Competency-based leadership: A critical imperative for Canadian health care

Canada is undergoing a profound leadership reckoning. The election of technocrat Mark Carney as Prime Minister marked not just a political shift, but a cultural reorientation toward competency, expertise and accountability. As populist rhetoric falters under the weight of complex realities – from climate instability to economic volatility – the public is increasingly demanding leaders who can do more than inspire; they must deliver results.

Nowhere is this demand more urgent than in our health-care system. With historic staffing shortages, rising wait times and escalating costs, the system is bursting at all seams. The question confronting Canada’s national and provincial medical associations is this: Will they follow the signal from the Canadian public and embrace a competency-based approach to leadership or risk irrelevance in a system that can no longer be guided by tradition alone?

Carney’s ascent to national leadership – a former Governor of both the Bank of Canada and the Bank of England – was not driven by populism or ideology. It was powered by his record of results, strategic vision and capacity to operate on a global stage. Voters responded not to slogans, but to substance. This turning point sends a clear message: the era of performative and representational leadership is waning. What matters now is competence.

In health care, this means that physician leaders, health executives and association presidents must possess not only medical or administrative credentials but also a demonstrable and credentialled skill sets in leadership, ethics, governance, finance, collaboration and systems thinking.

Canadian medical organizations have not been idle. The Canadian Medical Association (CMA) has long supported leadership development through its Physician Leadership Institute, emphasizing adaptability, equity and effective communication. The Canadian College of Health Leaders (CCHL) has developed the widely adopted LEADS in a Caring Environment Framework, which defines five core domains:

• Lead Self (self-awareness, integrity),
• Engage Others (team building, communication),
• Achieve Results (goal setting, outcome focus),
• Develop Coalitions (networking, cross-sectoral leadership),
• Systems Transformation (innovation and change leadership).

Similarly, the Public Service Commission of Canada and multiple provincial bodies – such as Ontario Health – have aligned their hiring and evaluation criteria to reward these competencies.

Yet in 2025, these frameworks must move from policy binders to practice. Leaders without these credentials (that is, organizations that nominate leaders following historical precedents) will fail now and in the future. We must look at professional governance credentials and experience as the gold standard by which future leaders are identified, trained and held accountable.

Competency-based leadership is not a theoretical ideal—it is a pragmatic solution to a system in crisis.

In Ontario, for example, new leadership within Ontario Health has prioritized data literacy, ethical governance and equity-focused reform. Post-pandemic recovery has depended on leaders who can coordinate multi-stakeholder initiatives, leverage analytics for triage and resource allocation and communicate transparently with the public and their constituents.

Similarly, in British Columbia and Nova Scotia, health reviews found that poor outcomes often stemmed not from a lack of funding but from a lack of leadership capacity – decision-makers without the skills to act decisively in complex, evolving environments.

These trends affirm what Harvard Business Review and Boston Consulting Group have found in global health-care systems: successful leaders consistently blend strategic clarity (“head”), emotional intelligence (“heart”) and effective execution (“hand”). This “generative leadership” model is particularly well-suited to Canada’s decentralized, multicultural and highly regulated health-care environment.

Skeptics argue that an overemphasis on competency models risks creating a class of “professional leaders” detached from frontline realities. They warn against standardizing leadership to the point of excluding diverse or grassroots voices.

These concerns are valid – and addressable. Competency does not mean homogeneity; it means intentionality. Associations must ensure their leadership pipelines reflect Canada’s diversity – geographically, culturally and professionally – while maintaining high standards for impact. Emotional intelligence, community credibility and moral courage are all competencies, too. In health-care leadership, we have historically promoted those that only come from academia or those that have worked on hospital boards because they know the sector well.

Another critique is that the real problem in health care is underfunding. But funding without capable leadership leads to inefficiency. Just as Carney’s economic leadership, as Bank of Canada governor, helped Canada emerge stronger from global downturns, only competent health-care leaders can ensure that future investments lead to meaningful outcomes.

In light of these realities, Canada’s national and provincial medical associations must all have a strategic mandate:

1. Reform Governance Structures to reflect competency-based evaluation and transparent succession planning.
2. Invest in Leadership Development for all levels – emerging physicians, executive staff and board members.
3. Incentivize Measurable Outcomes, aligning leadership appointments with performance and system impact.
4. Champion Public Trust by ensuring leaders represent both the system and the citizens it serves.

Associations must lead not just on clinical or advocacy fronts, but on the very question of what effective leadership looks like in 2025 and beyond.

Canada is in a moment that demands more – more wisdom, more rigor, more courage. Medical associations, like the government itself, are being asked not just to manage systems but to transform them. And that transformation begins with competent, credible and visionary leadership.