrong.

What happens?

Do you quietly change direction?

Rewrite history?

Explain why your decision was “reasonable at the time”?

Or say:

“You challenged this earlier. I disagreed with you. The evidence now shows you were right. Thank you for continuing to raise it.”

Imagine the cultural signal produced by a CEO saying that publicly.

Or a surgeon.

Chair.

General.

Principal.

Partner.

Site leader.

THE FASTEST WAY TO SHOW THAT DISAGREEMENT IS SAFE MAY BE FOR THE MOST POWERFUL PERSON IN THE ROOM TO PUBLICLY CHANGE THEIR MIND.

TOYOTA

Continuous improvement depends on recognising abnormalities and learning from them rather than defending the existing process. Toyota explicitly places continuous kaizen and employees' ability to think independently within its production philosophy.

AVIATION

Crew Resource Management similarly incorporates critique and debriefing, with feedback intended to be specific, objective and usable rather than defensive.

Inclusive leadership therefore requires more than speaking up.

It requires leaders capable of changing their minds.

10. MEASURE WHETHER POWER CAN ACTUALLY BE CHALLENGED

Stop measuring inclusion only with:

“Do you feel included?”

Ask harder questions.

When did somebody junior last change a senior decision?

How many serious concerns travelled upward?

How many received a response?

How long did it take?

Did anybody suffer disadvantage after speaking?

Which functions rarely challenge leadership?

Which executives receive almost no negative feedback?

That final question deserves attention.

A LEADER WHO NEVER HEARS BAD NEWS MAY NOT BE RUNNING AN EXCEPTIONAL ORGANISATION.

THEY MAY BE RUNNING A FRIGHTENED ONE.

The Australian evidence makes this particularly relevant.

DCA's 2025–26 Index found only 35% of workers considered their manager inclusive, compared with 56% for their team and 59% for their organisation. Workers with inclusive managers also reported substantially better teamwork, innovation and customer-service outcomes than workers with non-inclusive managers, although these survey relationships should not be treated as proof that inclusion alone caused those outcomes.

So perhaps boards should stop asking:

“Do we have an inclusion strategy?”

And start asking:

“SHOW US THE EVIDENCE THAT POWER CAN BE CHALLENGED HERE.”

THE 60-SECOND INCLUSIVE LEADERSHIP TEST™

Before an important decision, ask:

1. WHO HAVE WE NOT HEARD FROM?

2. WHAT EVIDENCE CONTRADICTS OUR PREFERRED ANSWER?

3. IS HIERARCHY STOPPING SOMEBODY FROM SPEAKING?

4. WHO THINKS I AM WRONG?

5. WHO ACTUALLY OWNS THIS DECISION?

6. HOW WILL WE CLOSE THE LOOP WITH PEOPLE WHOSE ADVICE WE DO NOT FOLLOW?

7. WHAT EVIDENCE WOULD MAKE US CHANGE OUR MIND?

Seven questions.

Sixty seconds.

A boardroom.

An Amazon fulfilment centre.

A Toyota production line.

An operating theatre.

A cockpit.

A construction site.

A technology company.

A government department.

The setting changes.

The leadership problem does not.

THE INCLUSIVE LEADERSHIP ACCOUNTABILITY LOOP™

At the Institute for Systems Integrity, we propose a simple operating model:

INVITE

→ HEAR

→ PROTECT

→ CONSIDER

→ DECIDE

→ EXPLAIN

→ LEARN

INVITE the challenge.

HEAR what is actually being said.

PROTECT the person raising it.

CONSIDER the evidence.

DECIDE with clear authority.

EXPLAIN what happened and why.

LEARN when new evidence shows you were wrong.

That is inclusion with accountability.

AND ONE RULE ABOVE ALL OTHERS

Never ask people to speak up unless you are genuinely prepared for them to say something you do not want to hear.

Because asking creates an obligation.

Not an obligation to agree.

Not an obligation to follow every suggestion.

Not an obligation to surrender authority.

But an obligation to:

hear,

consider,

decide,

explain,

and protect.

Amazon demonstrates the value of making disagreement part of leadership expectations.

Toyota demonstrates the value of building escalation into operations.

Aviation demonstrates that authority and challenge can coexist.

Healthcare demonstrates that psychological safety can become physical safety.

Challenger demonstrates the potential consequences when warnings and decision authority become disconnected.

Different industries.

Different consequences.

Same question:

CAN TRUTH TRAVEL UPHILL?

And perhaps every leader should finish the week by asking themselves:

“WHEN WAS THE LAST TIME SOMEONE JUNIOR TO ME TOLD ME I WAS WRONG?”

Then ask:

“WHAT DID I DO NEXT?”

If you cannot remember the last time somebody challenged you—

do not automatically conclude that your leadership is exceptional.

THEY MAY SIMPLY HAVE LEARNED THAT IT IS SAFER NOT TO TELL YOU.

Harvard References

D’Almada-Remedios, R., Tynan, E. and Wu, D. (2026) Inclusion@Work Index 2025–2026. Sydney: Diversity Council Australia.

Federal Aviation Administration (1998) Crew Resource Management Training. Advisory Circular AC 120-51C. Washington, DC: FAA.

Nembhard, I.M. and Edmondson, A.C. (2006) ‘Making it safe: The effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams’, Journal of Organizational Behavior, 27(7), pp. 941–966. doi:10.1002/job.413.

Presidential Commission on the Space Shuttle Challenger Accident (1986) Report of the Presidential Commission on the Space Shuttle Challenger Accident. Washington, DC: US Government Printing Office/NASA.

Toyota Motor Corporation (2026) Toyota Production System. Toyota City: Toyota Motor Corporation.

Amazon (2026) Amazon Jobs: Leadership and operational role materials. Amazon.