Over the past three years, I have immersed myself in leadership development literature related to health systems and health professions education. In my pursuit of a comprehensive leadership framework that encompassed leadership demonstrated at several levels and applied to health care, I came across Dickson & Tholl’s  (2014) “LEADS in a Caring Environment” framework. The recently released second edition Bringing Leadership to Life in Health: LEADS in a Caring Environment expands on the original leadership framework and represents the key skills, behaviors, abilities, and knowledge required to lead in all sectors and all levels of the health system. It provides an in-depth perspective on how LEADS is used in different contexts, including how LEADS relates to diversity and Indigenous cultures. This post highlights the five domains of the LEADS Framework. 

Health care is one of the most complex and caring social enterprises. Leadership in the health sector continues to be recognized as a key factor in improving healthcare. Leadership skills can help health professionals work effectively in a dynamic environment, promote collaborative practice, and minimize siloed work. Although there are several leadership frameworks and theories applied to the context of healthcare, defining best practices in leadership is difficult due to lack of standard definition of leadership, supporting frameworks, and robust assessment. In response, LEADS is a leadership framework designed to showcase the capabilities required of both formal and informal leaders to meet diverse challenges and bring about the cultural shifts in health care education that have long been called for by experts in the field. One distinguishing feature of the LEADS framework that I have found particularly fascinating is the differentiation between competence and capability. Although I concede that “competence” is a vital component to health professions education, I query whether a heightened focus on “capability” could incite greater appreciation for professional growth beyond formal education, and enhance the agency and potential of health care providers to become leaders in their own unique context.  In what follows, I describe each LEADS domain from the Canadian College of Health Leaders and provide concrete examples from the literature to illustrate how each domain is demonstrated in practice.

Lead Self: Self-motivated leaders are self-aware, develop themselves, and demonstrate character. They  support and challenge others to achieve their own professional and personal goals. They create engaging environments where others have meaningful opportunities to contribute, facilitating collaboration and cooperation to achieve results. As a case in point, brain research by Baron and colleagues has shown that developing mindfulness can improve one’s leadership flexibility. Mindfulness is a technique and approach to grow self-awareness, and build empathy with others in interpersonal relationships and contribute to better leadership. Furthermore, LEADS can be used to facilitate critical self-reflection, and highlight how leadership evolves with experience, time, and determination.

Engage Others: Engaging leaders foster the development of others, communicate effectively, and through these activities, build successful teams. They inspire vision by communicating clear and meaningful expectations and articulating outcomes. They act in a manner consistent with organizational values to yield effective, efficient public-centered service. To provide an example, leaders of today’s top companies are increasingly communicating through online platforms that include company websites, video, and social networks. In an article by Flury, nurse executives can use social media to enhance branding, engagement, and learning. This article provides guidance on how to operationalize effective communication using social media.

Achieve Results: Goal-oriented leaders strategically align decisions with organizational vision and values, and continually evaluate the impact of these same decisions. They employ methods to gather intelligence, encourage open exchange of information, and use quality evidence to influence action across the system. Goal-oriented leaders are politically astute, and capably negotiate through conflict, mobilizing support. Oliver and Cairney discuss the dos and don’ts of influencing policy, and highlight the importance of setting direction and achieving strategic alignment. Leaders use policy to shape and guide action in support of strategic imperatives of governments, national organizations, or large health authorities and hospitals. This article provides an evidence-based set of guidelines for researchers and policy makers to consider.

Develop Coalitions: Collaborative leaders create connections, trust, and shared meaning across organizations. By purposefully building networks they create results, mobilize knowledge, and navigate socio-political environments. In a discussion paper on boundary spanning, authors Horth and colleagues focus on how leaders can use traditional boundaries to develop coalitions to further organizational interests. They suggest that boundary spanning techniques include tearing down silos, and building partnerships and alliances in pursuit of a common goal.

Systems Transformation: Successful leaders demonstrate systems / critical thinking, encourage innovation, and orient themselves strategically towards the future. As a matter of course, they question the status quo, to identify issues, solve problems and implement effective processes across systems and with stakeholders. In order to orchestrate change, they engage others and create a climate of continuous improvement and creativity. They actively scan the environment for ideas, best practices, and emerging trends that will shape the system, actively contributing to change processes that improve health service delivery. Braithwaite and colleagues build a case for leaders needing to learn more about systems dynamics in healthcare and how to apply them in their work. To achieve this, they apply complexity and systems thinking practices to implementing health systems change. In doing so, they highlight the importance of the Systems Transformation domain as a guide to change practice. In addition, the framework enables physicians to lead by providing them with access to best practices of leadership, acting as an antidote to fragmented leadership practice, setting standards for development and accountability, and providing opportunities for efficient and effective system-wide leadership development and change.

As Graham Dickson notes, “leadership is the capacity to influence self and others to work together to achieve a constructive purpose.” Equipping future health professionals as leaders within their area of practice maximizes the potential to realize universal, efficient, and effective service delivery to the population.

The current COVID-19 pandemic situation has drastically changed our immediate approach to delivering healthcare. Through the lens of LEADS, how do health care providers utilize their leadership to respond to this global health crisis? Comment below to share your insights!


Did you know that the Harvard Macy Institute Community Blog has had more than 210 posts? Previous blog posts have explored topics including promoting collaboration and teamwork, growth mindset and medical education, and developing leaders through an international collaboration.

Billie Jane Hermosura

Billie Jane Hermosura PhD(c), PMP, RD is a dietitian and doctoral candidate at the University of Ottawa, Canada. Billie Jane’s areas of professional interest include health professions education and health workforce planning. Billie Jane can be followed on Twitter and/or LinkedIn.