By Branko Perunovic

It took me a few days to start unwinding from the grindingly busy work routine that has come to define my world for many years. I don’t know about you, but I’ve never been very good at maintaining the mental and emotional boundaries between work and other aspects of life. Surely, my explanation could resemble the clichéd answers to “what are your weaknesses” interview questions, or I could try to blame the always-on nature of our technology-driven civilization. However, it’s more likely tied to an inherent obsessiveness, deeply ingrained in pathology. This Janusian trait, while enabling us to excel in precision and thoroughness, simultaneously hinders our ability to let go. And ChatGPT is wrong—at least in my case. This trait doesn’t seem to improve with age.

Speaking of ChatGPT, I gave a holiday “homework” assignment to a few young leaders on my team, passing along a reference to a free online prompt engineering course. Obviously, I didn’t expect them to complete it over Christmas, but I would have half-expected them to at least explore what it was about. We’ll be discussing topics relevant to the use of generative AI in pathology many times this year. I’m confident that generative AI, if it hasn’t already, will soon become a foundational capability for sophisticated pathology professionals—much like how tools such as WordPerfect and Lotus 1-2-3 were an epiphany for my MS-DOS generation. Does anyone here still remember those?

This year’s blog will continue to flow like a chaconne of ideas, revisiting core principles and exploring new perspectives with each iteration. One of the key reflections will continue to be the unintended consequences of directionally and excessively target-driven management of NHS Pathology. Most are familiar with Goodhart’s Law and the futility of using specific metrics as benchmarks to control a system or guide behavior.

Nuance is essential, as few situations are purely black or white. Metrics such as turnaround times (TATs) are undeniably valuable tools for operational management, providing clear benchmarks and driving performance improvements. However, an over-reliance on these metrics risks oversimplifying the intricate realities of healthcare delivery. Healthcare operates as a complex adaptive system, characterized by interdependencies and emergent behaviors that linear metrics fail to capture. When these nuances are overlooked, the strategic management of healthcare can become misaligned with its core objectives, leading to unintended consequences and ultimately compromising patient outcomes.

We will also strive to promote systems thinking, particularly in discussions surrounding the financial management of pathology. On one hand, it is crucial to ensure that pathology remains sustainable, delivering the maximum health benefits within its budget. On the other hand, we must continue to advance by carefully balancing innovation with sustainability. This approach is not about reducing discussions to an often elusive and overly simplistic ideal of seamlessly aligning financial targets with measures of patient outcomes, equity, and quality. The broader healthcare ecosystem may not yet be sufficiently mature, integrated, technologically capable, or self-assured to fully embrace this path.

Achieving this ambition requires cultivating next-generation leadership that is adaptive, forward-thinking, and equipped to navigate the intricate challenges of modern pathology and modern healthcare. It is my hope that this blog can serve as a meaningful contribution toward shaping such leadership and advancing this goal.[epic_post_author compatible_column_notice=”” scheme=”alt”]