Liz Jones

In a time of transformation, health systems need a clearer definition of leadership.

But what, exactly, should that leadership look like?

By Jackie Basset, Principal, and Alexandra Bullock, Senior Consultant – Lotis Blue Consulting, SullivanCotter’s sister organization

The complexity of change in health care today, marked by workforce shortages—financial strain, growing demands for health equity, digitally-enabled care, and significant regulatory and policy shifts—is rapidly outpacing many organizations’ ability to respond. These challenges are not merely operational or strategic hurdles; they represent fundamental leadership issues that demand immediate attention and clear direction.

In this environment, health systems must elevate and equip leaders who can drive transformation while staying grounded in mission, culture, and strategy. But what, exactly, should that leadership look like?

Too often, organizations lack a consistent answer. Leadership expectations are implied rather than explicit. Development programs are well-intentioned but disconnected. Succession decisions default to tenure or reputation rather than readiness or fit. As a result, talent strategies remain fragmented and leaders are left without a clear picture of what’s expected of them.

Leadership competency models offer a better way forward. When thoughtfully designed and fully integrated, they define great leadership in the organization’s unique context. They align behavior with strategy, bring clarity to development, and strengthen accountability at every level.

Yet many health systems remain uncertain. Are competency models too abstract? Too HR-driven? Too time-intensive to be worth the investment?

This article aims to address those doubts. Drawing on research, we explore what leadership competency models are, why they matter, how they differ in health care compared to other industries, and how systems are using them today to shape the future of leadership—starting with a simple but powerful question.

If you asked ten of your leaders to define great leadership, would you get ten different answers?

This is the leadership alignment challenge that many health systems face. In a time when clarity, speed, and cultural consistency are paramount, organizations cannot afford ambiguity around what they expect from their leaders.

Competency models bring order to this ambiguity. At their core, they serve as a structured framework that defines the behaviors, skills, and mindsets required to lead effectively within a specific organization. They are not just a list of traits, nor are they generic templates pulled from other industries. When done right, they translate your health system’s vision and aspirations into concrete, observable leadership behaviors, that are required to execute your strategy and thrive in an increasingly challenging environment.

Contrary to common perception, these models are not only for HR. In fact, their greatest impact is felt when used by executives, mid-level leaders, and managers to guide real talent decisions, whether selecting the next CMO, designing a leadership development program, or conducting a performance conversation.

Nor are they static. The most effective models evolve alongside the organization’s priorities. Leading health systems revisit their models every three to five years, refining the language and focus to reflect changes in the environment and emerging expectations of leadership.

Competency models can be embedded in nearly every aspect of the talent lifecycle, from how leaders are hired and promoted, to how they’re developed, evaluated, and coached. And when embedded deeply, they serve as the connective tissue between leadership behavior and organizational performance.

What do top-performing health systems prioritize in their leadership models?

Our research across more than a dozen high-performing academic medical centers, integrated delivery networks, and regional health systems reveals a strong degree of alignment in the competencies they consider most critical.

Across these models, five themes consistently rise to the top:

1. Leading Change and Fostering Innovation
   As disruption becomes constant across care delivery, leaders must guide teams through change and create a culture of innovation. This includes navigating uncertainty, encouraging new ideas, and driving transformation proactively, not just reacting to it.
2. Strategic Thinking and Systemness
   Leaders need to think beyond their individual areas and make decisions that support the broader enterprise. Systemness means aligning actions with system-wide goals, balancing local and organizational needs, and integrating clinical, operational, and financial perspectives.
3. Collaboration and Relationship Building
   Strong relationships are foundational in health care. Leaders must foster trust and collaboration across teams, disciplines, and functions, ensuring that diverse voices are heard and aligned toward shared outcomes, both internally and with external partners.
4. Talent Development
   Great leaders don’t just deliver results, they grow others. This includes coaching, mentoring, and creating development opportunities that build individual and team capacity, while ensuring long-term leadership and workforce strength.
5. Personal Accountability and Mission Alignment
   Effective leaders model integrity, own their impact, and stay grounded in the organization’s mission. In health care, leadership is about stewardship—aligning personal behavior with the values, purpose, and priorities of the system.

These themes reflect not just what leaders need to do, but how they need to show up in a health care environment increasingly defined by complexity, integration, and human connection.

How leadership competencies have evolved over the years

Over the past five years, leadership competency models in major health systems have evolved significantly in response to the increasingly complex and rapidly shifting health care landscape. Key shifts include a move from a primary emphasis on clinical expertise toward strategic and systems thinking, recognizing that effective leadership now requires a broader, enterprise-wide perspective. Operational efficiency, while still critical, has given way to an expanded focus on innovation and digital transformation, as health systems strive to leverage technology for improved outcomes and patient experience. Additionally, traditional stakeholder management has evolved into collaboration and interdisciplinary leadership, reflecting the importance of fostering strong relationships across departments, disciplines, and external partnerships. Finally, with increasing workforce pressures, health systems have placed greater importance on resilience, stress management, and intentional talent development, ensuring a sustainable pipeline of capable, adaptive leaders equipped to navigate future challenges.

How health care leadership models differ from other industries

While many core leadership traits like communication, integrity, and results orientation are shared across sectors, health care leadership models reflect a distinct set of priorities rooted in the unique context of care delivery.

Mission-Driven Context: Health care leaders operate in a mission-driven environment where the stakes are higher and the definition of success is broader. Unlike corporate settings, where performance may be measured by growth or shareholder value alone, health systems must also consider patient outcomes, health equity, community impact, and cultural alignment.

Emphasis on Values-Based Leadership: Health care models place a stronger emphasis on values-based leadership. Competencies often include language around clinical collaboration, community accountability, and cultural humility—elements that are rarely emphasized in traditional corporate frameworks.

The Rising Importance of Emotional Intelligence: Another key distinction is the growing prioritization of emotional intelligence. While health care historically underinvested in leadership “soft skills,” that is changing rapidly. Today’s leaders must demonstrate empathy, manage complex interpersonal dynamics, and foster inclusive, psychologically safe environments, particularly in high-pressure, high-stakes settings.

Unified and Tiered Model Structures: Structurally, health care competency models tend to adopt unified system-wide frameworks with tiered behavioral expectations by leadership level, rather than developing role-specific competency maps. This approach promotes consistency across the organization while allowing for developmental nuance and progression.

Blending Science with Purpose: Ultimately, while health system models draw from behavioral science, they apply it through a lens of mission, ethics, and the lived realities of care. The result is a leadership approach that prioritizes not just what leaders achieve, but how they show up for their teams, their patients, and their communities.

How health systems are using competency models today

The best models are not theoretical, they are lived. They show up in the way leaders are selected, developed, and held accountable.

Across systems, we see models being used to guide 360-degree feedback processes, shape executive coaching conversations, and inform individual development plans that are grounded in real behaviors. Leadership programs are increasingly structured around key competencies, with curriculum aligned to the organization’s priorities.

Performance evaluations now often include both “what” and “how”, measuring results achieved as well as the way in which leaders lead. Succession planning efforts are also becoming more rigorous, with readiness assessed not only on experience, but on demonstrated alignment with core leadership expectations.

At one health system, the leadership model was used to elevate cultural humility as a core competency. That focus led to deeper integration of inclusive leadership practices into coaching engagements and succession decisions, resulting in a more diverse and values-aligned executive pipeline.

At another, competency models helped redefine how leadership success is measured, embedding both operational outcomes and culture-building behaviors into annual performance plans.

These examples underscore the point: competency models are not about checking a box. They are about operationalizing what leadership should look like in service of a broader mission.

Building a leadership competency model that works

Creating or updating a leadership competency model doesn’t require starting from scratch, but it does require intention and alignment. The most effective efforts begin by grounding the model in the system’s strategy, culture, and future direction, not by pulling in generic language from elsewhere.

The following success factors can help ensure your model is not only well-designed, but also adopted, applied, and sustained:

Anchor in Strategy and Culture: Creating or updating a leadership competency model should begin with a clear link to your organization’s mission, strategy, and culture. Rather than borrowing generic language, ensure the model reflects your unique values, priorities, and challenges. This grounding makes the model relevant and ensures it supports broader system goals, whether that’s improving patient outcomes, advancing equity, or navigating industry shifts. A well-aligned model becomes a strategic tool, not just an HR asset.

Engage Stakeholders Early: Involving a diverse set of leaders—clinical, operational, and administrative—early in the process is essential for buy-in and relevance. When stakeholders see their perspectives reflected in the model, they’re more likely to champion it. Cross-functional input also ensures the competencies reflect the lived realities of leadership in your health system, not just aspirational ideals. Engagement builds ownership and increases the model’s utility across roles.

Define Observable Behaviors: High-performing models go beyond abstract definitions to describe what each competency looks like in action. This means clearly articulating behaviors that signal proficiency at various levels. Observable indicators make expectations transparent and help leaders understand what “good” looks like. They also make the model easier to apply in development conversations, performance reviews, and coaching.

Pilot Before Broad Rollout: Before launching system-wide, test the model with a smaller group such as a specific leadership level or functional area. This pilot phase helps surface unclear language, missing behaviors, or unintended gaps. Gathering feedback allows you to refine the model and build early champions who can advocate for it during broader adoption. It’s a low-risk way to ensure the model is clear, relevant, and ready for scale.

Integrate Into Core Talent Processes: A competency model only gains traction when it’s embedded in the processes leaders already use like hiring, performance evaluations, development planning, and succession reviews. Embedding reinforces its relevance and creates consistency in how leadership is assessed and supported. It also enables leaders to use the model as a common language for expectations, growth, and accountability.

Keep It Dynamic: The best models evolve over time. As strategies shift and leadership challenges change, revisit the model every few years to ensure continued relevance. Treat it as a living tool to support leadership development, not a static document. Refreshing the model keeps it aligned to future needs and helps it remain a driver of learning, not just compliance.

Pro tip: Don’t try to do it all at once. Start by building and testing the model with one group such as executives or a specific leader segment before expanding it system-wide. Beginning with a focused cohort allows you to refine the model and create a strong foundation for broader adoption, ensuring clarity, cohesion, and long-term scalability.

The hidden cost of not having a model

Avoiding competency models due to concerns over rigidity or resource investment overlooks the significant costs of undefined leadership expectations: fragmented development, inconsistent promotions, reactive succession planning, and perpetuation of bias. Without clarity, organizations struggle to scale strategic execution, accountability, and cultural alignment.

In contrast, health systems leveraging clearly defined and integrated competency models are demonstrably better positioned to develop and retain top talent, drive cultural cohesion, and embed equity in leadership practices. Such systems cultivate leaders who lead purposefully, embodying mission-driven values at every level.

The case for defining leadership now

Defining leadership is not a luxury. It’s a strategic imperative.

As the workforce evolves, care models shift, and patient expectations rise, health systems need to be crystal clear about who they want leading the way forward and how they expect them to lead.

A strong competency model won’t solve every challenge. But it provides a powerful foundation for building the kind of leadership your system and your patients deserve.

If your health system is exploring how to define or evolve its leadership expectations, now is the time to invest in a model that reflects both where you are and where you’re going.

Editor’s note: A condensed version of this article first appeared in Chief Healthcare Executive. The full version is presented here.