A 2018 report by the US National Academies of Science, Engineering, and Medicine identified sexual harassment as an enduring problem in scientific fields, and especially in medicine.1National Academies of Sciences, Engineering, and MedicineSexual harassment of women: climate, culture, and consequences in academic sciences, engineering, and medicine. a consensus study report of The National Academies of Sciences, Engineering, and Medicine. The National Academies Press, Washington, DC2018Google Scholar, 2Dzau VJ Johnson PA Ending sexual harassment in academic medicine.N Engl J Med. 2018; 379: 1589-1591Crossref PubMed Scopus (64) Google Scholar, 3Choo EK van Dis J Kass D Time's Up for medicine? Only time will tell.N Engl J Med. 2018; 379: 1592-1593Crossref PubMed Scopus (37) Google Scholar Harassment and inequity are interdependent processes, and it is no coincidence that harassment is rife in environments that foster gender disparities in compensation, opportunity, and advancement.4Ogunsemi O Alebiosu O Shorunmu O A survey of perceived stress, intimidation, harassment and well-being of resident doctors in a Nigerian Teaching Hospital.Niger J Clin Pr. 2010; 13: 183-186PubMed Google Scholar, 5Shen H Inequality quantified: mind the gender gap.Nature. 2013; 495: 22-24Crossref PubMed Scopus (232) Google Scholar, 6Pinholster G National survey conducted by AAAS and Science confirms continuing obstacles to women in science. American Association For The Advancement Of Science.https://www.aaas.org/news/national-survey-conducted-aaas-and-science-confirms-continuing-obstacles-women-scienceDate: Sept 28, 2010Date accessed: January 31, 2019Google Scholar Flagrant examples of abusive and discriminatory treatment continue to emerge, such as sexual harassment and assault of trainees doing scientific fieldwork,7Clancy KBH Nelson RG Rutherford JN Hinde K Survey of Academic Field Experiences (SAFE): trainees report harassment and assault.PLoS One. 2014; 9: e102172Crossref PubMed Scopus (243) Google Scholar manipulation of entrance examination scores to limit the number of women at a Japanese medical school,8McCurry J Tokyo medical school admits changing results to exclude women.The Guardian. Aug 7, 2018; https://www.theguardian.com/world/2018/aug/08/tokyo-medical-school-admits-changing-results-to-exclude-womenDate accessed: January 21, 2019Google Scholar and the unremitting gender pay gap in medicine and science in North America and other countries.9Jena AB Olenski AR Blumenthal DM Stewart A Ubel P Jagsi J Sex differences in physician salary in US public medical schools.JAMA Intern Med. 2016; 176: 1294Crossref PubMed Scopus (399) Google Scholar, 10Doximity2018 physician compensation report: second annual study. Doximity, San Francisco, CA2018Google Scholar Potential corrective actions are hampered by a hierarchical, male-dominated culture that accepts abusive behaviour as part of professional socialisation and avoids holding offenders accountable, particularly when they are leaders, well-funded researchers, or deemed valuable to the organisational mission.11Jagsi R Sexual harassment in medicine—#MeToo.N Engl J Med. 2018; 378: 209-211Crossref PubMed Scopus (99) Google Scholar The estimated costs of workplace harassment are staggering, with established detrimental impact on physical, psychological, and professional wellbeing of both the targets and bystanders.12Fnais N Soobiah C Chen M et al.Harassment and discrimination in medical training: a systematic review and meta-analysis.Acad Med. 2014; 89: 817-827Crossref PubMed Scopus (354) Google Scholar The #MeToo movement has brought the scope and severity of harassment and inequity to the forefront of public consciousness. The hashtag trended in at least 85 countries. Women in medicine13Jewett C Women in medicine shout #MeToo about sexual harassment at work.The Washington Post. March 18, 2018; https://www.washingtonpost.com/national/health-science/women-in-medicine-shout-metoo-about-sexual-harassment-at-work/2018/03/16/81673f82-0c37-11e8-8b0d-891602206fb7_story.html?noredirect=on&utm_term=.4edc30d2a3a9Date accessed: January 21, 2019Google Scholar and science14Neill U When scientists say, “Me, Too”.Sci Am. Oct 18, 2017; https://blogs.scientificamerican.com/voices/when-scientists-say-me-too/Date accessed: January 21, 2019Google Scholar participated using hashtags such as #metoomedicine, #metooscience, and #metooSTEM. #MeToo was tremendously effective in raising awareness and, crucially, was a bridge to action, giving rise to goal-oriented organisations such as TIME'S UP, which coordinates responses to gender discrimination and harassment and develops solutions to address them. Initiatives of TIME'S UP have included establishing the TIME'S UP Legal Defense Fund, issuing strong statements from high-visibility platforms such as major entertainment industry events, and shining a light on harassment and inequity outside of entertainment, including among food service employees.15Bach N Time's Up is backing the sexual harassment complaints 10 women just filed against McDonald's.Fortune. May 23, 2018; http://fortune.com/2018/05/23/mcdonalds-sexual-harassment-claims-times-up/Date accessed: January 21, 2019Google Scholar What would it mean to have a Time's Up initiative in health care? The potential impact of moving from #MeToo to #TimesUp in medicine and science is no less important than for entertainment and media. It is but a small leap from systemic mistreatment of a subset of health-care workers to disparate poor health outcomes in populations that differ demographically from their health-care providers or researchers. As data of the global health benefits of female leadership emerge,16Downs JA Reif LK Hokororo A Fitzgerald DW Increasing women in leadership in global health.Acad Med. 2014; 89: 1103-1107Crossref PubMed Scopus (72) Google Scholar ensuring an inclusive work environment that allows the full biomedical and health-care workforce to thrive and advance becomes imperative. A Time's Up effort in health care would ask organisations to confront each of the obstacles to preventing and addressing inequity and harassment: unclear policies and reporting structures; poor adherence to procedures and follow-through on reported cases; little to no support or protection for targets of harassment or inequity; undue reliance on formal complaints or lawsuits to focus organisational attention on harassment; a punitive environment for whistleblowers; minimal consequences for perpetrators of harassment or discrimination; and absence of standardised approaches to ensure accountability. In practice, strategies to eliminate harassment and inequity would be modelled after other quality improvements in health care through improved structures, processes, and outcomes (panel).17Akachi Y Kruk ME Quality of care: measuring a neglected driver of improved health.Bull World Health Organ. 2017; 95: 465-472Crossref PubMed Scopus (74) Google Scholar Such a framework would establish minimum standards for addressing harassment and discrimination, while encouraging institutions to excel in this arena.PanelWhat “Time's Up” in health care would facilitate in organisationsStructures•Establish standardised policies, procedures, and resources for addressing sexual harassment and discrimination•Provide concrete prevention strategies, such as civility and bystander training interventions•Ensure adequate staffing to support prevention, surveillance, and investigatory activities•Provide adequate and safe reporting pathways, including options for “complaint handlers” (diverse in every way, including position within organisation)•Provide protections constraining retaliation against reporters of harassment•Provide routine education of the entire workforce•Establish procedures to detect bias and discrimination in recruitment, hiring, dismissal, mentoring, and allocation of compensation and other resources, promotion, and leadership rolesProcesses•Identify process measures to ensure existing policies and procedures are implemented effectively and to track intermediate benchmarks pending downstream outcome changes•Support means of adapting standardised policies to be optimally acceptable for an individual practice setting (eg, means of incorporating input from a diverse group of employee stakeholders)•Provide visibility and transparency of progress•Ensure processes are adapted regularly to meet or exceed current standards•Explore and implement organisational and cultural restructuring to avoid steep, vertical hierarchies•Perform root cause analysis of harassment cases to shed light on organisation factors fostering harassment and inequitiesOutcomes•Identify, measure, and track critical outcomes, including:•occurrence of discrimination and harassment•objectivity of hiring and dismissal•equity in allocation of compensation and other resources, promotion, and leadership roles•disproportionate attrition of women or under-represented minorities•numbers of formal complaints, investigations, and lawsuits•perceptions of overall culture of safety and respect•occupational, mental, and physical health outcomes of targets after harassment•sanctions against confirmed transgressors•Create internal and external incentives for achieving outcome targets—eg, tie progress in these outcomes to individual and organisational financial incentives Structures •Establish standardised policies, procedures, and resources for addressing sexual harassment and discrimination•Provide concrete prevention strategies, such as civility and bystander training interventions•Ensure adequate staffing to support prevention, surveillance, and investigatory activities•Provide adequate and safe reporting pathways, including options for “complaint handlers” (diverse in every way, including position within organisation)•Provide protections constraining retaliation against reporters of harassment•Provide routine education of the entire workforce•Establish procedures to detect bias and discrimination in recruitment, hiring, dismissal, mentoring, and allocation of compensation and other resources, promotion, and leadership roles Processes •Identify process measures to ensure existing policies and procedures are implemented effectively and to track intermediate benchmarks pending downstream outcome changes•Support means of adapting standardised policies to be optimally acceptable for an individual practice setting (eg, means of incorporating input from a diverse group of employee stakeholders)•Provide visibility and transparency of progress•Ensure processes are adapted regularly to meet or exceed current standards•Explore and implement organisational and cultural restructuring to avoid steep, vertical hierarchies•Perform root cause analysis of harassment cases to shed light on organisation factors fostering harassment and inequities Outcomes •Identify, measure, and track critical outcomes, including:•occurrence of discrimination and harassment•objectivity of hiring and dismissal•equity in allocation of compensation and other resources, promotion, and leadership roles•disproportionate attrition of women or under-represented minorities•numbers of formal complaints, investigations, and lawsuits•perceptions of overall culture of safety and respect•occupational, mental, and physical health outcomes of targets after harassment•sanctions against confirmed transgressors•Create internal and external incentives for achieving outcome targets—eg, tie progress in these outcomes to individual and organisational financial incentives Time's Up for health care would demand a commitment to the implementation of global changes across the health-care sector and to the acknowledgment that organisational tolerance of harassment contributes to its perpetuation.18Willness C Steel P Lee K A meta-analysis of the antecedents and consequences of workplace sexual harassment.Pers Psychol. 2007; 60: 127-162Crossref Scopus (527) Google Scholar Leaders of health-care organisations would be asked to visibly dedicate themselves to mitigating harassment and discrimination as a priority by assigning responsibility to offices and individuals empowered to impact overall culture change and allocating adequate resources to this mission. A wide spectrum of health-care professions, specialties, and settings would need to be engaged to convey a unified message that health care and biomedical science values and expects accountability. Consumers, regulators, philanthropists, and policy makers would all play a part in establishing expectations for health-care organisations to participate—or even excel—in these activities. Similarly, leaders of a Time's Up initiative in health care should represent the full range of diverse perspectives of professionals, including members who have historically been marginalised. Through in-person sessions and outreach, leaders could engage health-care practices, hospitals, and other institutions on an individual level, providing concrete resources—eg, templated measurement tools for repeated evaluation of institutional culture in relation to gender equity and sexual harassment.19Westring AF Speck RM Sammel MD et al.A culture conducive to women's academic success: development of a measure.Acad Med. 2012; 87: 1622-1631Crossref PubMed Scopus (64) Google Scholar Members of the movement would also engage with media to transform public expectations of behaviour within health-care settings. The health-care industry is one of the largest employers in the world and accounts for a global market projected to reach US$11·8 trillion by 2021.20ReportLinkerHealthcare Global Market Report 2018.https://www.reportlinker.com/p05312917/Healthcare-Global-Market-Report.htmlDate: February, 2018Date accessed: January 31, 2019Google Scholar Bringing safety and equity to its workforce is necessary to sustain the vitality of the health-care professions. These professions cannot meet productivity goals or fulfil their promise to society unless women are fully included—not only in numbers but also in respect, influence, and authority. A host of improved medical, surgical, and public health outcomes21Tsugawa Y Jena AB Figueroa JF Orav EJ Blumenthal DM Jha AK Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians.JAMA Intern Med. 2017; 177: 206Crossref PubMed Scopus (501) Google Scholar, 22Bhalotra S Clots-Figueras I Health and the political agency of women.Am Econ J. 2014; 6: 164-197Google Scholar, 23Wallis C Ravi B Coburn N Nam R Detsky A Satkunasivam R Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study.BMJ. 2017; 359: j4366Crossref PubMed Scopus (269) Google Scholar, 24Greenwood B Carnahan S Huang L Patient–physician gender concordance and increased mortality among female heart attack patients.Proc Natl Acad Sci USA. 2018; 115: 8569-8574Crossref PubMed Scopus (222) Google Scholar are associated with workforce and leadership heterogeneity, reinforcing what has been observed in other settings: diversity and inclusion improves collective intelligence. The health of our patients requires that systemic inequities be addressed. Now is the time for Time's Up in health care. For #LancetWomen see https://www.thelancet.com/lancet-women For #LancetWomen see https://www.thelancet.com/lancet-women EKC is: co-founder of Equity Quotient, a company that evaluates culture in health-care companies; President of the Gender Equity Research Foundation, a non-profit organisation that raises funds for research on equity in health care; and senior adviser to FeminEM.org, which supports the careers of women in medicine. EKC has received grant funding from the National Institutes for Health and the Insurance Institute of Highway Safety unrelated to this work. CLB has intellectual property in and receives royalties from BioFire Diagnostics; and has received grant funding from the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the National Institutes for Health, and Blue Cross Blue Shield of Texas unrelated to this work. RJ has stock options as compensation for her advisory board role in Equity Quotient; and has received personal fees from Amgen and Vizient and grants for unrelated work from the National Institutes of Health, the Doris Duke Foundation, the Greenwall Foundation, the Komen Foundation, and Blue Cross Blue Shield of Michigan for the Michigan Radiation Oncology Quality Consortium. N-LJ declares no competing interests.