FEATURE ARTICLE

Engaging the next generation of health leaders:Perspectives of emerging health leadersJennifer C. Hunt, MA, MHA, CHE; Emily Gruenwoldt, BAH, MHA; Adrienne Hagen Lyster, BComm, MPA

Abstract—Identifying and engaging the next generation of Emerging Health Leaders (EHLs) is a foremost challenge for theCanadian healthcare system. If intellectual capital is the currency of the 21st century, identifying and developing EHLs must be astrategic objective of innovative and progressive health organizations. We have integrated our experiential knowledge with somerelevant findings from the literature and data collected from a cohort of EHLs to assist senior leaders and organizations with thischallenge.

Identifying and engaging the next generation of Emerg-ing Health Leaders (EHLs) is a foremost challenge withinthe context of the current Canadian healthcare system.

The majority of senior leaders today are of the baby boomgeneration, many of whom are approaching retirement.Replacing their knowledge, experience, and expertise willrequire strategic conversations on talent management toensure the next generation of leaders has been identifiedand is prepared to assume the healthcare leadership helmand the challenges they will face. This will involve invest-ments of both time and money.Given our own professional experiences as EHLs and

having engaged in informal qualitative research regard-ing career barriers and enablers, we have our finger onthe pulse of EHLs’ preferred talent management strate-gies. We have incorporated our experiential knowledgewith some of the relevant findings from the literature aswell as data collected from a cohort of EHLs to ensurethat current and future leaders are prepared to providethe best healthcare system to the Canadian public.

PERSPECTIVES OF THE NEXT GENERATION OFEHLS

A brief survey was distributed to members of EHLs acrossthe country to learn what they felt were effective organi-zational strategies to identify and develop leaders. (Foradditional information on EHLs, please visit www.emerginghealthleaders.ca.) The survey was comprised of four

From The Ottawa Hospital, Ottawa, Ontario, Canada (Ms Hunt); Emerg-ing Health Leaders, Ottawa, Ontario, Canada (Ms Gruenwoldt); and PrimaryHealth Services Branch, Saskatchewan Health, Regina, Saskatchewan, Can-ada (Ms Lyster).

Correspondence: Jennifer Hunt, MA, MHA, CHE, The Ottawa Hospital, De-partment of Mental Health, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada

(e-mail: jhunt@toh.on.ca).Healthcare Management Forum 2011 24:4–80840-4704/$ - see front matter© 2011 Canadian College of Health Leaders. Published by Elsevier Inc. Allrights reserved.

doi:10.1016/j.hcmf.2010.12.001

questions (please see the Appendix for survey ques-tions); we performed a thematic content analysis of theirresponses.

THE CHALLENGE OF IDENTIFYING EHLS

Despite a steadily increasing demand for health systemleaders, a leadership gap has emerged. As a result, healthorganizations are scrambling to establish complex talentmanagement systems to help fill this void and to retaintheir EHLs. Far from being a “soft” initiative, talent man-agement is the engine that drives success in today’shealthcare environment.1 Jim Collins, author of “Good toGreat,” suggests that people are not your most importantasset, the right people are.2

Post-secondary institutions and private industry haverightly identified the demand for executive leadershiptraining as a multisector priority. If intellectual capital is thecurrency of the 21st century, identifying clinical and non-clinical EHLs must be a strategic objective of innovativeand progressive health organizations. But who are theseEHLs, and how are they most effectively prepared for se-nior leadership positions?When members were asked to identify the most effec-

tive ways for organizations to identify EHLs, they reflectedon the importance of considering both the intrinsic qual-ities and extrinsic behaviours that young leaders may pos-sess. Key characteristics that identify emerging leaders ac-cording to our survey data include valuing lifelonglearning, having strategic vision and innovative ideas, andpossessing strong communication skills. Extrinsic behav-iours of emerging leaders include pursuing graduate edu-cation, involvement in professional development activitiesand associations, and a willingness to take on increasedresponsibility and risk.In the past, EHLs were identified largely based on

qualitative measures. Literature from as recent as 10years ago would identify a “keeper” as “an employee anorganization would fight to keep.”3 Identifying EHLs, andtalent management more broadly, is now a rigorous and

quantitative science that begins with organizations

ENGAGING THE NEXT GENERATION OF HEALTH SYSTEM LEADERS: PERSPECTIVES OF EMERGING HEALTH LEADERS

engaging in a reflective exercise to identify the values,skills, and competencies that will enable them to realizetheir strategic priorities. Once these criteria are estab-lished, best practice would suggest that organizationsengage in a cyclical (ie, annual) nomination or volunteerprocess to identify EHLs, facilitated by a rigorous perfor-mance review process. In larger organizations, securingbroad engagement in the selection of candidates resultsin a stronger talent pool overall. A talent managementcommittee comprised of the CEO (or senior manage-ment representatives), midlevel managers, human re-sources representatives, and patient group or frontlinerepresentatives (if appropriate) is ideally situated to re-view applications/nominations against objective organi-zational criteria.EHLs are recognized as a small group of individuals

who embody the core competencies and values of theorganization, have shown superior accomplishments,and have inspired others to attain superior accomplish-ments in line with organizational priorities (Berger andBerger).4

This best practice approach for the identification of EHLsclosely aligns with survey data of members of EHLs. Re-spondents to the EHL survey suggested using the follow-ing formal and informal identification mechanisms:

1. Establish a framework for regular performance reviewsinvolving goal setting and feedback. This allows man-agement to monitor performance and to identify indi-viduals with high leadership potential;

2. Create a database to document the breadth anddepth of EHLs skills as they relate to organizationalpriorities; and

3. Use informal tactics such as recommendations andfeedback from colleagues.

The literature and survey data show that it is cruciallyimportant that EHLs are engaged in discussions regardingtheir identification as high potentials as well as in deter-mining the appropriate next steps in their development,which will be further discussed. There should be no stigmaattached to an emerging leader who, for any reason, de-clines to enter the accelerated development track for highpotentials.

DEVELOPING EMERGING HEALTH LEADERS: THEACE MODEL

Two of the four survey questions asked respondents toindicate how senior leaders and their organizations canretain EHLs and, more specifically, what steps their ownorganizations could take to develop these individuals forcurrent or future leadership opportunities. The responsesrevealed that organizational strategies should addressthree key areas, which we have termed the ACE Model:

Achievement, Continuing education, and Engagement. A

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third question was posed to learn about “current myths”(Table 1 outlines the details below).

Achievement

A common characteristic among EHLs is their strong ori-entation toward achievement. EHLs take pride in theirwork and appreciate the opportunity to disseminate theresults to others. The chance to translate knowledge ortheory into practice appeals to them, particularly whenstrategic analysis or consideration for environmental con-text is required. Stretch goals, those “that cannot beachieved by incremental or small improvements but re-quire extending oneself to the limit to be actualized,”5 aretherefore an important strategy to use with this group.6

Equally significant, EHLs need and want to be held respon-sible and accountable for their work. If organizations reg-ularly delegate authority or accountability to others, EHLsmay feel undervalued and/or frustrated, leading them toseek out external opportunities.Providing recognition is another strategy that will

assist in contributing to a sense of achievement. EHLs,typical of Generations X, Y, and the Millenials, valueinformal and formal acknowledgment of their accom-plishments. Withholding recognition until such time asan annual performance appraisal is a critical mistake;

Table 1. Five myths about EHLs

1. EHLs are not loyal to their organization. EHLs are incrediblyloyal, provided employers find ways to recognize them fortheir achievements and, furthermore, offer opportunities forcontinuing education. EHLs want to engage and be engagedto make a difference.

2. EHLs do not put in the hours. EHLs work just as hard as babyboomers; they may just work differently. Rather thanworking rigid 9 to 5 hours, EHLs value the opportunity towork in a flexible environment. Loosen the reins ontraditional policy and watch your EHLs thrive working athome or working non-traditional hours.

3. EHLs think they know it all. Quite the opposite! EHLs arelooking for opportunities to be mentored and coached bysenior leaders, within their organization or beyond. EHLsvalue hearing about the experience you have had, eventhough they may find alternate paths to achieve the samesuccess.

4. EHLs want more money. EHLs value recognition for theiraccomplishments. Financial incentives are motivating forsome EHLs but not all. Many would place value in flexiblework hours, opportunities for continuing education, orverbal recognition privately or before their peers.

5. EHLs are not interested in leadership positions because theyare too focused on work-life balance. Work-life balance isimportant to EHLs but so too is career satisfaction. Findingcreative solutions for EHLs to have both career achievementand family opportunities will increase their organizationalloyalty.

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Hunt, Gruenwoldt, and Lyster

instead, provide them with timely and specific recogni-tion for their accomplishments.Career advancement is perhaps the ultimate achieve-

ment for EHLs. Survey respondents indicated that theywould like their organizations to clearly identify the skillsand abilities that are required and valued in order toadvance. A tool such as the Canadian Health LeadershipNetwork’s “LEADS in a Caring Environment” frameworkprovides individuals and organizations with a shared un-derstanding of the key competencies and skills to lead intoday’s healthcare sector.7

Within the context of career advancement, it is impor-tant to understand that “skating,” which is when indi-viduals transition between positions every 2 to 3 years,can be a win-win for both the organization and EHLswhen the transitions are intraorganizational. In contrast,interorganizational skating has often been viewed as asign of employee disloyalty; however, this may be moreaccurately reflecting the reality that internal advance-ment opportunities are not available, are unknown, orare not provided to EHLs. These leaders understand theimportance of obtaining progressive career experience;organizations should be encouraged to provide suchopportunities and to ensure that EHLs are aware of thepossibilities for their future career growth eitherthrough the development of individualized career plansor through regular performance and goal reviews. Keep-ing EHLs apprised of advancement opportunities in theirorganization and those that are expected to be availablein the future are an important development and reten-tion tactic.

Continuing education

EHLs actively seek out professional development oppor-tunities. Providing support so that these leaders canattend workshops, seminars, or conferences is an excel-lent strategy to provide formal education while simulta-neously expanding their professional networks. Seniorleaders and their organizations may wish to examinetheir current level of professional development invest-ments for EHLs. If there is room for improvement, con-sult with your EHLs to learn about their professionaldevelopment priorities. To reach the next level, em-power EHLs to put into practice the theory they havelearned; this further enhances their skill set and demon-strates to them that their senior leaders want them tocontribute their knowledge and abilities. Organizationswho invest in continuing education are making an in-vestment into their future and an investment in theiremployees, which will result in strengthened commit-ment and loyalty in an era of competition for scarcetalent.Continuing education need not be formal. EHL survey

respondents indicated that organizations may wish to

consider establishing a corporate infrastructure for com-

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mittees, working groups, and special projects, whichoffers EHLs the opportunity to participate and contrib-ute as an equal player. Intraorganizational or externalsecondments, internships, or residencies are also effec-tive strategies as are formal or informal mentorshipprograms. Such programs are seen as key tools withwhich to provide EHLs with invaluable opportunities tolearn from senior leaders and to develop skills that arevalued by their organizations.

Engagement

An important component to retaining and developingEHLs is providing them with opportunities to engage withsenior leaders within their organizations. An adapted ver-sion of the ladder of engagement framework depicts eightlevels of engagement that EHLs may experience (Table 2).The higher the “rung,” the greater the degree of responsi-bility, accountability, and visibility and, therefore, thehigher the level of engagement.A multipronged approach that facilitates relationship

building and provides increased visibility of senior leaderscan foster a strong sense of engagement. It is important tonote that organizations do not necessarily need to makesignificant financial investments in order to create engage-ment among EHLs. Formal mentorship programs are anexcellent vehicle to engage these leaders and increasetheir feeling of connectedness to their organization. An-other option is to offer EHL annual forums or retreats heldby senior leaders. These forums provide opportunities for

Table 2. Ladder of engagement

Level Positioning of EHL Example

8 Engagement EHLs have ideas, set up project, andinvite others to join in decisionmaking.

7 Management EHLs have initial idea and decidehow project is carried out; EHLstake charge.

6 Collaborative Others have idea and EHLs areinvolved in each step of projectplanning and implementation.

5 Consultative Project designed/managed byothers but EHLs are consulted.Their views and input are valued.

4 Supportive Others decide on project. EHLsvolunteer their support andothers respect their views.

3 Tokenism EHLs are asked for their opinionsand have little to no control overhow views are expressed.

2 Decoration EHLs take part in a project/initiative.1 Manipulation EHLs do or say what others instruct

them to.

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ENGAGING THE NEXT GENERATION OF HEALTH SYSTEM LEADERS: PERSPECTIVES OF EMERGING HEALTH LEADERS

EHLs to raise concerns and questions, for groups to worktogether to identify new opportunities for continuous de-velopment, and for senior leaders to ask for input on keycorporate issues or initiatives.

CONCLUSION

Identifying and developing EHLs can involve informal andformal tactics. By creating opportunities that engage EHLsas per the Ladder of Engagement and implementing strate-gies that align with the ACE Model of EHL development,organizations can establish a strong foundation for talentmanagement. Research from the private sector has con-cluded that “leading organizations view talent managementas a strategic priority and an important long term invest-ment that needs reviewing, refining and reinvention (insome cases) as needs and priorities change.”8 Given theever-changing healthcare landscape, organizations that es-tablish EHL identification and development as an ongoingstrategic priority will ensure that they are cultivating theirtalent, will be better positioned to overcome potentialgaps in succession planning, and ultimately will assist inimproving our healthcare system.

APPENDIX: EHLS SURVEY ON IDENTIFYING ANDDEVELOPING EMERGING LEADERS

EHL is a grassroots initiative that began in with a small,core group of members in Ottawa with a vision to develop

Table 3. EHL survey results

Surveyquestion

Number ofresponses provided

Question #1 28 Mentorship programsResidency/internship/placemeDoes the person have a “visioDedicate one or two open spoFeedback from colleagues, wo

Question #2 48 Offering a mentorship prograFind challenging assignmentsDeveloping a culture of internRecognize their contributionsAllow for flexibility in work: h

Question #3 31 Make it a corporate priorityMentorshipSupport for continuing educaGive people opportunities toCreate ladders for leadership d

Question #4 18 That we are just here to breeToo academic and less practiFull of new ideas but not ablThat health leaders primarilyThat we are not dedicated to

emerging health system leaders across Canada. Presently,

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there are five pan-Canadian EHL nodes with over 400members representing various healthcare sectors.The on-line survey was e-mailed to all members by their

respective node cochairs. Participants were asked (but notrequired) to provide up to five answers for each of the fourquestions. Fourteen EHL members completed the surveyand provided a total of 125 qualitative responses out of apossible 280 responses. Please see Table 3 for a breakdownof the number of responses per question and specificexamples. The authors reviewed the survey responses toidentify emergent concepts that served as the content forthe ACE Model of EHL development.Question #1: In your opinion, what are the most effective

ways for organizations to identify “high potential” employ-ees for leadership positions (now or in the future)? Pleaseprovide up to five responses.Question #2: What specific initiatives can senior leaders

and their organizations take to retain “high potential” em-ployees? Please provide up to five responses.Question #3: Let’s assume your organization is interested

in developing its “high potentials” for future leadershippositions. What specific steps should they take? Pleaseprovide up to five responses.Question #4: What are some popular myths about

emerging health leaders or “high potentials” you’d like todebunk? Please provide up to five responses.

REFERENCES

1. Ogden G. Talent management drives success. Healthcare Reg-

Examples of responses

working groups/committees/task forces for motivated employeesf mouthth staff and senior leadershese individualsromotionhallenging assignments; personal “thank you” letterlocations, times

on projectspment so skills can be gained, implemented, and then built onand “climb the ladder” without doing the ground work

olve complex real life issuesto administrationorganization just because we do not work long hours

ntsn”ts onrd om wifor tal pto cours,

tionworkeveloze bycale to sgo inthe

istration. 2010;19:11.

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2. Collins J. Good to great: Why some companies make the leapand others don’t. New York: HarperCollins; 2001:44.

3. Sacolick I. Other companies should have to read this Netflixpresentation. Available at: www.businessweek.com. AccessedAugust 5, 2009.

4. Berger LA, Berger DR. The Talent Management Handbook: Cre-ating Organizational Excellence by Identifying, Developing &Promoting Your Best People. McGraw-Hill.

5. Retrieved on October 25, 2010 from www.businessdictionary.com.

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6. Deloitte Development LLC. Talent management in health care.2006. Available at: view.fdu.edu/files/brkprsgill.ppt. AccessedOctober 1, 2010.

7. Canadian Health Leadership Network. LEADS in a Caring Envi-ronment Framework. 2010. Available at: http://www.chlnet.ca/leads-caring-environment-framework. Accessed October 25,2010.

8. Lubitsh G, Smith I. Talent management: A strategic imperative.

Ashridge J. 2007;Spring:1-6.

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