A Message from the Guest Editor

One morning in late February, I had the news on in the background as I was getting ready for my day and thinking about the 3 hours I was going to spend with a group of leaders from a variety of industries and sectors talking about leadership. I was only half listening to the latest economic forecasts, political disagreements, and the cold wet weather forecast, when I heard a 13-year-old student begin to recount his experience at the school in Tumbler Ridge on February 10. I listened as this young man calmly and clearly described how a teacher got him and other students out of the hallway and into a small closet where they would remain for over 2 hours as the violent mayhem unfolded around them. When the reporter asked him what the teacher did while they were confined together, he said “he told us jokes and made us laugh.” Tears welled up in my eyes as he went on to describe how calm, kind and positive this teacher was as they stayed huddled together hoping their lives would be spared. What incredible leadership that teacher showed in a situation few of us can fathom. Leadership is everyone’s business. We are all called upon at different times and in different places to lead regardless of our formal titles or positions, education or experience. The question is, are we ready to lead when those moments find us.

The Canadian healthcare system is uniquely complex, deeply interdependent, and under constant pressure from demographic, economic, political, environmental, and workforce realities. We need leaders who can navigate these pressures and seize opportunities to ensure safe quality compassionate care. Effective leaders understand not only clinical operations but also the broader policy landscape, funding realities, and regulatory requirements. They must make decisions that balance fiscal constraints with ethical obligations to the people they supervise and the people they serve. And while we look for novel ways to leverage generative Artificial Intelligence (AI) and other emerging technologies to augment and, in some cases, replace human effort, we need leaders with strong moral compasses, excellent emotional intelligence, and the ability to build trusting relationships.

As experienced leaders retire, Canada faces a widening leadership gap across the healthcare system. The question is, are we preparing those around us to lead as these roles become available. New leaders often step into positions without adequate mentorship or training, inheriting responsibility for complex teams and vulnerable populations without the foundation required to succeed. Leadership preparation in healthcare is the theme of this edition and it is an honour and a pleasure to be the guest editor.

Investing in leadership development ensures continuity, stability, and a pipeline of capable leaders who can steward the system into the future. I believe preparing leaders is not optional; it is foundational to delivering safe, high-quality, relational, and person-centred care. When leaders are well prepared, they are more effective in supporting their teams, which in turn leads to better care for the people they serve.

Since my retirement from Nova Scotia Health in September 2023, I have continued to teach part-time at Mount Saint Vincent University, preparing many of our students for future careers in health and human services roles. I have also been developing and delivering continuing education programs focused on leadership, communication, and performance management. A consistent theme I hear from new and experienced leaders is that when they took that first leadership role, they felt they had been “thrown into the deep end of the pool.” Too many of us have had this experience. It doesn’t have to be this way.

In this edition, you will read about innovative approaches to preparing the next generation of health leaders. It is interesting that we didn’t receive enough articles on this theme to fill this edition. I hope what you read will spark some ideas and a discussion in your organization about how you prepare leaders to ensure their and your success.

In the first article, Smith and I detail the Ready to Lead microcredentials program launched in 2024 at Mount Saint Vincent University. This novel program provides continuing care assistants and licensed practical nurses working in continuing care with the opportunity to enhance their leadership skills and to help them prepare to progress their careers into formal leadership roles. Our goal is twofold—to increase leadership at the frontline and to prepare a new cadre of future health leaders. We lift the lid on the knowledge, attitudes, and skills effective leaders possess and ground participants in these through six modules and 90 hours of competency-based continuing education. In doing so, participants have articulated a new appreciation of the complexities of leadership, success in utilizing new skills and approaches in their current roles, and a realistic development plan to shape their ongoing leadership journey.

While nurses are expected to provide leadership at all levels from the point of care to the boardroom, Wolff identifies a lack of leadership development opportunities and a fragmented and variable approach to leadership preparation in nursing education which may mean nurses are not sufficiently equipped to meet the challenges current health leaders face. In an imaginative reconceptualization, Wolff proposes a new learning framework for both undergraduate and graduate nursing students grounded in four essential competences—leading self, building inclusive teams, creating healthy work environments, and demonstrating systems/critical thinking; she challenges us to rethink traditional theoretical and pedagogical approaches.

Young and her co-author issue a compelling call to mentor and develop emerging leaders by getting back to the basics through focusing on the four pillars of authentic leadership—self-awareness, trust, relational connectedness, and a focus on purpose. They argue that the healthcare ecosystem is an incredibly complex one in which future leaders must not only focus on improving clinical practice and patient outcomes, ensuring psychologically and physically safe workplaces, but also making ethically sound decisions about increasingly sophisticated generative AI technology, and being responsible stewards of financial, social, and environmental resources.

One of the most important responsibilities leaders have relates to the success and well-being of their team members. Corrente and co-authors present qualitative findings from a recent study examining promising practices to prevent, address, and recover from healthcare worker burnout. As more research emerges showing direct links between healthcare worker burnout and adverse patient outcomes, this toolkit provides a salient path forward with interventions that work at the individual, team, organization, and system levels.

In their thought-provoking article, Martin and colleagues challenge us to leverage the power of generative AI technology to predict, prevent, and address healthcare worker burnout. They argue persuasively that while burnout is a complex multi-factorial issue, we have strong evidence about these causal factors and we have rich and varied data sources to better understand them. They envision a system similar to one now in use in a Toronto emergency department that is used to identify patients whose conditions are deteriorating. Used responsibly and ethically, such a system could be used to identify, predict, and resolve the structural drivers of burnout—“fixing the work, not the workers” providing healthcare leaders with powerful new tools to support workforce well-being.

Verderber and co-author introduce us to another opportunity for health leaders to leverage emerging generative AI technology, in this case for the planning and design of the built environment. In a fascinating discussion, they lead us through the integration of generative AI technology in healthcare facility planning through three interrelated leadership responsibilities—oversight, accountability, and stewardship overtime. Laying bare, the possibilities and risks, they argue that we must explore this new terrain not simply as a neutral assistant tool but rather one with its own biases, limitations, and potential harms that will require extensive-intensive human oversight and control.

Leading transformational change is also a fundamental responsibility and critical skill set of health leaders. Following new legislation in 2021 in Ontario that enhanced the regulation of personal care workers which included voluntary registration, Akerele and co-authors explain how one large community hospital required all PSWs they employed to achieve their registration under the new legislation. Using the ADKAR model, they were able to support 98% of the PSWs to complete their registration with 97.5% of them reporting improvements in their communication and clinical skills.

Morrison offers us important insights into why the implementation of policies and strategies, responsibilities which largely fall to middle managers, does not always unfold as planned nor are intended changes always affected. These middle managers are at the intersection of strategic intentions, sociotechnical systems, and ever-changing routines and practices. Drawing on the Strategy as Practice field, the author seeks to find answers to how middle managers can improve policy and strategy implementation efforts and proposes four interrelated recommendations. These recommendations challenge middle managers to continue to develop their leadership skills related to critical thinking, evaluation, systems thinking, and structured reflection. These reflections remind us again how an evidence-based approach with strong leadership, clear communication, and a focus on trusting relationships can achieve great results.

In our next article, O’Grady and co-authors share the results of a rapid review of the academic literature and organizational reports to help the Niagara Ontario Health Team understand how health system capacity has been defined and framed. Interestingly, they found only three definitions and the most frequently cited framework was the 6-element World Health Organization Health Systems Framework. They identified an additional 11 elements not contained in this framework and an absence of equity in any of the frameworks examined. Their findings highlight the lack of a common understanding of health system capacity which compounds the vexing task of health system planning for health leaders.

The remaining articles in this edition focus on patient care. Okoh and co-authors tackle the persistent challenge of relational discontinuity and informational continuity, impacting transitions from community and hospital-based care to long-term care in rural Ontario. Faced with incomplete, inaccurate, or outdated information, this article provides insight into the various strategies receiving long-term care providers take to try to obtain the information they need to provide patient-centred care and smooth the move into their facility. Intriguingly they identify five factors that may influence their choice and implementation of these strategies. Their recommendations are a clarion call for better preparation in and focus on the importance of complete and accurate patient information and the need to share that information, the interconnectedness and interdependence of the care continuum, and the need for more investment and new roles in long-term care to facilitate these transitions.

Mulla and co-authors examine how resident and organizational factors influence antipsychotic use in long-term care in Canada with special attention given to age and gender disparities. Their retrospective longitudinal analysis of residents aged 65 and older without psychosis shines a light on the need for gender-responsive resident-level interventions as well as facility-level actions.

Augustyniak and co-authors conducted what may be the only Canadian study investigating the feasibility, readiness, and potential implications of using multiplex point-of-care tests for infectious diseases in hospital. Through their analysis of interviews conducted with healthcare providers in Quebec, Ontario, and British Columbia, they identified four major themes related to considerations health leaders must take into account and offer three recommendations to facilitate the effective use of this technology.

The last article focuses on how the healthcare experiences of trauma patients were improved through a novel Trauma Consult Service at the Queen Elizabeth II Health Sciences Centre in Nova Scotia. Adapting similar approaches taken by other speciality services, the team ensured trauma-trained clinicians remained attached to major trauma patients throughout their hospitalization. Green and team implemented real-time satisfaction surveys, gathering overwhelmingly positive evaluations from patients, family members, nurses, and physicians related to three themes—optimized system, skilled team, and patient-centred care.

And finally, my sincere gratitude to Dr. Christy Simpson for her insightful and thoughtful reflections on ethical leadership that beautifully weaves together the various threads of this edition. Why indeed would anyone choose to lead given the complexities, the pitfalls, the sacrifices, the never-ending challenges, and the risks involved in health leadership. Yet day in and day out thousands of leaders do just that and they do it well. Preparing future leaders for the possible moral injuries they may sustain and ensuring they have the supports they need to weather and grow from these experiences is aspirational. Leaders can and do make a difference but they cannot do it alone. We all benefit from effective leaders. Let’s all do what we can to ensure they are set up for success.