The document is notable for the breadth of its definition of diversity. The authors explicitly reject the idea that diversity is only about gender and ethnicity, extending it to language and cultural background, sexual orientation and gender identity, age, education level, religious belief, socioeconomic status, and physical abilities or disabilities. In the intensive care setting, they argue, this breadth has practical consequences. Multidisciplinary teams composed of professionals with varied experiences and perspectives enrich clinical discussions and generate innovative solutions to complex challenges. As staff and patient populations become increasingly multicultural, diverse teams are better placed to respect cultural differences in patient preferences, communicate with families, and deliver genuinely patient-centred care.

The paper also draws on evidence that representation within the healthcare workforce can shape the relationship between institutions and the communities they serve. Studies cited by the group suggest that greater diversity and representation among staff and leadership may improve communication, engagement and trust between hospitals and their patients, and that patient-clinician concordance by race or gender can influence communication quality and trust. A workplace in which all individuals feel valued, the authors add, is more supportive and collaborative, which matters in a specialty where burnout and workforce retention are chronic concerns.

A central conceptual contribution of the paper is its insistence on the distinction between equality and equity. Equality, the authors write, means treating everyone the same and providing identical opportunities or resources regardless of the differential barriers specific groups may face. Equity, by contrast, involves giving individuals what they need to succeed, acknowledging that certain populations encounter different obstacles, focusing on fair access to opportunities and support while accounting for differing needs and circumstances and removing avoidable barriers. The distinction matters because identical treatment can reproduce inequality when starting points differ, a point the authors apply both to careers of ICU professionals and to the care received by patients.

For healthcare professionals, the paper identifies a concrete gap: although evidence shows that workforce diversity enhances innovation and decision-making, women and ethnic minority groups remain underrepresented in leadership positions in intensive care. The authors call for structured mentorship programmes, transparent recruitment processes and robust data collection to drive systemic change rather than relying on policy statements alone. They point to surveys conducted within ESICM’s own early-career structures, which have documented demographic considerations and continuing gender-related challenges in securing sustainable, high-quality leadership, including cultural change, workplace parenting reforms, advocacy and mentoring as outstanding issues.

At the patient level, the paper argues that equity in intensive care requires access to appropriate, high-quality care to be guided by individual clinical need rather than limited by ethnicity, gender, age, socioeconomic status, language, disability or other personal characteristics, with the goal of comparable outcomes for all. The authors acknowledge that social determinants of health continue to influence both access to and quality of critical care, and they stress that inequities in the ICU mirror wider structural inequities in health systems. Addressing them, they argue, requires deliberate measurement and accountability rather than good intentions.

Clinical research receives particular attention. The paper warns that underrepresentation of minority groups in clinical studies limits the applicability and generalizability of results, since therapeutic strategies and outcome measures developed on unrepresentative populations may not transfer to the real diversity of ICU patients. Inclusive research, the authors contend, ensures that findings reflect the populations they are meant to serve. This connects to a broader theme of the document: the society’s research funding programmes, which specifically support the professional development of promising early-career researchers and encourage the involvement of investigators from low- and middle-income countries.

The authors are candid about the obstacles. Implicit biases, resistance to change, limited resources, inconsistent data collection and a lack of tools to monitor progress are described as common barriers to implementing EDI initiatives in intensive care. In many institutions, demographic and outcome data are not systematically collected, making it difficult to assess whether interventions actually work. The paper identifies the development of standardized EDI metrics as a key priority, so that healthcare organisations can measure progress and identify areas for improvement. It also sets guardrails for such measurement: where demographic information is self-reported, disclosure should be voluntary, data collection and reporting should protect individual privacy, and demographic categories should be adapted to the applicable legal, ethical and sociocultural context. As an initial step, the group recommends assessment of implicit bias for those currently in leadership positions, formally incorporated into a practical toolkit.

The society points to its own track record as evidence that change is achievable. Since the 2019 statement paper, ESICM reports that it has substantially increased the proportion of female speakers at its annual congress LIVES and improved gender balance across committees and society-organised events, developments the authors describe as progress toward the earlier goals while underscoring the need for more systematic assessment across all areas of EDI. Yet the paper also concedes that few resources are currently available to implement EDI initiatives, including limited funding for training programmes and insufficient protection of staff time to participate in EDI activities. It urges healthcare organisations to prioritise EDI within strategic planning and budgets and to seek external funding sources.

The position paper closes with a set of commitments that bind the society’s governance, education and scientific activities to its EDI agenda: advocating for equitable access to lifesaving and sustainable intensive care services worldwide; supporting mentorship, training and career advancement for meritorious individuals in underrepresented groups in compliance with local and national legal frameworks; ensuring diversity in research populations and leadership through global collaboration; sustaining respectful workplaces free from discrimination, harassment and bias; and accelerating the integration of evidence-based approaches into clinical education and guidelines. The authors frame these commitments as benchmarks to be revisited periodically through measurable indicators, and they call on the global intensive care community to share experiences, challenges and best practices. Inclusion, the paper argues, is not merely a policy aspiration but a daily practice, and the future viability and growth of the specialty depends on nurturing and promoting valued ICU professionals from every background.

Subject of Research: Equity, diversity and inclusion in intensive care medicine

Article Title: Promoting equity, diversity and inclusion in intensive Care: a position paper of the European Society of Intensive Care Medicine

Article References: The ESICM Diversity and Inclusion Group, Grasselli, G., Herridge, M. S., Abidi, K., Alexandre, J., Jagodzinska-Peškova, J., Laffey, J. G., Lobo, S., Puxty, K., Ramsay, P., Rodriguez-Ruiz, E., Van Mol, M. M. C., Ostermann, M., De Waele, J. J., on behalf of the ESICM Executive Committee, Azoulay, E., Boulanger, C., Derde, L. P. G., Donadello, K., … Wendon, J. A. (2026). Promoting equity, diversity and inclusion in intensive Care: a position paper of the European Society of Intensive Care Medicine. Intensive Care Medicine. https://doi.org/10.1007/s00134-026-08653-6

Image Credits: AI Generated

DOI: 10.1007/s00134-026-08653-6

Keywords: intensive care, equity, diversity, inclusion, ESICM, healthcare workforce, leadership, patient outcomes, clinical research, mentorship, EDI metrics, burnout