Hebatullah Elsafy, MD, MSc, an ASCP Mentor and Ambassador, created Papyrus Path Academy, a case-based learning community that brings together pathology trainees from different countries and training systems to learn from one another.

Here, Dr. Elsafy talks with Critical Values, sharing the impact of mentorship on her career, her connections to patient care, and what calls someone to leadership, “One of the biggest lessons I've learned is that leadership doesn't always start with a title or even with the intention of becoming a leader. Sometimes it starts by recognizing a need and being willing to do something about it. I've learned to listen more, make room for different perspectives, and recognize that some of the most meaningful things we build are things we build together.”

What initially drew you to pathology?

I didn't have a single “aha” moment when I knew pathology was right for me. It was something that evolved over time. At first, I was drawn in by curiosity. I wanted to understand the why behind disease, not just recognize it. The more I learned and looked through the microscope, the more I realized there was always another question to ask and something new to understand.

My journey in pathology began in Egypt and later continued in the United States. Training in two different health systems broadened my perspective and introduced me to different approaches, technologies, and areas of the field. It also reinforced something I have come to love about pathology: there is always more to discover. Whether it is a challenging case I haven't encountered before or a new development that changes the way we understand disease, the field continues to surprise me.

What remains constant is the connection to the patient. In pathology, the patient may not be sitting in front of you, but you encounter them through their blood, tissue, cells, and clinical story. A diagnosis that may take only a few lines on a pathology report can represent an enormous turning point in someone's life. What began as intellectual curiosity gradually became a sense of purpose. The fascination that brought me to pathology has never gone away; it has simply evolved along with me.

Can you share a moment when you felt especially connected to patient care?

One experience that has stayed with me happened early in my residency training in Egypt. I was involved in the care of a young woman in her twenties with acute leukemia. She was at a point in her life when she had so many plans for the future, and suddenly all of that had become uncertain. I was still very junior at the time, but she asked me to perform her bone marrow procedures because she felt comfortable with me and trusted me. I remember how much that trust meant to me, particularly so early in my training.

Unfortunately, I couldn't change her outcome, but caring for her changed something in me. She taught me very early in my career that being entrusted with even one part of someone's care carries a responsibility that goes far beyond performing a procedure or reaching a diagnosis. I encounter patients more often through a microscope than at the bedside, but I don't feel that the connection has disappeared. Our diagnoses can shape some of the most consequential decisions in a patient's care, and remembering the person behind the specimen gives both meaning and responsibility to the work we do.

Have you had any mentors or role models who influenced your career choice? How have they impacted your journey?

One mentor, in particular, introduced me to the world of research. He gave me opportunities to become involved in projects, encouraged me to ask questions beyond the individual case, and helped me understand how an observation in daily practice could develop into a meaningful research question. Research has since become an important part of my career, and I am very grateful that someone opened that for me early in my training.

My residency program director has been a wonderful example of that. She is incredibly approachable and welcoming with trainees, and she has created an environment where we feel comfortable coming to her, not only when we are excited about a new opportunity, but also when we are facing a challenge or simply need guidance.

Over time, I have come to realize that the mentors who stay with you are often the ones who are genuinely invested in your growth. I found myself wanting to offer others the same kind of support and encouragement that had been so meaningful to me. That was one of the reasons I became involved in volunteer roles with ASCP, particularly as an ASCP Mentor and Ambassador. To me, mentorship is not only about giving someone the answers; it is about giving them the confidence and support to find their own way.

Laboratory professionals are trained to pursue excellence. From the beginning of our careers, we learn the importance of accuracy and precision, how to follow complex laboratory procedures, troubleshoot problems, and meet quality as well as regulatory requirements.

Those who consistently demonstrate technical competence, sound judgment, and accountability often become the people others turn to for guidance—and eventually, the people considered for leadership roles.

Yet the capabilities that make someone an excellent laboratory professional are not, by themselves, the same capabilities required to lead a laboratory.

For many laboratory professionals, the transition into leadership happens with surprisingly little preparation. A strong clinical laboratory scientist may be promoted because they are technically capable and have demonstrated the ability to take on greater responsibility. Then, almost overnight, the expectations change. The person who was responsible for their own work is now responsible for the performance of others.

Many new leaders develop these capabilities through experience, mentorship, professional development, and leadership resources they seek out on their own. Some have the benefit of strong guidance. Others are largely left to learn through trial and error.

The challenge is that leadership development does not occur in isolation. While the emerging leader is learning how to lead, their decisions are already affecting employees, laboratory operations, quality, and patient care.

General leadership literature offers valuable lessons that apply across industries. Laboratory professionals, however, must translate those lessons into an environment shaped by technical complexity, regulatory requirements, quality systems, specialized personnel, and responsibility for the reliability of patient results.

This is where a laboratory-specific developmental lens can be useful.

Established frameworks already provide important guidance regarding laboratory leadership. The World Health Organization's Laboratory Leadership Competency Framework identifies core areas of laboratory leadership, while CLSI's quality-management standards provide guidance for establishing, measuring, and sustaining effective laboratory quality systems.^1-4

WHO and CLSI help establish what effective laboratory leadership and laboratory quality systems require. The Bench-to-Leader Framework focuses on the developmental transition of the professional who must learn to assume those responsibilities.

The framework examines the developmental shift that occurs as responsibility expands from one's own work to people, decisions, systems, and outcomes.

At its core:

Leadership is the progressive expansion of awareness, responsibility, and influence—from achieving individual excellence in the laboratory to helping people, teams, and systems achieve collective excellence in service of organizational and patient outcomes.

The Bench-to-Leader Framework describes five interconnected areas of development that reflect this progressively widening scope of awareness, responsibility, and influence:

1. Individual Excellence — Leading Yourself
2. Leading Others — Building Collective Excellence
3. Critical Thinking & Decision-Making — Navigating Complexity
4. Quality & Systems Thinking — Getting on the Balcony
5. Strategic Leadership & Stewardship — Shaping What Comes Next

These areas are interconnected rather than rigid or sequential. A leader continues developing across all of them as the scope and complexity of their responsibility grows.

Heifetz and Laurie describe the importance of leaders periodically stepping away from the immediate action—to “get on the balcony”—so that patterns and challenges can be recognized that may be difficult to see while fully immersed in the work.⁵ The metaphor of moving between the dance floor and the balcony is particularly useful when thinking about the transition from bench to laboratory leadership.

At the bench, we spend much of our time on the dance floor, immersed in the immediate work and focused on what needs to be accomplished in the moment. Leadership does not require abandoning that perspective. It requires learning to move between the dance floor and the balcony so that the leader remains connected to the realities of the work while also developing a broader view of the people, processes, and systems that influence performance.

Individual excellence — Leading yourself

Every leadership journey begins before the leadership title is earned. For laboratory professionals, that foundation is built through technical competence and a demonstrated ability to take responsibility for the work.

Demonstrating technical competence and accountability builds credibility and often leads to greater responsibility. But these are the beginning, not the end, of leadership development.

Individual Excellence extends beyond technical proficiency into self-leadership. The emerging leader must develop greater awareness of how they respond to feedback, manage mistakes and difficult situations, follow through on commitments, and recognize how their behavior affects the people around them.

Self-awareness and emotional intelligence become practical leadership capabilities at this point in the transition. As responsibility expands, the laboratory professional will increasingly encounter disagreement, uncertainty, competing priorities, and change. The ability to understand and manage one's own responses becomes an important part of leading effectively.^6,7

Individual Excellence should not be confused with perfection or with knowing every technical answer. It is about taking responsibility for one's work, behavior, professional development, and contribution to the laboratory.

Quality begins here as well. Before a leader can influence a culture of quality, they must first demonstrate a personal quality mindset. Accuracy, reliability, documentation, and follow-through are not simply regulatory requirements; they reflect our responsibility to the patients and clinicians who depend on laboratory information.

At the bench, success is often measured by what I accomplish.

Leadership begins to change that measure.

The question gradually expands from How well do I perform? to How do I contribute to the ability of others to perform well?

Leading others — Building collective excellence

For many new laboratory supervisors, one of the most significant changes is that the work becomes increasingly about people.

A strong laboratory professional may have spent years developing expertise and becoming the person others call when something goes wrong. Once responsible for a team, however, success can no longer depend primarily on what that individual can personally accomplish.

As laboratory professionals develop their ability to lead others, formal leadership training can provide additional tools and perspectives. Programs such as the ASCP Leadership Institute offer education focused on communication, team development, conflict management, and other competencies that support success in laboratory leadership roles.

The role begins to shift from technical expert to people leader.

Leading others requires a shift in how success is defined. The leader is now responsible for communicating expectations, developing people, addressing performance concerns, navigating conflict, and creating accountability across the team. These responsibilities can be especially challenging when a new leader is supervising former peers, as is often the case with internal promotions.

One of the common challenges in this transition is the instinct to continue solving everything personally. For an experienced laboratory professional, stepping in may feel efficient and familiar. But when the leader consistently becomes the answer, the team has fewer opportunities to build confidence and capability.

The role of the leader is not simply to ensure that the work gets done. It is to create the conditions in which people can perform well, develop, and understand what is expected of them.

That requires a thoughtful balance between accountability and trust. Employees need clarity about expectations and timely feedback when performance is not where it needs to be. At the same time, they need to know that raising a concern, admitting uncertainty, or bringing forward a potential error will be met with attention. In the laboratory, that balance is especially important because concerns that remain unspoken can have consequences for quality and patient care.

Research in healthcare teams has identified leadership support and inclusiveness as important contributors to psychological safety.⁸ For laboratory leaders, psychological safety does not mean lowering standards. It means creating an environment in which people can speak openly about problems while remaining accountable for their responsibilities.

When those conditions exist together, concerns are more likely to surface early, feedback can be more productive, and the team is better positioned to learn and improve.

Building Collective Excellence also requires understanding what allows a team to succeed as a whole. Teams develop their own dynamics, and the leader must learn how to navigate that dance while keeping people aligned around the work that needs to be accomplished. Leadership at this level is not only about managing individual performance; it is about creating the conditions for the team to work together effectively and achieve the outcomes expected of the laboratory.

The shift toward Collective Excellence occurs when the leader begins to understand that their success is reflected in the performance of the team and in their ability to bring out the best in others to achieve outcomes.

Critical thinking and decision-making — Navigating complexity

Laboratory professionals are accustomed to solving problems. The bench provides constant opportunities to troubleshoot, evaluate unexpected findings, and determine what should happen next.

Leadership expands the nature of those problems.

The leader is no longer looking only at the immediate technical issue. A single operational problem may involve people, workflow, risk, resources, regulatory expectations, and patient impact at the same time.

The question therefore becomes less about simply fixing what is in front of us and more about looking beyond the presenting issue to understand what is actually driving it.

A staffing concern, for example, may reflect workflow, scheduling, competency, or workload distribution. An apparent performance problem may be influenced by unclear expectations or inadequate training. A turnaround-time issue may begin well before the specimen reaches the testing area.

Critical thinking requires the leader to move beyond the obvious explanation, examine the available information, question assumptions, and consider risk and consequences. Decision-making requires taking that analysis further and choosing a course of action, often without perfect information.

Leadership also requires judgment about priorities. Not every problem can receive the same attention, and not every issue carries the same risk. The emerging leader learns to distinguish what requires immediate intervention from what should be monitored, investigated further, or addressed through longer-term improvement.

This is where technical problem solving begins to evolve into leadership judgment.

Quality and systems thinking — Getting on the balcony

One of the most important transitions from bench professional to laboratory leader is learning to see beyond the immediate testing activity.

A laboratory professional may spend much of the workday focused on a specific bench, testing area, or portion of the testing process. A leader must increasingly understand the entire laboratory value stream and how the preanalytic, analytic, and postanalytic phases influence one another.[9]

This is where the dance floor and balcony perspective becomes especially useful.

On the dance floor, we are immersed in the immediate work. From the balcony, the emerging leader begins to see how that work connects to what happens before and after it and to the broader quality systems that support laboratory performance.

CLSI's Quality System Essentials provide an established structure for understanding these interdependencies.[3] For the emerging leader, this means developing fluency in laboratory quality management and understanding not only whether the work is being performed, but how quality is monitored, how problems are investigated, and how processes are improved.

Quality indicators become especially important because leadership requires moving from assumptions to measurement. It is one thing to assume that specimen rejection is increasing or turnaround time is worsening. It is another to examine the data, understand the trend, identify contributing factors, intervene, and determine whether performance actually improved.³

Developing expertise in quality improvement methodologies can help leaders translate measurement into meaningful change. ASCP’s Continuous Quality Improvement Certificate Program, as an example, provides laboratory professionals with practical approaches for analyzing processes, implementing improvements, and sustaining quality outcomes across complex laboratory systems.

The same principle applies to problem solving. Correcting an individual event may restore today's operation, but root-cause analysis pushes the leader to understand why the process allowed the event to occur and what needs to change to reduce the likelihood of recurrence.

The distinction is fundamental:

At the bench, the laboratory professional is responsible for performing their part of the testing process well. As leadership responsibility expands, the focus shifts to understanding how the entire system works, how its parts interact, and how quality can be measured and improved.

Getting on the balcony means seeing the laboratory not simply as individual benches or departments, but as an interconnected system designed to produce reliable information for patient care.

Strategic leadership and stewardship — Shaping what comes next

As responsibility expands further, leadership moves beyond managing today's operation toward preparing the laboratory for tomorrow.

Strategic leadership requires the leader to look beyond the immediate demands of the day and consider what the laboratory will need next. This may mean anticipating changes in workforce capability, technology, resources, and organizational priorities while continuing to protect quality and patient care.

At this point, the leader increasingly becomes a steward of the system.

Stewardship means thinking about the long-term strength of the laboratory rather than only today's performance. It includes building capability in others, making thoughtful use of resources, strengthening quality systems, and reducing dependence on any one individual.

A laboratory that cannot function effectively without a particular leader or technical expert remains vulnerable. Developing future leaders and strengthening the capability of the team are therefore part of stewardship.

The strategic leader must also help the laboratory adapt. Technology, automation, workforce pressures, financial constraints, and changing clinical needs will continue to reshape laboratory practice. Leadership at this level requires not only responding to those changes but helping the organization prepare for them.

Success becomes less about what the leader personally accomplishes and more about what the people and systems around that leader become capable of accomplishing.

Quality as a thread throughout the journey

Although Quality and Systems Thinking is one area of the framework, quality does not begin there.

It begins with responsibility for one's own work and expands as leadership responsibility grows. Over time, the leader becomes increasingly responsible for the quality of the team's performance, the decisions that shape the work, the systems that support it, and ultimately the conditions necessary to sustain quality.

The same is true of communication, ethical responsibility, regulatory compliance, patient safety, and change. These responsibilities do not belong to only one area of development; their scope increases as the leader's field of influence expands.

Expanding the definition of excellence

Technical expertise, reliability, integrity, and quality remain important throughout the leadership journey. What changes is the scope of responsibility.

The bench professional begins primarily responsible for the quality of their own contribution. Leadership expands that responsibility to the performance of other people, the decisions that guide the work, the systems in which the work occurs, and ultimately the future capability and outcomes of the laboratory.

This is why leadership development should begin before someone receives a leadership title. Laboratory professionals preparing for leadership can begin developing greater self-awareness, strengthening their communication and people-management skills, learning to frame problems more broadly, and becoming more familiar with the quality systems that extend beyond their immediate bench.

Most importantly, they can begin learning to move intentionally between the dance floor and the balcony—remaining close enough to the work to understand its realities while stepping back far enough to see the patterns, relationships, risks, and systems that cannot always be seen from the bench.

The transition from bench to leader is the expansion of responsibility from individual excellence to collective excellence—helping people, teams, and systems perform at their best in service of the patients and organizations that depend on the laboratory.

References

1. World Health Organization. Laboratory Leadership Competency Framework. Geneva, Switzerland: World Health Organization; 2019.
2. Clinical and Laboratory Standards Institute. QMS01: A Quality Management System Model for Laboratory Services. 5th ed. Wayne, PA: CLSI; 2019.
3. Clinical and Laboratory Standards Institute. QMS12: Developing and Using Quality Indicators for Laboratory Improvement. 2nd ed. Wayne, PA: CLSI; 2019.
4. Heifetz RA, Laurie DL. The work of leadership. Harv Bus Rev. 1997;75(1):124-134. Reprinted December 2001.
5. Clinical and Laboratory Standards Institute. QMS14: Quality Management System: Leadership and Management Roles and Responsibilities. 2nd ed. Wayne, PA: CLSI; 2024.
6. Stoller JK. Emotional intelligence: leadership essentials for chest medicine professionals. Chest. 2021;159(5):1942-1948.
7. Cavaness K, Picchioni A, Fleshman JW. Linking emotional intelligence to successful health care leadership: the Big Five model of personality. Clin Colon Rectal Surg. 2020;33(4):195-203.
8. O'Donovan R, McAuliffe E. A systematic review of factors that enable psychological safety in healthcare teams. Int J Qual Health Care. 2020;32(4):240-250.
9. Plebani M, Sciacovelli L, Aita A, et al. Performance criteria and quality indicators for the pre-analytical phase. Clin Chem Lab Med. 2015;53(6):943-948.