Rapidly changing environment calls for new approaches to leadership

Editor’s note: One in a series of monthly columns examining leadership in health care from CHLNet, representing more than 40 health organizations.

This month’s Top Three focuses on the issue of senior and executive leadership. It follows up on the previous month’s discussion of organizational structure and how much of health-service delivery in Canada is provided through large quasi-bureaucracies that demand effective strategic leadership to function effectively.

Most of us believe that the strategic leadership function is fulfilled by those who are part of the senior leadership team: CEOs, vice-presidents, board directors and those in their inner circle. In large quasi-bureaucracies, these expectations are based upon a hierarchical organizational design, with a traditional leadership paradigm of organization governance connected to heroic and single-actor leadership perspectives. However, today’s very fluid and rapidly evolving external environment for health-care organizations may well call into question the long-term viability of the “traditional” approach, suggesting new ways of conceptualizing how strategic leadership can be operationalized.

Regardless of the model used, the critical success factor is ensuring that senior leaders utilize strategic interventions effectively to meet the needs of patients, families, communities and citizens.

This month’s Top Three explores this critical success factor.

The three references contribute to this discourse in the following ways. The first two explore the operationalization of strategic leadership from a structural and organizational perspective. The third article shows how appropriate strategic action – in a large health-care organization – can be implemented to address emergent modern health care issues.

  1. A chapter in book one explores the notion of moving towards a more distributed, shared way of exercising the strategic leadership function in such organizations.
  2. Article 2 outlines how strategic leadership – as practiced by the CEO and the senior leadership team – need to focus on building an executive team with a set of special skills to be successful in positioning one’s organization effectively in today’s rapidly changing environment.
  3. Article 3 articulates a “systems” strategic leadership approach. It profiles the efforts of a single case; Vanderbilt University Medical Center and its efforts to embed strategies to mitigate health inequities in its COVID-19 command centre.

Article 1: The strategic leadership role in organizations. Strategic Leadership.

Summary: This book chapter is not specific to health care but provides insights into how there is pressure – as our Leading Through COVID Action Research study shows – for strategic leaders to challenge traditional organizational structures and processes to ensure health-care delivery meets the needs of patients, families and communities.

The author argues that as the global marketplace becomes more complex with continually changing demands and expectations, new mental models may be needed to understand the changing nature of organizations and effective strategic leadership.

The traditional perspective identifies those at the top as the strategic leaders. Another viewpoint is to see strategic leadership as a shared function, extending the responsibility for strategic leadership throughout the organization and distributing the leadership role among integrated networks of leaders. This chapter focuses on the hierarchical perspective of strategic leadership as well as shared strategic leadership.

Article 2: Reinventing your leadership team. Harvard Business Review.

Summary: This article brings another perspective – drawn again from the business community as opposed to health care – relative to the exercise of strategic leadership emanating from the executive office.

Drawing on their research at 12 prominent global firms, the authors note the seemingly contradictory skills that strategic leaders are expected to have – both great visionaries and expert executors, for example. They argue the rise of digitization is necessary for many businesses’ continued success, but in an increasingly complex world, what companies really need to do is build new forms of competitive advantage and transform themselves for the future.  And that requires fundamental changes in their top leaders – not just in individuals’ capabilities but in the way they collectively steer the ship.

The authors focus on the urgent imperative to improve leadership teams. They suggest that CEOs should:

  • Identify the roles that are needed at the top to reimagine and deliver on the company’s purpose;
  • Fill those roles thoughtfully, assembling a diverse group of people who think boldly and work together harmoniously;
  • Focus the team on driving transformation rather than managing the current business;
  • Take ownership of the team’s behaviour, fostering trust, collaboration and a commitment to leading the company forward rather than dwelling on personal advancement

Article 3: A systems approach to addressing COVID-19 health inequities. NEJM Catalyst Innovations in Care Delivery.

Summary: Health system leaders cannot allow other priorities to interfere with a commitment to address health inequities. Racial and ethnic minorities are dying from COVID-19 at alarmingly high rates, demanding immediate action.

Vanderbilt University Medical Center (VUMC) has embedded strategies to mitigate health inequities in its COVID-19 Command Center. A key strategy is the creation of interactive dashboards that are reviewed daily and allow disaggregation by race, ethnicity, language and postal code. Of the first 45,954 patients tested for SARS-CoV-2 at VUMC, 2,310 had limited English proficiency (LEP). The positivity rate for patients with LEP was 26 per cent compared with 6 per cent for patients with English as a primary language.

In addition to alerting local and state health departments of these higher rates, VUMC strategists created multilingual resources, assessed interpreter services capacity and engaged trusted community organizations. Early lessons learned at VUMC may help others implement a systems approach and immediately begin addressing pandemic health equity.

Link to LEADS: The LEADS framework guides leadership action within organizations. In traditional organizational structures, the Lead Self (L), Engage Others (E) and Achieve Results (A) domains shape much of what concerns front-line and mid-level leaders, with the Develop Coalitions (D) and Systems Transformation (S) domains in the background, operationalized as needed. Senior leaders – CEOs and executive teams charged with the primary responsibility for strategic leadership – must embrace the L, E and A but also spend time in the D and S domains.

As strategic leadership is shared more broadly throughout the organization, leaders at all levels may be required to master all domains on a more regular basis. As the examples in the Top Three show, regardless of the approach strategic leadership embraces the use of all domains of LEADS, requiring self-leadership, team and organizational leadership and systems leadership.

CHLNet is a social enterprise of 40+ organizations called “network partners” who gather around health leadership. Part of its mandate is to share emerging leadership practices for 21s century care. Visit to learn more.

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Graham Dickson


Graham Dickson (PhD) is a professor emeritus of leadership studies at Royal Roads University; a principal in LEADS Global; and the Research Advisor to the Canadian Health Leadership Network, a role that stimulates sharing of articles relative to the practices of modern health leadership in Canada and abroad.

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