Cady leads research to update national health leadership framework

Learn more about Professional and Continuing Studies, and about the Master of Arts in Leadership - Health Specialization program.

Almost 20 years ago, the LEADS in a Caring Environment framework was published by the Canadian College of Health Leaders, providing an outline for health care leadership across Canada that is sustained to this day.

Now with MITACS, Canada's innovation connector, providing grant funds, a Royal Roads University researcher is leading the latest update of the framework  as health care leaders in every province and territory face unprecedented challenges ranging from aging infrastructure, the expanding uses of AI, and financial constraints to overwhelmed emergency rooms and stressed staff.

Phil Cady, an RRU associate professor of leadership awarded the MITACS post-doctoral research fellow and a multi-year grant to study LEADS, is with Zoe MacLeod, the university’s associate vice-president, Professional and Continuing Studies on the project.

Commissioned by the Canadian College of Health Leaders, LEADS Global and the Canadian Health Leadership Network, the purpose of the research is to refresh the framework. —Cady says presents a common understanding of what good leadership looks like across all levels of service provision in health care, and is used by more than 80 per cent of Canadian health care jurisdictions,and includes the most current knowledge of leading practices worldwide.

Challenges of today’s health care leaders

“We’re looking at what are the contemporary issues leaders are facing and what leadership is required to address it,” says Cady, who’s a graduate of Royal Roads’ Master of Arts in Leadership and Doctor of Social Sciences programs.

“So much has changed since 2009,” he says, pointing to not only the COVID pandemic and funding challenges but, also, to studies such as In Plain Sight, which addressed widespread Indigenous-specific racism in the BC health care system.

The goal of the research, he says, is to ask health care leaders: “What are those challenges? What leadership is required to address them and do you feel that the framework is sufficient? If it's not, where does it need to change?”

The research will continue through next year but early evidence shows national or systemic challenges include: federal funding, lack of primary care physicians, artificial intelligence and politicization of health care. It also shows organizational issues around financial constraints, overwhelmed emergency rooms and psychological safety of staff. Further, with respect to psychosocial challenges, there are continued concerns regarding anti-racism, misinformation, stress and burnout, and political interference.

Leadership development is crucial

One area of leadership that deserves consideration, Cady says, is leadership development around topics such as:

• digital self-awareness, including knowledge of emerging technologies, AI ethics, and data-driven decision making;
• sustainable practices, to ensure the long-term viability of healthcare systems and resources;
• advocacy around issues such as equity, anti-racism, misinformation, disinformation, and staff wellness;
• a culture of belonging that recognizes and values diverse identities, perspectives and lived experiences; and
• resilience and adaptability to support staff in high-stress, uncertain situations.

Talking to leaders, finding focus

To gather information, Cady and associates are working on an extensive scoping literature review around the topic of health leadership, whittling down a list of 9,700 articles. They’re holding focus groups and conducting semi-structured interviews with key informants in health care.

There’s also a working group of 10 people from health organizations that use the LEADS framework as well as academics from other Canadian universities, and a number of volunteer researchers, including past Royal Roads students and four doctoral students, including two from RRU.

“It's an intense, massive process,” Cady says. “It's heartwarming. I feel buoyed by the good support out there and the fact that people want to do something about these things. These aren't just complaints. People say, we need to lead differently.”

At the end, he will be making recommendations to the steering group, likely in May 2026, and that group will decide whether to accept those recommendations.

“It's a national framework and changes have implications,” he explains.

“The strength of the framework is that it holds a unifying way to have conversations about leadership. It's a vocabulary.”

Health leadership research is “an important step forward”

“Today’s environment calls for leadership that is adaptive, relational and grounded in equity and this work is an important step toward meeting that need,” says Zoe MacLeod, RRU’s associate vice-president, Professional and Continuing Studies.

“Being involved in the creation of the original LEADS framework, I’ve seen first-hand how it has shaped leadership conversations and capabilities across Canada. It is a privilege to support this next stage of research as the framework is revisited and revitalized,” she adds.

“I’m deeply grateful to Dr. Cady and the entire research team, who are working tirelessly and collaboratively to ensure this renewal reflects the voices and realities of leaders across the health system.”

Learn more about Professional and Continuing Studies, and about the Master of Arts in Leadership - Health Specialization program.

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