One of the biggest virtues of the New South Wales Leadership Framework is it’s conceptualisation of the practice of leadership in the health sector: from self to system. The framework ultimately encompasses theories, concepts and ideas about leadership that begin at the micro level (e.g., understanding self and one’s values, beliefs, aspirations, strengths and limitations), and ends up at exploring the strategic leadership needed to create large, national health reform (Dickson, Tholl, et al 2014). What is intended is to see leadership as a lifelong career journey, with the leader’s role and perspective always grounded in self while at the same time influenced by, and influencing, the larger health world around her (Dickson & Tholl, 2014).


Margaret Tannis Comack (2012) captures the essence of this theme in her article, A Journey of Leadership From Bedside Nurse to Chief Executive Officer in which she articulates her own personal journey of leadership through the lens of the Canadian LEADS framework, which is very similar in content and orientation to the New South Wales leadership framework. Much of what she talks about emphasises an organic systems approach to leadership; i.e., whereby leadership is always about creating generative change either in self, work units, organisations, or health systems. Tam Lundy, in her monograph entitled Generative Change: A Practical Primer (2014) provides a clearly written, well-articulated overview of generative change, starting with self (neuroplasticity of our brains and or ability to change ourselves: the Leading and Developing Self-domain of the NSW LF) She states that “Generative change is the best fit when….Our aim is to foster health, well-being & healthy development, now and for future generations.”  This is the goal of health and wellness, whether we pursue it at the individual level (i.e., for patients) or at a system level (for nations) (p. 13).


Other publications echo the role of leadership in generative change. In an article by Leo, Senior and Butler (2012) they profile the advances in neuro-scientific research, “providing concrete examples of the various processes that may impact on our leadership-relevant actions” (p. 216). The focus is on how leadership and cognitive neuroscience interact, validating specific behaviours consistent with effective self-leadership and employee engagement in an organisational context. Tonkin (2013) explores the differences between authentic leadership and transformational leadership, and their impact on overall job satisfaction of employees, arguing that authentic leadership constructs are a stronger predictor of employee engagement and implies suggestions for practical interventions. Both articles explore the Leading and developing self, and Engages people and builds relationships domain of the NSW framework. A white paper from the American College of Physician Executives extends this focus to the physician community, outlining from the ACPE’s perspective, the value of engaging physicians as leaders, for organisational performance (Angood, 2014).


In terms of the role of outcomes in generative change, captured by the Achieving Results of the HETI framework, it is worthwhile to mention the white paper by Leavitt Partners in the USA entitled The Accountable Care Paradigm: More than Just Managed Care 2.0. (Muhlestein, Croshaw, Merrill, Pena, and James, 2014). A key element of health reform in the USA, an ACO emphasises the intent to hold hospitals and engaged partners (e.g., providers in a geographic area) accountable for financial risk for the measured health of a population, and to align financial and professional incentives to encourage the product of high quality outcomes for that population. Of great interest here are the agreed upon measures for which ACOs will be accountable (RTI International, 2014).


Generative change in the form of health organisation and system change, and the difficulties of ‘Transforming the system’ are captured in two Canadian publications. The first is Chronic Condition: Why Canada’s Health-Care System Needs to be Dragged into the 21st Centuryby Jeffrey Simpson (2014) Mr. Simpson is a journalist who came to the conclusion that despite the fact that health care cannot continue as it is, it is so politically charged (as he states: Medicare is the third rail of Canadian politics. Touch it and you die) that solutions to change the system are beyond rational public debate (2014). Harvey Lazar and his team (2014) in their book Paradigm freeze: Why it is so hard to reform health-care policy in Canada, came to a similar conclusion; however, they also emphasised the inability of professional provider groups and different health organisations to ‘partner and collaborate across boundaries’ (a final NSW leadership framework domain), claiming that politics and self-interest are confounding efforts to make the Canadian system a true ‘system’ in that generative sense.


I think you will find all of these publications fascinating. They profile the inherent complexity of leadership, and the need to constantly work on aspects of self and system for generative change to occur. They touch base with all five domains of the NSW Leadership Framework. Good luck with your efforts!



Angood, P. (2014). The Value of Physician Leadership. ACPE White Paper. Tampa FL: American College of Physician Executives.

Comack, M. T., (2012). A Journey of Leadership From Bedside Nurse to Chief Executive Officer. Nursing Administrative Quarterly, 36(1), 29–34.

Dickson, G., Tholl, B. (Principal Investigators) and Baker, G.R., Blais, R., Clavel, N., Gorley, C., Grimes, K., LeBlanc, D., Lindstrom, R., Marchildon, G., Mills, S., Philippon, D., Power, C., & Solberg, S. (2014, July). Leadership in Health Systems Design Research Project: Partnerships in Health System Improvement Cross-Case Analysis Final

Dickson, G. & Tholl, B. (2014). Bringing Leadership to Life in Health: The LEADS in a Caring

Environment Framework. London, UK: Springer.

Lazar, H., Lavis, J., Forest, P-G., Church, J. (2014). Paradigm freeze: Why it is so hard to reform health-care policy in Canada. Montreal and Kingston: McGill-Queen’s University Press.

Leo, N., Senior, C. & Butler, M. (2012). Leadership research and cognitive neuroscience: The state of this union. The Leadership Quarterly. 23, 213–218.

Lundy, T. (2014). Generative change: A practical primer. Albany, CA: Communities that Can! Institute.

Muhlestein, D., Croshaw, A., Merrill, T., Pena, C., and James, B. (2014). The Accountable Care Paradigm: More than Just Managed Care 2.0. Centre for Accountable Care Intelligence: Leavitt Partners. Available @

RTI International & Pelligren (2014). Accountable Care Organization 2014 Program Analysis Quality Performance Standards Narrative Measure Specifications. Centers for Medicare & Medicaid Services: Baltimore.

Simpson, J. (2012). Chronic condition: Why Canada’s health-care system needs to be dragged into the 21st century. Penguin: Toronto.

Tonkin, T. (2013). Authentic versus transformational leadership: Assessing their effectiveness on organisational citizenship behaviour of followers. International Journal of Business and Public Administration, 10(1), 40-61.