09

LEADERSHIP COMPETENCY DEVELOPMENT FOR EXECUTIVE-LEVEL POSITIONS
AT VANCOUVER ISLAND HEALTH AUTHORITY
By
LAURA CROSS
BBA, Simon Fraser University, 1985

BMT, Capilano University, 2000
An Organizational Leadership Project Report submitted in partial fulfillment of

the requirements for the degree of
MASTER OF ARTS
In
LEADERSHIP HEALTH
We accept this Report as conforming

to the required standard
Lynn Stevenson, PhD, Project Sponsor
Marie Graf, MA, Faculty Supervisor
Wendy Rowe, PhD, Committee Chair
ROYAL ROADS UNIVERSITY

September 2011
© Laura Cross, 2011

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thesis. Neither the thesis nor la thèse ni des extraits substantiels de celle-ci
substantial extracts from it may be ne doivent être imprimés ou autrement
printed or otherwise reproduced reproduits sans son autorisation.
without the author's permission.
In compliance with the Canadian Conformément à la loi canadienne sur la

Privacy Act some supporting forms protection de la vie privée, quelques
may have been removed from this formulaires secondaires ont été enlevés de
thesis. cette thèse.
While these forms may be included Bien que ces formulaires aient inclus dans
in the document page count, their la pagination, il n'y aura aucun contenu
removal does not represent any loss manquant.
of content from the thesis.
Library and Archives Bibliothèque et
Canada Archives Canada
Published Heritage Direction du
Branch Patrimoine de l'édition
395 Wellington Street 395, rue Wellington

Ottawa ON K1A 0N4 Ottawa ON K1A 0N4
Canada Canada
Your file Votre référence
ISBN: 978-0-494-84087-0
Our file Notre référence

ISBN: 978-0-494-84087-0
NOTICE: AVIS:
The author has granted a non- L'auteur a accordé une licence non exclusive
exclusive license allowing Library and permettant à la Bibliothèque et Archives
Archives Canada to reproduce, Canada de reproduire, publier, archiver,
publish, archive, preserve, conserve, sauvegarder, conserver, transmettre au public
communicate to the public by par télécommunication ou par l'Internet, prêter,
telecommunication or on the Internet, distribuer et vendre des thèses partout dans le
loan, distrbute and sell theses monde, à des fins commerciales ou autres, sur
worldwide, for commercial or non- support microforme, papier, électronique et/ou
commercial purposes, in microform, autres formats.
paper, electronic and/or any other
formats.
The author retains copyright L'auteur conserve la propriété du droit d'auteur

ownership and moral rights in this et des droits moraux qui protege cette thèse. Ni
thesis. Neither the thesis nor la thèse ni des extraits substantiels de celle-ci
substantial extracts from it may be ne doivent être imprimés ou autrement
printed or otherwise reproduced reproduits sans son autorisation.
without the author's permission.
In compliance with the Canadian Conformément à la loi canadienne sur la

Privacy Act some supporting forms protection de la vie privée, quelques
may have been removed from this formulaires secondaires ont été enlevés de
thesis. cette thèse.
While these forms may be included Bien que ces formulaires aient inclus dans
in the document page count, their la pagination, il n'y aura aucun contenu
removal does not represent any loss manquant.
of content from the thesis.
Leadership Competency Development ii
ABSTRACT
The Vancouver Island Health Authority (VIHA) has prioritized the need for leadership
competency development, especially at the executive leadership level. This organizational
leadership project explored supportive strategies for developing competent executive leaders
from within VIHA‘s internal talent pool. Qualitative data were gathered through an action
research methodology using an appreciative inquiry lens focus. VIHA employees at the vice-
president and executive vice-president level provided valuable insights, knowledge, and ideas on
the topic of executive leadership competency development through participating in a series of
one-to-one interviews followed by one focus group. Inquiry recommendations include the use of
a leadership competency framework, offering experiential and educational development
opportunities, organizing a mentoring program, developing a 360-degree feedback review plan,
and creating a team learning environment. To protect the rights of all participants, this project
was conducted according to the ethics policies of both Royal Roads University and VIHA.
Leadership Competency Development iii
ACKNOWLEDGEMENTS
I am grateful to so many people who made this document and my 2-year journey through
the Master of Arts in Leadership Healthcare program at Royal Roads University (RRU) possible.
First, I would like to thank the project sponsor from VIHA, Dr. Lynn Stevenson, for her
dedication to my learning and the creation of this Organizational Leadership Project (OLP).
Lynn gave me unwavering advice, support and guidance every step of the way. I would like to
thank Karen Pettit, VIHA‘s Director of Strategic Solutions for her genuine interest, continual
assistance, and sage advice to guide me throughout. Thank you to Karen Nash, a VIHA
administrative assistant whose extraordinary coordinating skills help me contact and book the
participants. To team inquiry members Alison Young, Lorie Hunchak, and Jillian McKenna,
thank you for your support. Thank you to my excellent and efficient editor Shanaya Nelson.
I have such gratitude for my RRU academic advisor Marie Graf who guided my learning
with expertise, conviction, and most of all with a big heart. Thank you Pat, Tom, and Janis from
Marie‘s OLP on-line cohort; together we shared many trials and triumphs. To the Vancouver
study group Joanne, Alison, Karen, and Devon, we were an awesome supportive learning team
who shared and learned together, and we were full of laughter. To my fellow RRU learners and
faculty, all of you contributed to enriching my learning journey.
Thank you to all my friends and family who were so supportive and encouraging. Special
mention to my parents, Tom and Geraldine, and my two children, Travis and Fraser. My biggest
thanks, which I cannot express in words, is my deep gratitude to my loving husband and friend,
Mario. He kept me going when I hit obstacles, he celebrated all of my successes, and he never
stopped believing in me. All of you made my learning journey possible. Thank you!
Leadership Competency Development iv
TABLE OF CONTENTS
ABSTRACT .................................................................................................................................... ii
ACKNOWLEDGEMENTS ........................................................................................................... iii
LIST OF FIGURES ...................................................................................................................... vii
CHAPTER ONE: FOCUS AND FRAMING ..................................................................................1

Significance of the Inquiry.........................................................................................................3
Organizational Context ..............................................................................................................5
Organizational Systems Analysis of the Inquiry .......................................................................7
Summary ..................................................................................................................................10
CHAPTER TWO: REVIEW OF LITERATURE ..........................................................................12

Leadership Competencies of Health Care Executives .............................................................12
Leadership defined .............................................................................................................13
Leadership versus management .........................................................................................14
Leadership competencies defined ......................................................................................15
Competencies of today‘s health care executive leaders .....................................................16
Leadership competency frameworks .................................................................................18
Executive Leadership Development ........................................................................................19
The need for leadership development in health care .........................................................20
Learning leadership ............................................................................................................20
Talent development and retention ......................................................................................22
A synopsis of leadership development programs ..............................................................23
Summary ..................................................................................................................................25
CHAPTER THREE: INQUIRY APPROACH AND METHODOLOGY ....................................27

Inquiry Approach .....................................................................................................................27
Project Participants ..................................................................................................................28
Inquiry Methodology ...............................................................................................................30
Data collection tools ..........................................................................................................30
Study conduct.....................................................................................................................33
Data analysis ......................................................................................................................37
Ethical Issues ...........................................................................................................................40
Respect for human dignity .................................................................................................40
Respect for free and informed consent ..............................................................................41
Respect for vulnerable persons ..........................................................................................41
Respect for privacy and confidentiality .............................................................................42
Respect for justice and inclusiveness .................................................................................42
Balancing harms and benefits – minimizing harm and maximizing benefit .....................42
Summary ..................................................................................................................................43
Leadership Competency Development v
CHAPTER FOUR: ACTION INQUIRY PROJECT RESULTS AND CONCLUSIONS ............44

Study Findings .........................................................................................................................44
Interview data.....................................................................................................................44
Focus group data ................................................................................................................52
Study Conclusions ...................................................................................................................58
Conclusion 1: VIHA executive-level leadership competencies.........................................59
Conclusion 2: Supportive learning opportunities ..............................................................61
Conclusion 3: Supportive personalized development through assessment tools ...............62
Conclusion 4: VIHA as a learning organization culture ....................................................64
Scope and Limitations of the Inquiry.......................................................................................65
Summary ..................................................................................................................................67
CHAPTER FIVE: INQUIRY IMPLICATIONS ...........................................................................68

Study Recommendations .........................................................................................................68
Recommendation #1: Adopt the LEADS in a caring environment leadership
competency framework ................................................................................................69
Recommendation #2: Offer formalized on- and off-the-job leadership development
programs ......................................................................................................................71
Recommendation #3: Offer a formalized mentorship program .........................................73
Recommendation #4: Implement a supportive 360-degree review feedback program .....75
Recommendation #5: Create a learning environment and team cohort model ..................76
Organizational Implications .....................................................................................................77
Implications for Future Inquiry................................................................................................80
Summary ..................................................................................................................................82
REFERENCES ..............................................................................................................................84
APPENDIX A: VANCOUVER ISLAND HEALTH AUTHORITY EXECUTIVE TEAM

ORGANIZATION CHART.....................................................................................................89
APPENDIX B: LEADERSHIP COMPETENCY FRAMEWORK OVERVIEW ........................90
APPENDIX C: INQUIRY TEAM MEMBER LETTER OF AGREEMENT ...............................92
APPENDIX D: LETTER OF INVITATION FOR INTERVIEW ................................................93
APPENDIX E: INQUIRY RESEARCH STUDY CONSENT FORM FOR INTERVIEW .........95
APPENDIX F: SCRIPT FOR EMAIL INVITATION REQUEST FOR INTERVIEW ...............99
APPENDIX G: LETTER OF INVITATION FOR FOCUS GROUP .........................................100
APPENDIX H: INQUIRY RESEARCH STUDY CONSENT FORM FOR FOCUS GROUP ..102
APPENDIX H: INTERVIEW QUESTIONS WITH EXTRA 3 QUESTIONS ..........................107

Leadership Competency Development vi
APPENDIX J: FOCUS GROUP AGENDA ................................................................................108
APPENDIX K: FOCUS GROUP DIAGRAM PRESENTING CORE EXECUTIVE-LEVEL

LEADERSHIP COMPETENCIES AT VIHA.......................................................................109
APPENDIX L: LEADS 360-DEGREE FEEDBACK ASSESSMENT ......................................110

Leadership Competency Development vii
LIST OF FIGURES
Figure 1. LEADS in a caring environment leadership capabilities framework .............................71

Leadership Competency Development 1
CHAPTER ONE: FOCUS AND FRAMING
Vancouver Island Health Authority (VIHA) has identified human resource management
as an area of critical risk (Vancouver Island Health Authority [VIHA], 2009, p. 3) and is
currently establishing a formal people development program aimed at attracting and retaining
talented leaders (Wale, 2010, p. 2). The current objective is to enable senior leaders in the
management team to experience a breadth of leadership learning and development opportunities
relevant for moving forward in their careers into the executive level within VIHA.
In order to maximize the use of in-house leadership talent, VIHA‘s newly created People
Plan 2010/11 (Wale, 2010) has chartered a Leadership Continuity Plan (LCP) that will ―provide
a formal structure for discussions and plans for individuals to achieve their professional
development and career goals, and take on expanded or new roles‖ (Wale, 2010, p. 2). VIHA‘s
formalized LCP project charter‘s main objective is to identify, develop, and retain talented
employees who demonstrate an aptitude for working at the senior level (Wale, 2010, p. 3). This
is ―a strategic process that minimizes leadership gaps for critical positions and provides
opportunities for top talent to develop the skills necessary for future roles‖ (Wale, 2010, p. 2).
The charter‘s scope targets executive leadership positions as ―roles where a national shortage has
been identified‖ (Wale, 2010, p. 3).
The health care climate in Canada is becoming increasingly complex and is facing a
senior leadership shortage due to ―aging of the leadership cohort, burnout, lack of succession
planning, appropriate training, mentoring the next generation of leaders‖ (Hewitt, 2006, p. 7). In
order to be sustainable, now and into the future, the healthcare system needs strong leadership
(Dickson, 2007, p. 1; Hewitt, 2006, p. 7). Leadership roles of today and tomorrow are much
more ―skill and knowledge intensive than in the past‖ (Conference Board of Canada, 2007, p. 3).
VIHA recognizes that in as early as 5 years a shortage in the senior leadership team is anticipated
if nothing is done (Wale, 2010, p. 2). Through effective leadership continuity planning VIHA
intends to maintain a highly capable executive leadership team by equipping themselves with an
available internal pool of recently trained and competent leaders ready to move into the senior
positions as they become vacant.
I became interested in leadership development and succession planning approximately 3
years ago, when I recognized the need to develop my leadership competencies to gain
professional leadership growth within my own health care organization. One of my mentors from
the Canadian College of Healthcare Leaders (CCHL) saw that there would be a good fit between
my interest and passion for developing leaders from within the organization and VIHA‘s goals in
establishing a leadership continuity program. Thus my mentor kindly introduced me to Dr. Lynn
Stevenson, the Executive Vice-President of People Organizational Development, Practice and
Chief Nurse at VIHA. As a result VIHA has sponsored this organizational leadership project
(OLP), which explored how senior employees from the management team can gain the essential
leadership competencies needed at the executive team level. As a keen learner and inquirer of the
subject of leadership competency in healthcare, I was positioned externally to VIHA when
leading this action research study.
The inquiry question explored in this OLP was: How can Vancouver Island Health
Authority support the development of leadership competencies for employees targeted to move
into executive-level positions? Three subquestions supported the primary question:
1. What are the essential competencies needed to work at the executive leadership level
in healthcare?
2. How can VIHA strategize to support high-potential employees in gaining the
appropriate leadership competencies?
3. How can these competencies be monitored and measured?
Significance of the Inquiry
Attracting and retaining capable staff is one of VIHA‘s strategic priorities (VIHA, 2009,
p. 45). VIHA aims to minimize current and future leadership gaps in critical positions (Wale,
2010, p. 2) by implementing their People Plan 2010/11, which includes a LCP that aims to
strategically target knowledge and skills transfer for a variety of levels and professions. This
strategy is in response to the evident aging population that VIHA serves, and the aging
workforce and impending retirement boom. ―The average age of VIHA‘s workforce is 45, which
is about 16% higher than the national average‖ (VIHA, 2009, p. 45). According to the
Conference Board of Canada (2007), ―the Canadian health care workforce will be retiring in
record numbers, draining the health sector of skilled employees and leaders . . . the aging
population will increase the demand for health care services, putting the health care system under
mounting pressure‖ (p. 1).
VIHA sees the benefits in positioning itself as ―an employer of choice with structured
career planning and recognition of potential for its employees‖ (Wale, 2010, p. 7). The goal of
supporting professional growth is to increase employee job satisfaction and deepen the
commitment towards current and future employment at VIHA, thereby mitigating the high costs
associated with workforce departures. Llorens (2009) asserted, ―By creating a well-trained pool
of talent throughout a variety of areas, the pipeline for high-level successors is not only
maintained, but meaningful for organization wide strategic success‖ (p. 57). Furthermore,
―companies which place a heavy emphasis on leadership development experience considerably

higher financial returns than companies that do not‖ (Collins & Collins, 2007, p. 18). VIHA
recognizes the significant financial losses they face if they are unable to fill key leadership
vacancies with capable internal employees (Wale, 2010, p. 2).
The timing of this OLP aligned in parallel with VIHA‘s development of a comprehensive
LCP, which started in December 2010 and is estimated to end in March 2012. This OLP
provided insights and recommendations to VIHA in their approach to talent retention and
development for their executive pool as part of their LCP‘s objectives and strategies. The
positive change that informed the LCP from this project was twofold. First, the project
uncovered the required core leadership competencies essential for executive and vice-president
positions at VIHA. The LCP stated clearly that VIHA wanted to discover and ―become
transparent about the knowledge, skills, and abilities that are required for various roles in the
organization‖ (Wale, 2010, p. 2). Second, the project produced recommendations for change or
enhancement on development opportunities for senior-level employees to gain the necessary
educational and experiential skills and competencies to position them for transition into a higher
executive role. Without this project, VIHA may have been at risk of overlooking the wealth of
in-house knowledge generated from the wisdom, experience, and insights of their senior and
executive leaders. Furthermore, this organizational knowledge in combination with the ensuing
comprehensive literature search guided key discoveries on core leadership competencies for
senior leaders. This project also provided key recommendations regarding the establishment of a
well-rounded and robust leadership competency development program, which subsequently
could help reach the targeted objectives of the LCP as part of the People Plan 2010/11 (Wale,
2010) for VIHA‘s senior leadership team.

Organizational Context
VIHA serves approximately 750,000 people, which is 17% of the British Columbia (BC)
population (VIHA, 2009, p. 14). They operate 150 facilities over 56,000 square kilometres
separated into three regions namely, North, South, and Central areas of the Province (VIHA,
2009, p. 14). VIHA employs approximately 17,000 health care professionals and technicians and
approximately 1,700 physicians (VIHA, 2009, p. 14). It is expected that the population will grow
by 4.4%, or 32,800 people by 2013 (VIHA, 2009, p. 14). VIHA (2009) is concerned about the
current and future aging demographics of the populations they serve: ―An older population is one
of the most significant challenges we face now, and will continue to face for at least the next
twenty years‖ (p. 15).
VIHA‘s workforce is also threatened by an anticipated retirement boom. A strategic
approach to minimize leadership gaps in critical leadership positions is deemed essential due to
the fact that many employees in executive positions at VIHA will be retiring within the next 5 to
10 years (Wale, 2010, p. 2). Thus, ―finding and keeping the right people is the most critical
challenge we face‖ (VIHA, 2009, p. 37). In addition, there is already a recognized growing
leadership gap in BC‘s health care system (Dickson, 2008, p. 4). A strategic LCP would enable
VIHA ―to retain skills, experience and organizational memory‖ (Wale, 2010, p. 6) and to retain
the ―next tier of qualified healthcare leaders‖ (Collins & Collins, 2007, p. 16). The objective is to
obtain the appropriate number and type of staff, now and into the future (VIHA, 2009, p. 3).
This OLP focused on discovering ways for VIHA‘s ―top talent to develop the skills
necessary for future roles‖ (Wale, 2010, p. 2) in critical senior executive-level positions. VIHA
―affirms the importance of a leadership succession and career planning program in achieving the
organization‘s goals, and this work aligns with VIHA‘s strategic priority‖ (Wale, 2010, p. 2) of
being ―a leading organization with a safe healthy workplace, engaged work force, and
continuous learning‖ (VIHA, 2009, p. 49). The People Plan 2010/11 was developed in
recognition that change in human resource management is necessary (VIHA, 2009, p. 37).
Traditional human resources approaches of the past are insufficient due to current and future
labour talent shortages and the aging population (VIHA, 2009, p. 37).
Each executive team member in consultation with their staff is responsible for strategic
direction and meeting performance goals and objectives for VIHA, such as the People Plan
2010/2011 (Wale, 2010). The executive team ―provides leadership in planning, managing,
delivering and evaluating health services across the entire region, in collaboration with the
British Columbia Ministry of Health Services‖ (VIHA, 2009, p. 10). The provincial government
appoints a board of directors to govern VIHA, who are typically selected for their backgrounds
in senior positions from an assortment of business sectors. Collectively they hold a wide variety
of capabilities in areas such as health care operations and planning, finance, business, and human
resources. The chief executive officer (CEO), together with the board members and executive
team have established VIHA‘s vision, mission, and values, which were communicated in
VIHA‘s (2009) Five-Year Strategic Plan1. VIHA‘s vision is: ―Healthy people, healthy island
communities, seamless service‖ (VIHA, 2009, p. 11). VIHA‘s (2009) mission is: ―To serve and
involve the people of the islands to maintain and improve health‖ (p. 11). VIHA‘s (2009) values
are: (a) care, compassion, and respect; (b) quality and excellence in services; (c) competence,
knowledge, and evidence-based practice; (d) partnerships and collaboration to share
responsibilities with all stakeholders; (e) integrity, accountability and ethical practice;
1
From Vancouver Island Health Authority (VIHA) Five-Year Strategic Plan 2008 – 2013 (p. 11),
by Vancouver Island Health Authority, 2009, Victoria, BC: Author. Copyright 2009 by the
Vancouver Island Health Authority. Reporinted with permission.
(f) innovativeness to support new learning and research; (g) pride and recognition of everyone‘s
contributions towards excellence; (h) diversity in order to accommodate unique needs; (i) client
focus for an integrated and seamless system; and (j) sustainability by efficiently and effectively
using available resources to meet needs (p. 11).
There are also three consistent overarching strategic goals anchored in VIHA‘s vision,
mission, and values that align with a comprehensive leadership continuity program. These are:
(a) improved health and wellness for VIHA residents; (b) quality, patient safety, and client-
centered care and services; and (c) a sustainable, affordable, publicly funded health system with
a safe, healthy work environment (VIHA, 2009, p. 21).
The executive team is made up the CEO, five vice-presidents, and three executive vice-
president portfolios that report to the CEO. The management team includes those in the
executive team, plus various directors, supervisors, and managers who report up to the executive
vice-president portfolios. The vice-president and executive vice-president leadership level at
VIHA was the focus of my OLP, and participants invited came from this sector. This team
―provides leadership in planning, managing, delivering and evaluating health services across the
entire region‖ (VIHA, 2009, p. 10). The organization chart in Appendix A outlines these teams.
Organizational Systems Analysis of the Inquiry
Healthcare organizations such as VIHA are highly complex social systems comprised of
many subsystems that must integrate to reach their goals (McNamara, 2010, para. 5). According
to Kotter (1999), organizational systems are interdependent with one another; therefore, people
need to be aligned and connected via their ―work, technology, management systems, and
hierarchy‖ (p. 57). During the facilitation of change, these individuals need to synthesize and
―line up and move together in the same direction‖ (Kotter, 1999, p. 57), which can sometimes
present a challenge for many organizations. Porter-O‘Grady and Malloch (2007) stated the
following on system synthesis:
If systems are to be effective they must link, integrate, and coordinate all work effort in a
dynamic mosaic that supports and advances the work effort. All elements of the system
must ultimately synthesize so common efforts and aggregated work of each component of
the system merge to create a dynamic that results in an effective ―dance‖ between each
element that moves the whole system toward fulfilling its purpose and meaning. (p. 283)
Complex systems are impacted and influenced by both external and internal forces. In
context of this project and the LCP, external partnered systems that relate with one another
include: BC Ministry of Health, five other Provincial Health Authorities, BC Leadership and
Development Collaborative, CCHL, Healthcare Leaders Association, Leaders for Life, BC
Health Authority Leadership Development Collaborative, Healthcare Human Resources Strategy
Council, and Royal Roads University. In collaboration with these organizations VIHA aims to
orchestrate and champion an effective LCP as part of the strategic People Plan 2010/11 (Wale,
2010) and is explained further below.
VIHA (2009) described that the People Plan 2010/11 ―guides [us] in recruiting and
retaining staff, maintaining and enhancing skills, and providing a safe and healthy workplace‖
(p. 13). Furthermore, ―the creation of VIHA‘s LCP is based on the Interior Health Authority‘s
(IHA) recently established leadership continuity program‖ (Wales, 2010, p. 2). Collaboration
across the provincial health authority system between VIHA and IHA is a significant
collaborative relationship toward the development of VIHA‘s LCP, and towards continued
success for both of these health regions. It is anticipated that the remaining four provincial health
authorities will also benefit from sharing the mutual success of VIHA and IHA‘s leadership
continuity planning programs, by possibly adopting similar programs. Other external partners in
BC and Canada such as the BC Health Authority Leadership Development Collaborative,
Healthcare Human Resources Strategy Council, CCHL, Healthcare Leaders Association, and
Leaders for Life have a vested interest in the quest of the LCP, and have been and will continue
to engage with VIHA in learning from their efforts and outcomes of such a proactive people
development initiative. Royal Roads University is a progressive university in the same city as
VIHA, and offers several leadership certificate, undergraduate, and graduate programs. VIHA
and Royal Roads University work together to formulate appropriate leadership training
development as part of the delivery of the People Plan 2010/11 (Wale, 2010).
External forces in the system that interrelate and challenge with the LCP goals are as
follows: (a) Globally—VIHA has been impacted by the recent economic downturn, and
increasing consumer demands (VIHA, 2009, p. 19) and worldwide labour shortages (p. 18);
(b) Nationally—VIHA recognizes that they have the highest seniors rate in Canada (VIHA,
2009, p. 26) and an aging workforce that is becoming significantly problematic;
(c) Provincially—VIHA competes with labour shortages with four other Health Authorities, and
is unable to offer competitive salaries (Wales, 2010, p. 2); and (d) Community. VIHA‘s
geography includes many challenging and remote areas to serve. Many populations are at high
risk for health conditions requiring capable leadership. The largest overall external systems
influence is the impact of the aging workforce and labour shortage.
The entire executive team is a group of senior professionals who, in collaboration within
and across their departments specialize in many aspects of strategic planning for VIHA. In
collaboration with the BC Ministry of Health, the senior executive team ―establishes specific
performance objectives and works to ensure they are met or exceeded‖ (VIHA, 2009, p. 10). The
LCP was endorsed in May 2010 by the Governance and Human Resources Committee of the
Board in May 2010 (Wales, 2010, p. 2). The strategic planning process (i.e., annual, 3 year, and
5 year) looks as factors such as: community engagement, health needs, demographics, industry
trends, risks, government direction, and capacity modeling (VIHA, 2009, p. 13). The
Organizational Development Department at VIHA is leading the LCP as part of the People Plan
2010/11 (Wale, 2010), because they have come to the conclusion that traditional strategic
planning for human resources ―will not be enough to address the workforce gap‖ (VIHA, 2009,
p. 18).
One major objective of the People Plan 2010/11 (Wale, 2010) is retaining high quality
employees. Mixed age groups make up the work force system that are either currently in high-
level senior roles, or if targeted for leadership development, could potentially be eventually
filling into a senior executive role. These include: (a) Pre-boomers, ages 63+; (b) Baby Boomers,
ages 44 to 62; (c) Generation X, ages 30 to 43; and (d) Generation Y, age less than 30 (VIHA,
2009, p. 18). These four separate generations carry different knowledge and expectations and
must be considered as a valuable and important aspect of the system for success of the LCP.
VIHA plans on partnering with post-secondary organizations such as Royal Roads University,
and the BC Ministries of Health Services and Education to facilitate ongoing educational
programs for their targeted professional staff (VIHA, 2009, p. 39).
Summary
Canada‘s health sector is a $130-billion industry that demands solid leadership in such
complex times (Hewitt, 2006, p. 5). No matter what the age group or where in the system, it is
evident that competent leadership is needed throughout the national health care system to
navigate the fast-paced, ever-changing environment, in which unwavering safety and customer
service are paramount for sustainability and success. Positions that will be most impacted are the
baby-boomers retiring from management-level positions who hold a high level of experience and
education (Hewitt, 2006, p. 5). All in all, ―health care renewal and sustainability in Canada
cannot occur without highly competent people in leadership positions influencing health policy
and/or the delivery of care‖ (Hewitt, 2006, p. 7). Moving forward into Chapter 2 is a literature
review that provides a scholarly review on leadership competencies, the need for competent
executive leadership, succession and talent planning, and leadership development options and
opportunities.
CHAPTER TWO: REVIEW OF LITERATURE
The main inquiry question explored in this OLP was: How can Vancouver Island Health
Authority support the development of leadership competencies for employees targeted to move
into executive-level positions? A scholarly literature review from a wide assortment of academic
writing on executive-level leadership including health care provided a foundation to inform and
shape this project.
This literature review has informed two main topics: leadership competencies of health
care executives and executive leadership development. The first topic provided insight and
understanding on the fundamentals of what leadership is and what makes a competent executive
health care leader today. The latter topic explored the demand for leadership development and
examined various options that can formulate leadership development recommendations toward
creating an effective LCP at the executive level for VIHA.
Leadership Competencies of Health Care Executives
One fundamental goal of this OLP was to identify for VIHA the core leadership
competencies needed in executive-level health care leadership positions. To begin, I presented
definitions and concepts of the term leadership to provide a solid foundation for the remaining
concepts of this chapter. I then provided: (a) the distinction between leadership and management,
(b) the definition and purpose of leadership competencies, (c) competencies essential for today‘s
executive health care leaders, and (d) an overview of leadership competency frameworks. These
topics were explored to form a foundational base of knowledge towards leadership development,
talent retention, and leadership development programs.

Leadership defined
Since the beginning of the 20th century there has been immense interest on leadership
and a large body of literature written on the subject (Clemmer, 2003; Dickson, 2003; Yukl,
2010). Indeed, there are ―as many definitions of leadership as there are authors on the topic‖
(Anderson, Malby, Mervyn, & Thorpe, 2009, p. 7). It is no surprise then that my literature search
revealed a plethora of definitions on leadership. The overall theme common to many definitions
found was that effective leadership involves the ability to motivate others toward reaching
organizational goals and objectives.
The three following definitions of leadership from health care sources provide relevancy
to this OLP. The National Center for Healthcare Leadership (NCHL) defined leadership as the
ability to ―create and communicate a shared vision, champion solutions for organizational and
community health challenges, and energize commitment to goals‖ (Calhoun, Vincent, Baker,
Butler, Sinioris, & Chen, 2004, p. 429). Porter-O‘Grady and Malloch (2007) described
leadership as being ―about building and sustaining long-term relationships that effectively
converge around common goals directed to meeting the mission and purposes of organizations‖
(p. 198). Lastly, Dickson (2008) explained leadership as ―the capacity to influence others to
work together to achieve a constructive purpose‖ (p. 3). These above-noted definitions
commonly used action words such as create, energize, building, sustaining, and influencing to
describe leadership. One could say ―leadership is action, not a position‖ (Clemmer, 2003, p. 21)
and ―leadership is first and foremost a way of being‖ (p. 21). Lastly, Bennis (1994) summed up
that leadership is ―like beauty; it‘s hard to define, but you know it when you see it‖ (p. 1).
Leadership versus management
It is worth noting that a wide assortment of literature identified that there could be
confusion on the differences between the terms leadership and management. Health care
executives have many management and administrative responsibilities, yet according to the
definitions above they need to be effective facilitators of achieving organizational goals. Many
people interchange leadership and management and see them as one and the same (Clemmer,
2003, p. 17). However, ―management is as distinct from leadership as day is from night‖
(Clemmer, 2003, p. 17). Kotter (1999) stated that leadership isn‘t ―necessarily better than
management or a replacement for it‖ (p. 51). Instead, Kotter claimed that leadership and
management are two distinct disciplines both with their own function and both equally necessary
for corporate success (p. 51).
Dickson (2008) stated, ―Management . . . is the body of knowledge and skills we use to
organize, plan, and control resources when direction has already been set‖ (p. 6). Management is
about executing already-acquired skills to challenges that do not require further learning
(Edmonstone & Western, 2002, p. 35). Leadership is needed to navigate others through complex
change (Clemmer, 2003; Dickson, 2003, p. 6; Kotter, 1990, p. 86) and ―enables people and
organizations to face adaptive challenges where new learning is required‖ (Edmonstone &
Western, 2002, p. 35). Leadership can be seen as the quality needed to deal with complexity and
chaos, whereas management complements leadership by handling daily order (Anderson et al.,
2009, p. 7). Organization success relies on those who have mastered a healthy balance of skills in
both leadership and management (Clemmer, 2003; Dickson, 2008; Kotter, 1999; Yukl, 2010).
VIHA is looking to develop their internal staff that already have health care management
experience into learning to becoming stellar leaders at an executive level.

Leadership competencies defined
All leaders must be prepared to continually learn and grow and to realize that competence
in the leadership role is ―neither static nor ensured‖ (Porter-O‘Grady & Malloch, 2007, p. 206).
Leadership competencies improve ―slowly over time as a result of mindful practice, feedback,
and more practice‖ (Dye & Garman, 2006, p. xx). Leaders need to participate in an ―assessment
of competence and the need to adjust in the role as it responds to new demands‖ (Porter-O‘Grady
& Malloch, 2007, p. 206). Furthermore, ―competencies of leadership may mature, broaden, and
be honed as the individual‘s scope of responsibility increases . . . adapting these core
competencies to the challenges of their time‖ (Decrane, 1996, p. 256).
―Competencies are a set of professional and personal skills, knowledge, values, and traits
that guide a leader‘s performance, behavior, interaction, and decisions. Because leadership is a
complex undertaking, it requires many competencies‖ (Dye & Garman, 2008, p. xiii).
Competencies can also be defined as ―outcomes-relevant measures of knowledge, skill, abilities,
and traits and/or motives‖ (Garman & Johnson, 2006, p. 13). Robbins, Bradley, and Spicer
(2001) discussed that competencies could be viewed as the measurement of only the minimal
acceptable standards to do the job (p. 192). For the purposes of this OLP, the term competency
means ―characteristics of employees with behavioral implications that are thought to be
associated with successful performance of their job‖ (Garman & Johnson, 2006, p. 14) and refers
to the discovery of outstanding performers (Robbins et al., 2001, p. 192). VIHA‘s LCP involves
targeting future leaders who have the potential to be high achieving leaders. ―Those in the
position of selecting leaders can benefit from learning about competencies‖ (Dye & Garman,
2008, p. xix), as it enables them to assess candidates for recruitment.

Collins and Collins (2007) pointed out that understanding capabilities of health care
leaders is necessary in order for organizations to identify, nurture, and cultivate the talent to
strategically place employees in the right positions to meet organization needs (p. 20). However,
in the Canadian healthcare system ―there is little agreement on what the minimum competencies
for health leaders/managers [are]‖ (Hewitt, 2006, p. 18). To complicate matters, as the health
system changes, so too will the competency requirements (Hewitt, 2006, p. 19).
Competencies of today’s health care executive leaders
According to Ford (2009), health care leaders of today and tomorrow require different
competencies than in the past. Competencies such as technical skills, industry knowledge,
analytical reasoning, building teamwork, communication, and negotiating are not enough, as
leaders will need to navigate an even more complex health care system (Ford, 2009, p. 101).
―Leadership is assuming a new importance as organizations employ and rely on a growing
number of knowledge workers‖ (Anderson et al., 2009, p. vii). Executive-level leaders, such as
VIHA executives, are known as ―knowledge workers‖ (Anderson et al., 2009, p. 8), meaning that
their results and success rely heavily on their thinking and actions, such as their responsibility for
strategic planning. Senior executives have the highly responsible task of managing information
and are often held responsible for organization-wide performance (McAlearney, 2010, p. 206).
Executives are responsible for: governing action plans, yielding desired results, sound decision-
making, effective communication, focusing on opportunities, running productive meetings, and
placing the needs of the organization first (Druker, 2004). They are also known to have the
ability to be ―integrative‖ (Martin, 2007, p. 62) thinkers, a discipline of being able to holding two
opposing ideas in their heads and being able to creatively generate new ideas from them.
A wide assortment of literature provided information on what it takes to be an effective
leader. Over the years, Kouzes and Posner (2007) have conducted global studies to discover what
qualities people look for from a leader, and the results consistently are as follows: honesty,
forward-looking, inspirational, and competent (p. 29). Kouzes and Posner (2007) asserted that
leadership involves five practices namely, (a) model the way to others—through shared values;
(b) inspiring a shared vision—by envisioning the future; (c) challenge the process—by taking
risks and looking for opportunities and being innovative; (d) enable others to act—by
encouraging collaboration and building trust, and (e) encourage the heart—recognize other‘s
excellence and celebrate values and victories (p. 26). Dye and Garman (2008) asserted there are
four cornerstones to effective leadership, namely (a) self-awareness, both intellectually and
emotionally; (b) compelling a vision for others to follow; (c) ability to develop interpersonal
relationships; and (d) masterful execution, by achieving results in accomplishing tasks and
strategies. Dye and Garman emphasized that a compelling vision ―tends to be both the most
visible and the most closely associated with senior leadership roles‖ (p. xxiii). Dickson and
Lindstrom (2010) concurred and said the following about health care leaders creating vision:
Leaders orient themselves strategically to the future. Leaders are visionaries: they
envisage a brighter, progressive future, and they express hope in that future. They enroll
others in a common understanding of that future, and utilize strategy to define and engage
people in creating it. (p. viii)
Dickson and Lindstrom (2010) claimed that leadership in health care is about caring, which is the
overall needed commitment to ensure quality care towards the health of the communities served
and to the health of the organization. Effective health care leaderships competencies are
categorized as follows: (a) leading self with awareness, (b) engage others in leading and learning,
(c) achieve results of the vision, (d) develop coalitions with internal and external stakeholders,
and lastly (e) systems transformation (Dickson & Lindstrom, 2010, pp. 4–5). In particular to
systems thinking, competent leaders must be able to reason analytically, and navigate
strategically across many layers of the system (Dickson & Lindstrom, 2010, p. 12). Competent
leadership clearly encompasses many capabilities ranging from demonstrating astute business
acumen that includes strategic planning, to exuding effective interpersonal skills.
A large part of effective leadership involves a paradigm, often known as soft skills, which
includes the world of feelings, emotions, and relationship development. Goleman (2000) defined
the term emotional intelligence (EI) as the ability for leaders to manage themselves in
relationship effectively, and includes self-awareness, self-management, social awareness, and
social skill (p. 80). Some theorists view EI as a skill can be learned over time (Goleman, 2000,
p. 88; Parker, 2008, p. 141) and that EI is ―twice as important as other qualities for jobs . . .
particularly at the highest positions in an organization‖ (Parker, 2008, p. 138). Leaders who
develop high EI have the potential to improve organizational functioning by ―inspiring
enthusiasm, cooperation and trust in employees‖ (George, as cited in Parker, 2008, p. 138).
Leaders with high self-awareness can master several leadership styles and choose them
adaptively and selectively as needed in different situations, while being mindful of their EI
(Goleman, 2000). ―There is hard evidence that those ‗soft‘ leadership principles are the major
factor in what makes a high-performance team or organization‖ (Clemmer, 2003, p. 25). Lastly,
Leider (1996) stated that leadership involves using your heart, and that leaders cannot get desired
results without ―getting into ‗that soft stuff‘‖ (p. 190).
Leadership competency frameworks
Over the past decade there has been an emerging interest in ―competency-based
performance systems‖ (Calhoun et al., 2008, p. 375) in health care. Leadership competency
frameworks are viewed as useful in order to foster leadership development toward both
individual job success and corporate success (Garman & Johnson, 2006, p. 14). Leadership
competency frameworks can promote a foundation for the ―training and development initiatives
for health leadership‖ (National Center for Healthcare Leadership, 2011, p. 1). The purpose of
leadership competency frameworks is to provide a set of identified competencies as a supportive
means to measure the performance competencies of leaders at all levels in an organization
(Calhoun et al., 2008, p. 376). VIHA aims to articulate the core leadership competencies needed
at the executive level, in order to enhance their ability to then develop future leaders and to have
a benchmark measure of each individual‘s progress.
This literature search uncovered a multitude of leadership competency frameworks
designated for the healthcare sector. Many vary, starting with their domains, which are broad
categories of capabilities, each of which has lists of criteria of competencies. Appendix B
outlines three healthcare leadership competency frameworks from Canada, the United States, and
the United Kingdom respectively: (a) A pan-Canadian leadership framework known as the
LEADS framework endorsed by the Canadian Health Leadership Network, (b) the NCHL Health
Leadership Competency Model, and (c) the Leadership Qualities Framework from the National
Health Services. For purposes of this OLP, the pan-Canadian framework LEADS has been
adopted by the CCHL and VIHA, and will be used as the framework of choice for this study.
Executive Leadership Development
This portion of the literature review discussed the demand and purpose of leadership
development and examined an overview of approaches for development of executive-level
leadership competencies. Topics discussed in this section to inform leadership development
further were: the need for leadership development, theories on learning leadership, talent
retention and development, and a synopsis of leadership development programs.

The need for leadership development in health care
The healthcare sector is facing a leadership shortage (Collins & Collins, 2007;
Conference Board of Canada, 2007; Dickson, 2008; Hewitt, 2006; Leatt & Porter, 2003; Ogden,
2010; Wells & Hejna, 2009), increasing the demand for a healthy supply of well-trained and
developed leaders. According to the Conference Board of Canada (2007), ―increasing
globalization, shifting demographics, and technological changes mean Canadian workers face
increasingly diverse and complex environments‖ (p. 3) and ―the health sector is not immune to
Canadian labour trends; in fact it may even be more vulnerable‖ (p. 4).
As the health care sector continually changes and becomes increasingly complex, the new
generation of executives needs to be more diverse and require ―savvy technological skills, along
with highly specialized knowledge and strong management experience‖ (Burt, 2005, p. 50).
Leadership roles need to be flexible to adapt to these changing needs (Garman & Johnson, 2006,
p. 13). Identifying leadership competencies is significant as this information can enable
successful ―strategic human resource management practices . . . targeted recruiting . . .
identifying career ladders, and talent/management succession planning (Garman & Johnson,
2006, p. 15). VIHA is interested in examination of a leadership retention strategy that
incorporates learning and development aimed at the senior level.
Learning leadership
The LCP at VIHA involves targeting and developing leaders in the organization who
have the high potential to develop into leaders at the executive level. A vested interest into their
leadership development leads one to the conclusion that many aspects of gaining leadership
competencies can be learned. Interestingly, there has been much debate on whether leaders are
born or made (Kouzes & Posner, 2007, p. 339; Dickson, 2008, p. 8; Yukl, 2010, p. 13). The trait
theory suggests that ―leadership depends on personality characteristics, which may themselves be
‗born‘ or ‗bred‘‖ (Anderson et al., 2009, p. 9). These theorists believe that leadership is an inborn
natural trait that cannot be taught, thus there is no point in trying to develop leaders (Collins &
Collins, 2007, p. 19). Drucker (1996) insisted that there may be born leaders, however, ―there
surely are far too few to depend on them‖ (p. xi). Furthermore, set leadership styles, traits, and
personalities do not exist (Drucker, 1996, p. xi) and because of this leaders present themselves in
all varieties (p. xii).
Many theorists support the notion that leadership is a skill that can be learned by any
interested individual (Dickson, 2008; Kouzes & Posner, 2007; Leatt & Porter, 2003). Kotter
(1999) agreed and asserted that leadership is not ―mystical and mysterious . . . [and] is not the
province of a chosen few‖ (p. 51). Dickson (2008) likened leadership to artistry, in which the
discipline is continuously studied, practiced, developed, and honed over time (p. 6). Bennis‘s
(1994) viewpoint is more situational, and he stated that each leader and each circumstance is
unique; therefore, with ―something like leadership, just as with art, you reinvent the wheel every
single time you apply the principle‖ (p. 134). Drucker (2004) also asserted that many successful
executive leaders ―differ widely in their personalities, strengths, weaknesses, values, and beliefs‖
(p. 63). ―Some are born effective . . . effectiveness is a discipline [that] . . . can be learned and
must be earned‖ (Drucker, 2004, p. 63). Echols (2007) viewed leadership talent, however, as
one‘s inherent strength, and differentiates it from learning, which is acquirement of ―skills,
knowledge and experience‖ (p. 37). Each identified high-potential leader from VIHA will bring
their own unique set of experiences, traits, and skills. Each has been identified for their
leadership abilities and talents, with the premise that they can learn and gain leadership
competencies with sufficient support and strategies.

Talent development and retention
Health care organizations need to practice the cultivation of talent from within (Burt,
2005, p. 15). Cejka Serach (as cited in Burt, 2005) conducted a survey in the United States in
2005 and found that ―successful hospitals with the best practices are those that promote from
within their own ranks‖ (p. 15). Leadership continuity is a strategic career planning process that
aims to cultivate high performing talent within an organization in order to gain the skills
necessary for future career roles (Wale, 2010, p. 2). It is imperative to realize that high-achieving
leaders in health care typically leave their organizations if their professional development is not
made a high priority (Leatt & Porter, 2003, p. 25; McAlearney, 2010; Ogden, 2010, p. 10). It is
no wonder that many organizations view their leadership talent as a competitive asset (Wells &
Hejna, 2009, p. 67). ―Failing to invest now in the continuing development of top-performing
staff sets the stage for a talent drain‖ (Ogden, 2010, p. 10). In addition, ―investing in leadership is
the best way to avoid the high costs of staff turnover and associated disruption in continuity of
care‖ (Ogden, 2010, p. 10). Not only are leadership development programs attractive to
employees, they also help with employee retention (McAlearney, 2010, p. 207), and ―promote a
culture that values human and social capital‖ (Vloeberghs, as cited in McAlearney, 2010,
p. 207).
Health care organizations need to identify and develop talent in order to ―perform and
compete at a high level in the new health care economy . . . they could fall behind in retaining
and recruiting top staff in a marketplace where turnover is high and qualified talent is scarce‖
(Ogden, 2010, p. 8). Fiztenz (as cited in Leatt & Porter, 2003) stated, ―The most compelling
challenge facing organizations entering the new millennium is not the general shortage of talent.
It is the dearth of executive leadership‖ (p. 19). In relation to this inquiry study, VIHA‘s aims to
identify, strengthen, retain, and promote talent from within because they believe that ―with the
appropriate training, cultivating leaders from within an organization can provide the most
effective leadership candidates‖ (Collins & Collins, 2007, p. 19). McCauley and Wakefield
(2006) discussed talent management as a process that encompasses ―workforce planning, talent
gap analysis, recruiting, staffing, education and development, retention, talent reviews,
succession planning, and evaluation‖ (p. 4). Organizations such as VIHA who adopt such
practices are then able to assess talent and place ―the right people in the right roles‖ (p. 4).
Leadership development programs have the propensity to be ―transformative for healthcare
organizations‖ (Burt, 2005, p. 16); however, they can also be expensive, overwhelming, and
time-consuming (Burt, 2005, p. 16; Collins, 2009, p. 259).
A synopsis of leadership development programs
Leadership development programs provide a way for leaders to receive training and
education to support their professional growth needs (McAlearney, 2008, p. 320), and this
―should take place under the dominant objective of developing and improving organizational
performance‖ (Shortell, as cited in Leatt & Porter, p. 28). Leadership development ―includes
individual and organizational development, formal and informal learning, and is always a
supplement to the ‗natural‘ learning that takes place organically in organizations‖ (Anderson et
al., 2009, p. 12). Senge (2006) emphasized the potential of a workplace culture that values and
practices mutual learning, where organizations can:
build ―learning organizations‖, organizations where people continually expand their

capacity to create the results they truly desire, where new and expansive patterns of
thinking are nurtured, where collective aspiration is set free, and where people are
continually learning how to learn together. (p. 3)
People in health care organizations of today need to be adaptive and continuously learn in order
to response to complexity and change. ―In organizations with significant adaptive capacity, there
is an openness and commitment to learning . . . [and] being open to learning is a critical capacity
for anyone seeking to enable their organizations to adapt‖ (Heifetz, Grashow, & Linsky, 2009,
p. 105).
Despite the strong evidence related to the need for leadership development, ―leadership
development activities across organizations are highly varied, with little evidence available to
indicate program prevalence, content, or effectiveness‖ (Leatt & Porter, 2003; McAlearney, as
cited in McAlearney, 2010, p. 208). The Canadian health care sector is no exception—the wide
array of leadership development programs is inconsistent across the board (Conference Board of
Canada, 2007, p. 1). Collins and Collins (2007) stated that it is ―difficult for organizations to
accurately identify the appropriate skills required to be a successful leader‖ (p. 19). One reason is
because there is such a ―variety of ways of delivering leadership development (in-house
provision, external provider, mixed models)‖ (Edmonstone & Western, 2002, p. 46).
Yukl (2010) stated that developing leadership competencies could be managed mainly in
three ways: formal training, developmental activities, and self-help activities (p. 200). Training
and development programs can also include ―training in general management and personal
leadership skills; training in the specific areas of negotiation and finance; developmental
coaching, and 360- degree feedback; and a formal mentoring program‖ (McAlearney, 2010,
p. 207). Coaching is about ―the development of knowledge and skills‖ (Conference Board of
Canada, 2007, p. 15) that one needs to do the required job. Walker, Kelly, and Hume (2002)
asserted, ―Coaching is a managerial technique to develop an explicit set of employee
expectations‖ (p. 3). The organization, rather than the protégé, is usually the benefactor of
coaching (Walker et al., 2002, p. 3). A 360-degree feedback program consists of a survey
instrument regarding relevant leadership competencies which provides feedback used for
development or performance appraisal of an individual candidate, a team, or of an organization
(Dye & Garman, 2006, pp. 223–224). Lastly, mentoring is defined by the Conference Board of
Canada (2007) as ―the process by which individuals transfer their knowledge and experiences in
a one-on-one counseling or teaching role to improve the learning or development of less
experienced workers‖ (p. 15).
The National Health Service Association in England has identified three sources of
leadership skill development from: (a) another person, in the form of coaching, mentoring or role
modeling; (b) tasks, such as special projects, job rotations, secondments, job shadowing, or
acting up/across positions; and (c) others, such as task forces, working parties, action learning,
and networking (Edmonstone & Western, 2002, pp. 37–38). Overall, leadership development
programs must be based on long-term learning, be directly focused on the content of the leader‘s
real work, and include reflective learning through feedback from self and others (Shashkin &
Shashkin, 2003, p. 142).
Summary
It is evident from this literature review that the Canadian health care system is becoming
increasingly complex and is also facing a leadership shortage. Developing highly competent,
adaptive, and effective leaders is needed more than ever. According to Burt (2005), ―having a
leadership development plan in place allows senior management to have a clear picture of the
kind of leaders organizations need to meet specific goals‖ (p. 16). Furthermore, investing in
learning and development is ―a strong retention activity‖ (Echols, 2007, p. 40), whereby learning
enhances the collective human capital asset of an organization.
Combined with this literature review, the inquiry study provides recommendations on
how VIHA can best develop their targeted future executive employees towards a continuous
high-quality, competent level of leadership now and for several years to come. Moving forward
next into Chapter 3, I will discuss the conduct of my action research and data gathering process
with the VIHA Executive team.

CHAPTER THREE: INQUIRY APPROACH AND METHODOLOGY
The main inquiry question of this research inquiry study was: How can Vancouver Island
Health Authority support the development of leadership competencies for employees targeted to
move into executive-level positions? Three subquestions supported the primary question,
namely: (a) what are the essential competencies needed to work at the executive leadership level
in healthcare, (b) how can VIHA strategize to support high-potential employees in gaining the
appropriate leadership competencies, and (c) how can these competencies be monitored and
measured?
This chapter is divided into four main sections. The first section discusses the inquiry
approach used for this inquiry project. The second section describes the action inquiry team, and
how the participants were selected and invited to partake in this project. The third section
describes the inquiry methodology, and the final section explains the ethical obligations, policies,
and requirements set forth by Royal Roads University, which this project adhered to.
Inquiry Approach
An action research inquiry approach was chosen to conduct this project. Action research
is a ―systematic approach to investigation‖ (Stringer, 2007, p. 1) in which participants
collaboratively engage in a process to work towards solving problems and effecting change in
their own organizations (Coghlan & Brannick, 2007, pp. 3–4). The overall premise of action
research is that it is an all-inclusive approach for real people to be involved in gaining new
knowledge towards enhancing their daily work-life situations (Coghlan & Brannick, 2007;
Glesne, 2011; Stringer, 2007). Qualitative research is used when ―the phenomenon under
investigation is not quantifiable‖ (Klopper, 2008, p. 62) and aims to ―emphasize meaning rather
than measurement‖ (Curtis & Redmond, 2009, p. 57). It is a ―human-centered methodology‖

(Palys & Atchison, 2008, p. 7) that strives to seek deeper understanding from people‘s
experiences about an issue in order to make improvements or enhancement to what already is
being practiced (Giddings & Smythe, 2007, pp. 38–39). This approach was a suitable style for
this inquiry project because it allowed me to uncover and provide meaningful information
specified for the learning of VIHA‘s executive team, rather than generalized information, which
is more typical of standard scientific research approaches (Stringer, 2007, p. 1).
Appreciative inquiry (AI) was used as an overarching approach during this study. AI is a
philosophy for change that concentrates on ―what works‖ (Hammond, 1996, p. 3) and on
―building on what is already successful, rather than what is deficient‖ (Coghlan & Brannick,
2007, p. 11). AI is a positive method that looks to shape future solutions by embracing and
expanding on the best practices of today (Hammond, 1996, p. 21). Rather than focusing on what
is lacking, the lens of AI is a positive and cyclical process of four ―D‖ phases, namely:
(a) discovering the best of ―what is‖ (Coghlan & Brannick, 2007, p. 18), (b) dreaming and
envisioning ―what could be‖ (p. 18), (c) designing ―what should be‖ (p. 18), and finally (d) the
destination of ―what will be‖ (p. 18). It was determined that this approach reflects the values of
VIHA. ―AI is an approach that fosters engagement which aligns with VIHA‘s organizational
approach to learning‖ (Dr. L. Stevenson, personal communication, February 10, 2011).
Project Participants
This section discusses the selection of potential participants and the action inquiry team
that assisted in conducting this project. To obtain participants for this inquiry, an approach
known as ―purposeful sampling that consciously selects people on the basis of a particular set of
attributes‖ (Stringer, 2007, p. 43) was used. Participants from VIHA were chosen based on
similar traits, experiential background, and knowledge on the topic (Curtis & Redmond, 2009, p.
62). Since this OLP examined leadership competency development at the senior executive level
at VIHA, participants invited in the inquiry process were selected from the executive and vice-
president portfolios of the organization. Additionally, these participants are esteemed colleagues
of the project sponsor, and as an executive team, they are in the collaborative capacity of being
able to act on any recommendations for enhancements and changes produced from within this
OLP.
The action inquiry team that assisted this project was composed of: three graduate
students from the cohort of the 2009 Master of Arts Health Leadership program at Royal Roads
University, a VIHA human resource consultant, a VIHA administrator, a professional academic
editor, and a professional transcriptionist. Prior to conducting the study, the student inquiry team
members assisted in pilot testing the data collection methods—a series of private interviews and
one focus group. With permission from my sponsor, a VIHA consultant working concurrently on
the LCP provided assistance. Two inquiry team members, namely the VIHA consultant and one
graduate student, assisted during the facilitation of the focus group session. Throughout the
entire process the VIHA administrative inquiry team member assisted with communication of the
invitations and with coordinating the logistics of meeting space and times. The academic editor
inquiry team member provided advice on adhering to the Royal Roads University‘s formatting
standards. Lastly, the professional transcriptionist inquiry team member was hired to transcribe
the recording of the data collected from the focus group. To protect the rights and confidentiality
of the participants, all of these assistants signed an inquiry team member agreement form (see
Appendix C).
Inquiry Methodology
Data collection tools
The data gathering process in action research is ―an ongoing process that emerges as the
investigation proceeds‖ (Stringer, 2007, p. 67). Two methods were chosen for data collection.
The inquiry process started with a series of one-to-one interviews in the private office space of
each participant, followed by a single focus group session approximately 10 days later. All
interviewees were able to participate in the focus group. A few additional participants from the
senior executive team who were unavailable for interviews were invited and able to attend the
focus group. There were a total of 6 private interviews and 9 focus group participants.
Known as the most common qualitative data collection tool, interviews provide in-depth
data on the participant‘s experiences, beliefs, and knowledge (Ryan, Coughlan, & Cronin, 2009,
p. 309). Interviews are seen as a ―reflective process‖ (Stringer, 2007, p. 69) and are a ―data
generating‖ (Coghlan & Brannick, 2007, p. 100) method that allows participants an opportunity
to contribute their individual thoughts, perspectives, and ideas. The reflective and sharing nature
of the interviews yielded full-bodied qualitative data on the topic of leadership competency
development. It was observed that all interview participants were fully engaged in the inquiry
process, and hence offered an abundance of wisdom, ideas, knowledge, and individual opinions
on the topic of leadership competencies and leadership development. Many individualistic ideas
as well as many reoccurring themes were noted amongst the series of interviews.
A subsequent form of data generation used was a focus group, which is a method known
to work well alone or combined with other data gathering tools (Curtis & Redmond, 2009, p. 57).
My intention was to initially conduct one-to-one interviews to establish a relationship and
familiarity with each participant. This approach worked well; being external to the organization,
the personal interviews allowed me the individualized time needed to gain a trust and rapport
with each participant. After the interviews were completed, the combined knowledge was
synthesized down to further refine focus group questions. Focus group questions sought to
generate action through questions inquiring on the desired future state of developing competent
executive leaders at VIHA. Focus groups can simply be viewed as a group interview experience
(Stringer, 2007, p. 73) with the purpose of ―stimulating new ideas and creative concepts‖ (Curtis
& Redmond, 2009, p. 58). As with the one-to-one interviews, participants were asked to express
their experiences and knowledge on their own terms (Stringer, 2007, p. 74).
Focus groups differ in that they emphasize group interaction (Curtis & Redmond, 2009,
p. 59) and encourage different perspectives to be discussed out in the open (Palys & Atchison,
2008, p. 159). However, focus groups may discourage some from freely sharing their unique
views (Palys & Atchison, 2008, p. 160) and could result in some participants withholding
valuable contributions. Overall, it was observed that the mix of in-person interviews followed by
a focus group complemented one another. The former encouraged a safe venue for gaining
rapport and trust through private responses, and the latter encouraged ―embellishment and
negotiation of public opinion‖ (Palys & Atchison, 2008, p. 160). The focus group provided an
opportunity for participants to share diverging perspectives in a safe environment (Curtis &
Redmond, 2009, p. 59). A sense of familiarity established between the participants and myself
resulted from conducting the private interviews beforehand. It is believed that the interviews
paved the way for further in-depth information sharing at the focus group session on the topic of
leadership competency development. The two focus group inquiry team members and I observed
that the focus group participants were actively engaged in the discussion process.
Both the interviews and focus groups were ―in-depth open-ended discussions that
addressed a predefined topic of interest to the group and researcher‖ (Goodman & Evans, 2006,
as cited in Ryan et al., 2009, p. 39). In alignment with the goals of this qualitative inquiry study,
open-ended questions were useful when I, as the researcher, wanted to obtain genuine answers
and opinions from the participants (Palys & Atchison, 2008, p. 171) and when I wished to
minimally affect the participants‘ contributions (p. 173). Questions have the potential risk to be
created from a researcher‘s perspective (Stringer, 2007, p. 70) and, therefore, needed to be
carefully designed. Questions must be ―concrete questions that will ‗tap‘ into [the] content‖ of
the research‖ (Palys & Atchison, 2008, p. 167). The wording of a question is also important
(Glesne, 2011, p. 113). My academic supervisor was a valuable resource and provided
constructive feedback while I was planning and formulating the questions for both data gathering
methods. For further insurance, the questions from both methods were also pilot tested with the
student inquiry team members to determine clarity, flow, and relevancy to the study. After all,
―the data you get are only as good as the questions you ask‖ (Glesne, 2011, p. 113).
Three extra questions were prepared as an anticipated addition to the original five
interview questions that interviewees received in their letter of invitation. The outcome was that
five of the six interviews permitted time for the extra questions. These questions were to gather
information on: perceived skills needed to replace executives today, leadership competencies
most desired in one‘s colleagues, and retention of generation X and Y leaders. Appendix I
reveals the entire list of interview questions. Before conducing the interviews, one inquiry team
member assisted by testing the interview procedure and participating in a mock interview. This
team member provided feedback on the relevancy of the questions, the length and flow of the
session, and my interviewing skills. Interviewing is a complex process that takes much practice
to master (Glesne, 2011, p. 118), thus this step was instrumental in honing the interview
questions and the flow and effectiveness of my approach.
Understanding that the executive team traditionally requires agendas for all of their
meetings (K. Pettit, personal communication, May 25, 2011), focus group questions were
prepared in an agenda format, with expected time allocated for each question, to suit their
expectations. Appendix J reveals the agenda provided to the executive team. A dry run of the
focus group session was conducted with three inquiry team members. This diverse group of team
members provided feedback on the questions, the overall flow of the session, and on refining the
opening diagram depicting leadership competencies. Glesne (2011) stated that running a pilot
study is important in order to ―test the language and substance of your questions . . . the overall
length of your interview . . . [and] how your introduction to the study works‖ (p. 56). The inquiry
team members provided valuable feedback on all of the above.
Study conduct
This section provides a step-by-step account of the study conduct, which includes how
data were collected, how the data were analyzed, and describes the data analysis procedures
taken. Before collecting data, potential participants needed to be informed and invited. To initiate
this process efficiently, participants were first invited to the interview phase of the study via a
confidential personal email with an attached letter of invitation (see Appendix D) and an
informed consent form (see Appendix E) for the interviews. The VIHA administrative inquiry
team member distributed the invitations and consent forms along with a scripted introduction of
me as the researcher and a description of the OLP in the body of the email (see Appendix F).
Focus group letter of invitations (see Appendix G) and informed consent forms (see Appendix
H) were subsequently hand delivered to each potential participant‘s personal office mailbox in a
sealed envelope marked ―confidential.‖ The VIHA administrative inquiry team member booked
the times and locations for both the interviews and the focus group. Invitations sent to each
potential participant included the exact same information and instructions to ensure fairness and
consistency in communication. Signed informed consent forms were reviewed and collected at
the beginning of all data gathering sessions.
At the onset of both the interviews and the focus group participants were verbally
informed the following: the purpose of the study, my role as a student conducting the inquiry, the
confidentiality of the study, their role as a voluntary participant, and their option of withdrawal
without judgment and in confidence at anytime. The focus group participants were also requested
to keep the discussion confidential and confined strictly to group members. Before commencing
with the formal questions, participants were asked for permission to record the session. I verbally
guaranteed that all recorded and written data would be securely stored.
Prior to conducting both methods of data collection, the academic supervisor advised me
of two important principles when facilitating: (a) to ensure that sufficient silence was allowed
when presenting each question, and (b) to be careful of approach and language used when
guiding the dialogue as it unfolded. My use of silence proved to be effective, and it is known as a
useful probe that allows the respondent time and space for sharing their own beliefs and thoughts
(Glesne, 2011, p. 124). An example of some neutral language and phrases used to illicit the true
voices of participants were: ―Tell me more about that?‖ (Stringer, 2007, p. 70), and ―Is there
anything else you would like to add?‖ (p. 70). While facilitating sessions, ―research facilitators
should take a neutral stance throughout . . . yet remain keenly attentive‖ (Stringer, 2007, p. 72). I
was careful to not agree nor disagree with the responses, but instead to engage in what they were
saying by being attentive and by occasionally paraphrasing aloud to clarify the message and to
demonstrate that I desired to know the exact meaning of the message of the respondent.
Researcher bias and opinion must not interfere in the interviewing process (Glesne, 2011, p. 23),
and these techniques allowed for true representation of the participant‘s words and thoughts.
The first phase of data collection began with a series of private one-to-one interviews that
varied anywhere from 25 to 45 minutes in length. With permission from participants, the
dialogue from all sessions were audio recorded on my computer and a back-up voice memo
recording system was used in case of any technical malfunction issues. Participants were
provided a printed copy of the questions for a visual reference and a pad of paper to jot down
thoughts as they occurred during the session. I scribed point-form field notes during the
interview to act as a reference throughout the discussion. The interview questions were designed
to discover current thinking on leadership competencies needed at the executive leadership level.
Information from the interviews was subsequently analyzed to further refine questions for the
focus group. Valuable information gained from the literature search was also taken into
consideration when refining the focus group questions.
In the focus group, questions were formulated to spur dialogue on the design and
destination of the future on leadership development. The intent of the focus group was for
participants to share in a group setting their wisdom to flesh out action ideas and to foster group
learning and sharing. The focus group was planned to have a maximum of 12 participants for
approximately 90 minutes, as it is recommended to hold focus groups between 1 to 2 hours
(Glesne, 2011, p. 132). I had planned for the session to be 60 minutes long due to time
constraints of the executive team. In fact, the session included 9 participants and lasted
approximately 45 minutes.
The focus group session opened with a diagram depicting core executive-level
competencies generated from analysis of the first two interview questions of all six interviews
(see Appendix K). It was observed that use of this diagram was effective in fostering discussion
on leadership development. First, it provided the team a framework comprised of their collective
viewpoints on leadership competencies, which seemed to capture the interest of all group
members. Second it served as an informative anchor and reference point throughout the session
when discussing the primary topic of executive leadership development.
Assistance from two inquiry team members allowed me the ability to fully concentrate on
facilitating the session. One inquiry team member had three roles: (a) time keeping, (b) recording
the session, and (c) scribing observation notes. The other inquiry team member‘s role was to
scribe brief notes on large flip chart paper at the front of the room to capture main points of the
discussion. This provided a useful point of reference for the group members to follow, as their
thoughts and ideas segued from question to question. Both team inquiry members did not speak
during the facilitation phase of the focus group. These assistants also helped set up the room,
collect consent forms, hand out agendas, prepare the recording, and tidy up at the end.
From both the interviews and focus group, I analyzed all of the data towards forming
recommendations for change. I used ―multiple data sources to provide contradictory and
confirming interpretations‖ (Coghlan & Brannick, 2007, p. 127). Triangulation involves
incorporating ―multiple sources of information‖ to increase the credibility of a study (Stringer,
2008, p. 58). ―Data analysis involves organizing what you have seen, heard, and read so that you
can figure out what you have learned and make sense of what you have experienced‖ (Glesne,
2011, p. 184). Information for this data analysis was gathered from: listening to the recordings of
all interviews and focus group, reading the ensuing transcriptions, my own observations,
interview session field notes, focus group observation notes and flip chart notes, and linking this
with information gathered from the in-depth literature review.
Data analysis
Data analysis involves a ―process of distilling large quantities of information to uncover
significant features and elements that are embedded in the data‖ (Coghlan & Brannick, 2007, p.
95). There was a large amount of qualitative data that were captured from the interviews and
focus group transcriptions. These data were organized and synthesized down in order to ―identify
information that clearly represents the perspective and experience of the stakeholding
participants‖ (Coghlan & Brannick, 2007, p. 98).
Since the interviews preceded the focus group, these data were analyzed first to refine the
questions for the focus group and to make any necessary changes in consultation with my faculty
supervisor. Data from both session types were recorded on my personal computer. I transcribed
the interviews myself and hired a professional transcriptionist as part of the inquiry team to
transcribe the focus group discussion. All transcriptions were originally written word-for-word
and then were condensed into bulleted point-form format to make it more efficient for
participants to review. Approximately one month after the start of the data collection process,
participants received, along with an acknowledgement of thanks for their willingness to
participate in the project, copies of the point-form transcriptions to confirm for accuracy of
content.
To begin analyzing the qualitative data, words, phrases, and sentences were highlighted
by units of meaning (Stringer, 2007, p. 100). Also incorporated was thematic analysis, in which
―the researcher focuses analytical techniques on searching through the data for themes and
patterns‖ (Glesne, 2011, p. 187). The aforementioned leadership competency diagram provided
at the focus group (see Appendix K) was a result of coding and theming the responses from the
interview questions that asked participants to share what they think are the core leadership
competencies needed at the executive level, and how they would rank them.
Interview data on leadership competencies and the focus group data on leadership
development were analyzed and themed as separate entities. As reoccurring themes in each of
these two sets of data occurred, coloured highlighter pens were used to code and categorize the
common groups of data from the printed transcriptions. For example, when examining interview
questions on leadership competencies, yellow highlighting was used for answers that mentioned
the term strategic thinking, orange was used for answers that incorporated the term EI, and so
forth. Data that stood out alone were acknowledged and included by underscoring or circling
them with a distinct coloured felt pen. Once the colour coding was finished, this information was
transferred onto a separate piece of paper, each dedicated to a separate question or group of
questions fleshing out similar information. If several people gave the same answer to a question,
a number would be assigned to how many times this was indicated. For example, if the term
strategic thinking arose six times in response to the same question, the number 6 in a circle
would represent that many participants gave a similar answer to that specific question. This
provided a benchmark for the magnitude of the data, which allowed me to analyze how many
executives had similar or divergent thinking.
From there subthemes with similarities were placed under one or more theme header to
continue the process on each dedicated page. This gave me the ingredients to design a mind map,
combining data from both the interviews and focus group. Mind maps reveal categories that
allow for ―a large number of activities to be included under a relatively small number of
headings‖ (Glesne, 2011, p. 101). The mind map also revealed the categories and themes from
generated data and included a coded system as to how many times each piece of data was
supported. An original intention was to create one mind map inclusively. However, two mind
maps resulted given that there were two distinct sets of data from within the main inquiry
question and also due to the large amount of data collected. The first mind map captured
categorized themes on leadership competencies and subsequently was represented in diagram
format and presented at the onset of the focus group. After conducting the focus group, more
data on leadership competencies emerged and this information was themed and added to the
original leader competency mind map. The second mind map was based on leadership
development. A third mini mind map focused on leadership development ideas solely for
generation X and Y. This mini mind map was eventually merged as a subsector of the main
leadership development mind map. Thus, two mind maps resulted: one on leadership
competencies, and the other on leadership development. Chapter 4 will discuss in detail the
significant overarching themes that emerged as a result of this data reviewing process.
It was important that data collected would be credible, dependable, and trustworthy.
Trustworthiness is essential for action research, and I was mindful every step of the way to
mitigate personal bias and not to over-simplify the analysis process (Stringer, 2007, p. 57). It was
important to ―rigorously establish the veracity, truthfulness, or validity of the information and
analyses that have emerged‖ (Stringer, 2007, p. 57). Trustworthiness was also gained through
establishing credibility and dependability (Stringer, 2007, p. 57). One way credibility was earned
with the participants was by engaging them in the process of the inquiry (Glesne, 2011, p. 49;
Stringer, 2007, p. 57). Rapport was established through conversations and interactions in the
interviews and focus groups. Credibility was made evident through: (a) keeping a diary on the
OLP process (Glesne, 2011, p. 189; Stringer, 2007, p. 58); (b) allowing participants to review
transcription data for accuracy (Stringer, 2007, p. 58); and (c) triangulation, which involves
using ―multiple data sources and identifying key informants or collaborators‖ (Palys & Atchison,
2008, p. 42). Dependability was established by providing to the participants a full account of the
steps taken in order to conduct the action research (Stringer, 2007, p. 59) as outlined in this OLP.
I also established dependability by visibly being organized and openly available throughout the
inquiry study process.
Ethical Issues
―Research ethics refers to principles that guide the way we interact with research
participants and the commitment to safeguard their rights and interests‖ (Palys & Atchison,
2008, p. 69). Researchers must be vigilant and uphold ethical protocol during the entire study
process. One must realize that ―human participants are unique among the many parties involved
in research, because they bear the primary risks of the research‖ (Canadian Institutes of Health
Research, Natural Sciences and Engineering Research Council of Canada, & Social Sciences and
Humanities Research Council of Canada [Tri-Council], 2010, p. 22). Listed below are the
guiding ethical principles upheld during this inquiry study, as outlined in the Royal Roads
University‘s (2007) Research Ethics Policy:
1. Respect for Human Dignity

2. Respect for Free and Informed Consent
3. Respect for Vulnerable Persons
4. Respect for Privacy and Confidentiality
5. Respect for Justice and Inclusiveness
6. Balancing Harms and Benefits
7. Minimizing Harm
8. Maximizing Benefit. (Section D, para. 2)
Respect for human dignity
Respect for human dignity is an underpinning guide in all of the eight principles, and it
―requires that research involving humans be conducted in a manner that is sensitive to the
inherent worth of all human beings and the respect and consideration that they are due‖ (Tri-
Council, 2010, p. 8). I conducted myself in a respectful manner in regards to my social relations
with all of the participants involved in my OLP. Respect was evident by openly communicating
with participants in a friendly, trusting, appreciative, and transparent manner.
Respect for free and informed consent
Respect for free and informed consent ―implies that individuals who participate in
research should do so voluntarily, understanding the purpose of the research, and its risks and
potential benefits, as fully as reasonably possible‖ (Tri-Council, 2010, p. 27). Thus, it was
ensured that the participants comprehended the consequences of participating in the study by
signing a comprehensive informed consent form (see Appendices E and H) (Stringer, 2007, p.
55). Furthermore, the nature of action research made it ―imperative to ensure that all participants
know what is going on, that the processes are inherently transparent to all . . . they are in effect
engaging in a mutual agreement about the conduct of a study‖ (Stringer, 2007, p. 55). At the
beginning of all data gathering sessions there was verbal confirmation with all participants to
ensure they understood the contents within the signed informed consent form, knew that their
involvement was voluntary, and knew that they could withdraw at any time without judgment. I
offered to answer any questions to further clarify understanding of free and informed consent.
Respect for vulnerable persons
The principle to respect vulnerable persons asserts that we are obligated to protect those
who demonstrate a ―limited capacity, or limited access to social goods, such as rights,
opportunities and power‖ (Tri-Council, 2010, p. 10). I was not aware of any vulnerable persons
in my OLP process. The pool of participants invited were high-level executive leaders with
competent decision-making skills and, therefore, were not considered vulnerable people.
Respect for privacy and confidentiality
Respect for privacy and confidentiality is a two-fold principle. First, ―privacy refers to an
individual‘s right to be free from intrusion or interference by others‖ (Tri-Council, 2010, p. 55),
and second, ―confidentiality refers to the obligation of an individual or organization to safe-guard
entrusted information‖ (p. 56). The letter of invitations (see Appendices D and G) stated that the
research process would be kept private and that all documentation collected would be protected
and kept confidential. It was confirmed and ensured that storage of written records would be
under a locked security system, and that when the study was complete the information would be
disposed of in a timely and safe manner, such as being shredded.
Respect for justice and inclusiveness
Respect for justice and inclusiveness is a rule to ensure that participants ―neither bear an
unfair share of the direct burdens of participating in research, nor should they be unfairly
excluded from the potential benefits of research participation‖ (Tri-Council, 2010, p. 47).
Participants were all invited to contribute in an equitable manner and were all included in
learning the final recommendations and outcomes of the inquiry.
Balancing harms and benefits – minimizing harm and maximizing benefit
Researchers need to balance harms and benefits to consider ―the foreseeable risks, the
potential benefits and the ethical implications of the research . . . throughout the life of the
project‖ (Tri-Council, 2010, p. 22). This study had the potential to cause participants some harm
in the form of personal stress, because they were requested to give up valuable time from their
busy work schedules in order to participate. The focus groups could have potentially caused
stress associated with conflict and discomfort felt by sharing divergent opinions and viewpoints
openly in a group setting. It was observed that this dynamic did not occur with this group of
members. Foreseeable benefits gained were in the form of knowledge obtained and
recommendations delivered on leadership competency development to support the organizational
needs of VIHA. In addition participants may have felt benefit and personal satisfaction in
knowing that were assisting a graduate student in learning. In order to minimize harm interviews
and focus groups were offered at the most convenient time and location to cause the least
disruption to participants‘ work schedules. Knowledge acquired from this research was intended
to maximize benefit both to current and future employees in senior leadership at VIHA.
Participants were told that they would be fully informed of the knowledge gained and
recommendations made from this OLP.
Lastly, conflict of interest may happen when the interests of researcher and participant
conflict or compete, and is particularly problematic when ―the researcher is in a position of
power relative to the research participant (Palys & Atchison, 2008, p. 72). I did not experience
conflict of interest or position of power dynamics to be of ethical concern with my OLP. This is
due to the fact that I was external to the organization, and that I do not hold a director, vice-
president, or executive position in the health care system.
Summary
This chapter on research methodology has covered the inquiry approach, participant
selection, action inquiry team, inquiry tools, study conduct, data analysis, and ethical issues
involved in the research process. Chapter 4 will reveal findings from the data generated from the
inquiry study and will also draw upon inquiry study observations and references from literature
to formulate study conclusions.

CHAPTER FOUR: ACTION INQUIRY PROJECT RESULTS AND CONCLUSIONS
The purpose of this chapter is threefold: to discuss the inquiry project observations and
findings, to provide a robust set of conclusions, and to outline the scope and limiting factors that
affected the process of this study. The main inquiry question of this research inquiry study was:
How can Vancouver Island Health Authority support the development of leadership
competencies for employees targeted to move into executive-level positions? Three subquestions
supported the primary question:
in healthcare?
This chapter describes the findings and subsequent conclusions regarding essential
leadership competencies needed at an executive level at VIHA and also describes how to develop
and measure such high-level leadership. This chapter begins by sharing the main features of the
qualitative data gathered from the inquiry study participants at VIHA. Overall categories,
themes, and subthemes towards recommendations are divided into two main categories:
leadership competencies and leadership development. AI, which is a positive forward-thinking
approach, was used throughout the inquiry study.
Study Findings
Interview data
Invitations to participate in the interview phase of this study were sent to those employees
who work in the vice-president executive level of VIHA. Six of the eight vice-president and
executive vice president level employees were able to attend a face-to-face individual interview.
To protect anonymity of these participants, each recording and subsequent transcription was
securely stored and assigned a secret code, such as I-1, I-2, and so forth. Interview data were
disclosed by questions categorized into themes category, which are summarized in Table 1 found
at the end of this section.
Essential leadership competencies
Four of the eight interview questions aimed to discover the core leadership competencies
that are essential at the executive level. Two major competencies emerged as themes from these
interview questions: strategic awareness and EI. Participants were asked to rank the
competencies in order of importance. Five out of six participants placed strategic awareness as
the top first or second in priority of ranking. Four out of five participants ranked EI or elements
of EI as the first, second, or third in importance.
The first main competency was strategic awareness, which included subthemes such as
political awareness on many levels, systems thinking, critical and analytical thinking, change
management, innovation and risk management, and inquiry. One participant emphasized that
effective leaders must ―think strategically as opposed to tactically . . . strategic is global . . . you
need to look at all the variables, look at the whole picture and [gain] a 360 degree view‖ (I-1).
The second main competency was EI, which incorporated team collaboration,
interpersonal skills, developing others, trust and openness to others, collaborative spirit, ethics
and integrity, building a vision, being flexible, being courageous, and ability to suspend
judgment. Partnerships, and team collaboration was strongly emphasized across all of the
interview responses. One participant stated, ―A real leader knows their strengths and limitations
and knows when to bring in other folks‖ (I-3).

The third main competency that emerged from three of the six participants was the
importance of having health care experience and expertise in order to be an effective leader. One
participant articulated, ―Health care experience is important because we‘re here to help make
lives better for the people that we serve . . . and this is important in our thinking‖ (I-1).
Some participants struggled with ranking the leadership competencies due to the
importance of all of them. One participant stated, ―There are not any [competencies] that aren‘t
equally important‖ (I-2), and another stated, ―To be honest, for an executive role, you need to
have them all‖ (I-4).
Developing leaders
The remaining four interview questions focused on discovering participants‘ knowledge
and thoughts on: (a) successful ways to develop as an executive leader, (b) current leadership
development practices that VIHA could enhance and build on, (c) what an ideal leadership
development program (or programs) would look like, and (d) ways to influence retention of
future generation X and Y leaders. Three strong themes emerged from the data: leaders need to
be self-learners, leadership development is best gained through work-related activities in
combination with educational opportunities, and leadership development training needs to have
an individualized approach in concert with core curriculum.
The strongest theme that resonated with all participants when asked what they practice in
order to hone their own leadership competencies was one of staying current through self-learning
which included: ongoing reading, on-line courses, webinars, and networking at many levels at
VIHA and in the health care industry. One participant advised, ―There is so much learning on-
line now. In my world, there are lots of areas you can go to self-learn‖ (I-1). Another participant
stated, ―Networking and reading is critical‖ (I-5). In addition, ―webinars are useful when
something interesting comes up‖ (I-6). One participant acknowledged the importance of lifelong
learning by saying, ―The more I learn, the more I realize I don‘t know‖ (I-3).
Another theme that emerged was related to on-the-job opportunities. Four out of six
participants shared that they look for leadership growth at the workplace in activities such as
finding new work assignments or projects, using colleagues as their mentors, and being a mentor
or teacher to others in the organization. One participant shared, ―I mentor others and learn from
being a mentor. I seek mentoring with my colleagues in an informal way, for example with
something I‘m struggling with‖ (I-4). Another respondent reflected, ―Keeping current in this
industry is challenging‖ (I-5). This participant continued to state that executives need to ―look at
where there are things going on in the organization . . . if there is an opportunity to learn . . . dive
into it so you can learn from it‖ (I-5).
A third theme that arose was the use of sources outside of VIHA to hone leadership
capabilities through venues such as: conferences and seminars, targeted skill development
courses and university programs, engaging in new provincial initiatives, and using an external
leadership development coach. A few respondents mentioned the difficulty of finding the
dedicated time to taking courses and attending conferences. One participant said that enrolling in
conferences and courses ―depends on workload‖ (I-2). Another participant stated, ―Finding the
time to take a 2 week course is difficult‖ (I-5).
When asked the question on what leadership development support VIHA currently
practices that works well and what an ideal program for leadership competency development
should look like, four major themes arose. The first theme, unanimous amongst all participants,
was that of giving developing leaders personalized and individualized support. Participants
shared four avenues for such support: communicating directly with the new leader to identify
where they need to learn and grow, provide mentoring both formal and informally, establishing a
360-degree review to assess their capabilities, and hiring an executive coach. Participants shared
that leadership development should be delivered as an individualized learning plan combined
with some common curriculum and training and include a mix of theoretical and practical
content. To be considered in this core training is that newer leaders often ―have enormous
leadership skills, but need [to gain] management skills‖ (I-3). An individualized learning plan
ideally will ―be different for everybody . . . it will not be a cookie cutter approach‖ (I-2). A
common curriculum is important, but it is worth ―doing an assessment, so we don‘t send people
on courses that they have already done‖ (I-3).
The second theme discussed by four of the six interview participants was VIHA‘s two
internal leadership development programs. The LCP was shared as a new program that is
anticipated to have high potential toward developing executive-level leaders. This program is
coming into fruition concurrently with the timing of this OLP and is targeted to identify and
develop high-potential executive leaders from within VIHA. One respondent shared that the LCP
program is ―about grooming a person who would be the ultimate best fit . . . it helps the
individuals identify their career path‖ (I-5). Leading in a Learning Organization (LILO) is a
well-established one-year internal leadership development course offered to a wide variety of
employees from different levels and sectors at VIHA; three respondents saw LILO as favourable.
―LILO is well worth continuing and has had good success‖ (I-2); however, it is not targeted for
those leading at the executive level. VIHA also offers ―various one-day workshops and courses
that are great‖ (I-6).
Five of the six participants also chose to speak about the concerns and gaps in what
VIHA currently offers for leadership development. One participant reflected, ―As I moved up
into higher jobs, it would have been ideal to have resources on leading people‖ (I-6). Another
respondent shared, ―What we could be doing more is clear communication [when] working with
people to improve their leadership‖ (I-4). Another participant shared, ―There has been a gap at
VIHA—between management, and then what? There hasn‘t been a formal process‖ (I-5). One
respondent reflected that the LCP program could have the potential to send the wrong ―messages
to those leaders who haven‘t been picked [for the LCP]‖ (I-2). Lastly, a participant stated, ―In the
past it [leadership development at VIHA] hasn‘t been strategic enough‖ (I-3). This participant
continued on a positive note and stated about the LCP, ―We are trying to have an array of
offerings, but be strategic‖ (I-3).
The third theme shared by five participants was that of increasing the scope of work
experience. Participants believed that health care leadership experience at VIHA could be
enriched and gained through: job shadowing, secondments both internal and external to VIHA,
and assignments to special projects. The fourth and final theme that emerged in this section was
that of VIHA continuing to support employee educational opportunities, such as scholarships for
graduate level degrees, sending candidates on formal courses, and sponsoring employees to
attend relevant workshops, seminars and conferences.
The final question of the interviews focused on retention of the younger leaders of today
and tomorrow, commonly known as generations X and Y. This question seemed to generate the
most divergent scope of opinions. Three interviewees shared a theme of accommodation
through: being flexible (I-2, I-4, I-5), by offering them ―meaningful work‖ (I-4), providing them
―the variety they may be looking for‖ (I-2), by recognizing that they want ―challenge, flexibility,
innovation, empowerment, involvement, and respect‖ (I-4), and by realizing that ―they need to
release their creativity and knowledge . . . they value work/life balance . . . and don‘t want to
commit their souls to an organization like the baby boomers did‖ (I-5). Two participants did not
agree in entirety with this thinking. One interviewee admitted that the ―younger generation of
leaders will re-conceptualize leadership‖ (I-3); however, ―that this new generation is no more
different than when I was young‖ (I-3). One participant shared that ―literature discusses their
need for work–life balance and flexibility, but I don‘t buy it‖ (I-6). This person pointed out that
VIHA values the hard work, and that ―generation X and Ys who are already doing well at VIHA
get that piece. It is not an age thing, just a convenience thing‖ (I-6).
Summary
The interview data provided rich information on two primary overarching themes of the
inquiry questions namely, essential executive leadership competencies and strategies to develop
the competency levels of executive leaders. Table 1 delineates these two overarching themes into
related main themes and corresponding subthemes. Response rate are revealed by percentage of
respondents for each theme and subtheme that emerged.
Table 1
Interview Data Overarching Themes, Main Themes & Subthemes – Executive Level Leadership
Competencies and Leadership Development for VIHA
Percentage
of
Overarching Themes Related Main Themes & Subthemes Responses
Leadership Competencies Strategic Awareness 100%

Political awareness – all levels 50%
Critical/Analytical thinking 66%
Change management 83%
Inquiry, innovation, risk 50%
Emotional Intelligence 83%

Interpersonal skills/Relationships 66%
Team Effectiveness/Collaboration 83%
Developing & Enabling Others 50%
Ethics & Integrity 33%
Trust/Openness to others 16%
Leading vision 33%
Health Care Experience 50%
Leadership Development Self- Learning 83%

Reading 33%
Webinars/on-line learning 33%
Networking 33%
Workplace Experiential Opportunities 66%

On-the-job learning 16%
Using colleagues as mentors 33%
Being a Mentor/teacher to others 33%
Educational Opportunities 100%

Conferences & Seminars 33%
Courses/university education 83%
Provincial Initiatives 16%
External Leadership Coach 16%
VIHA courses 16%
Ideal Leadership Development Program 100%

Individualized support via: mentoring, 83%
360-degree review, executive coach
Core curriculum – theoretical and 50%
practical management content
Work Experience via: job shadowing, 83%
secondments, special projects
Supporting learning – financial 83%
resources for education/training
Consideration of generation X & Y 66%
VIHA‘s Current Leadership Development 100%

Offerings
LCP 66%
LILO 33%
Student coops 16%
Mentoring – informal 33%
360-degree reviews 16%
Education/conferences/workshops 50%
Note. VIHA = Vancouver Island Health Authority; LCP = Leadership Continuity Plan; LILO =
Leading in a Learning Organization.
Focus group data
Analysis of the interview data helped refine questions for the subsequent focus group,
which intentionally honed in on leadership competency development. Rich qualitative data were
generated from this focus group session. Participants discussed the topics throughout the focus
group with a sense of genuine openness, trust, and respect for each other. Many ideas and
opinions on leadership competency development were shared and built on, and it was noticeable
that judgment was suspended as genuine dialogue occurred. To protect anonymity of these
participants all participant quotations are cited using the code FG.
On-the-job leadership development
The first question asked group members to share what type of on-the-job leadership
development opportunities would be effective for those targeted to moving into an executive-
level role. This question generated a rich team discussion. Overall, participants shared the
following two main themes: (a) supported stretch assignments, which include new leaders being
involved in special projects, change management projects, job shadowing in new roles, attending
board and senior meetings, taking external courses that are based on real-workplace assignments,
taking on a teaching role, becoming involved in research; and (b) supported learning and
assessment through mentoring or coaching, 360-degree reviews, and self-assessment.
Stretch workplace assignments
One respondent recommended a ―supported stretch opportunity that is in line with your
current capability or [in a] capacity that is beyond your experience set‖ (FG). Another participant
shared that job shadowing is a way of ―just going out to see if you can experience what
somebody does and see if it really matches up with your view of what it is when you see that
group of people‖ (FG). Leaders can also learn by ―taking on teaching roles in the organization,
and becoming involved in research‖ (FG). In regards to attending board meetings and senior
discussions, one member stressed, ―Leadership development is just simply exposure so that
participation [is] almost silent participation‖ (FG). Participants agreed when one member said
that aspiring executive leaders need ―a balance of exposure‖ (FG). Another participant shared
that it is important for these new leaders to get ―in the moment opportunities, so we need to make
sure that [they] know large strategic decisions . . . to contextualize all those pieces and the
environment in which a decision has arrived‖ (FG). Lastly, one participant described the premise
of external leadership development courses described as ―applying some of the on-the-job work
and looking at it in a leadership development program‖ (FG).
Supported learning
Mentoring and coaching was the other theme of on-the job learning and was shared as
being an effective and supportive tool for leaders to safely assess, learn, and grow. One
participant shared that ―mentoring or coaching in general is a very good on the job support for
someone moving into a more senior position‖ (FG). In addition, ―mentors could be internal, or an
outside coach could be hired to come in a work with a senior leader‖ (FG). Participants also
agreed that 360-degree reviews are needed, providing that there was support after receiving
them. Included in this would be an ―opportunity for introspection, such as self-assessment‖ (FG).
Off-the-job leadership development
The second focus group question asked what type of off-the-job learning activities and
programs would be most useful and sustainable for those ready to move into a senior position.
Four themes were shared: relevant education, external secondments, governance experience, and
self-care. First, everyone agreed that a relevant formalized master‘s level degree program is
essential. Other leadership development programs were discussed, such as the Project
Management Institute courses, which has training that ―acts similar to on the training with your
partner and the courses‖ (FG). Secondments were also recommended for new leaders to ―get
exposure to other roles outside of one‘s area, even outside the organization‖ (FG). Another
participant suggested that aspiring leaders gain ―governance roles and volunteering, being part of
a professional institute‖ (FG) garnered much discussion and agreement in the session. One
participant emphasized the importance of self-care and the ability to ―deal with work–life
balance‖ (FG) due to the high demands that an executive-level job places on one‘s life. This
conversation generated many nods of agreement.
Content of LCP program
The next question was to generate information on what type of content and material
should be taught to those targeted employees in the LCP program. The first respondent
prescribed ―academic, experiential, and self-refection as a delivery mix for leadership
development‖ (FG). A dialogue then ensued regarding exposure and training on strategic
awareness, which tied into the strongly themed leadership competency fleshed out in the
interviews. During the discussion on strategic awareness development, participants stated that
this should include: ―the whole environmental context piece at a strategic level‖ (FG), ―a global
picture‖ (FG), and acquiring ―a 360-degree view‖ (FG) of the health care environment both
―nationally and internationally‖ (FG). EI was also a main feature in this part of the discussion,
resonating with the strong theme from the interviews in which EI was identified as a vital
competency. Group members discussed effective EI as: ―influencing others‖ (FG), ―building
relationships‖ (FG), ―maintaining personal integrity‖ (FG), ―learning to communicate with
language that is clear and concise‖ (FG), ―learning to expose yourself in front of the team‖ (FG),
and ―learning how to dance and quickly adapt to changes‖ (FG). Participants agreed that
strategic awareness is a piece of EI, as one needs to ―be able to shift quickly‖ (FG) and requires
learning of both skills sets. As demonstrated in the leadership competency diagram in Appendix
K, strategic awareness and EI are interdependent leadership competencies. Lastly, participants all
wholeheartedly agreed with this closing remark of this section: ―health care is a serious business,
but leaders don‘t have to be so serious‖ (FG). This comment generated a lively discussion with
laughter all round.
Evaluating leadership development
The fourth question asked the participants to comment on the best way to monitor and
evaluate leadership competency as individuals progress in learning to becoming a senior leader.
Participants‘ responses strongly suggested the use of formal assessment tools: 360-degree
reviews, formal performance evaluations, establishing review boards, and having a solid grasp
on core leadership competencies as a benchmark for evaluation and interpretation. In regards to
formal leadership evaluation, one participant said, ―The 360-degree tool is fabulous‖ (FG). A
participant shared, ―A performance evaluations tool . . . seems to be working fairly well in terms
of semi-annual and annual check-in points‖ (FG). Another participant presented an idea outside
of VIHA‘s practice, namely a review board, ―where you present your staff to a board . . . it‘s
really helpful in terms of understanding [employee] competencies and where they need more
help‖ (FG).
The theme of an informal approach emerged as a way to evaluate leadership
development. One participant shared that by having ―relaxing conversations, you can ask how
they are planning to do specific tasks and goals, and ask if they have seen any improvement‖
(FG). Also shared was the piece on introspection, in which aspiring executive leaders can self-
reflect ―what they have learned, gained, worked on . . . how they feel about their performance,
and why‖ (FG). Much discussion ensued throughout this section, revealing that evaluation of
leadership competencies can be left to one‘s personal interpretation and that what is needed is
―measurement against clear goals‖ (FG).
Summative executive thoughts
The last focus group question was an overview asking the team to share anything that
resonated for them. Just as in the interviews, the team reiterated the importance of new leaders
being able to grasp strategic awareness. Also shared in commonality with the interview answers
was the required ability to learn and master the many components of EI.
Collaborative executive team
What resonated the most from this final closing question and from the interview sessions
was the sense of high regard that these executives have on the functioning ability of their own
existing executive team. One interview respondent said, ―At our table we are high functioning, a
lot of respect, a lot of EI‖ (I-2). Another interviewee shared, ―Our team is most collaborative,
especially if one of us has a challenge that needs overcoming‖ (I-4). In the focus group it was
evident from the dialogue that this group of executives together agree that they collectively make
a well-functioning and cohesive team.
Summary
Table 2 summarizes the salient themes and subthemes collected from the focus group
data gathering session. The overarching aim of inquiry for the focus group was on leadership
development at the executive level at VIHA. The four main focus group themes that emerged
were as follows: on-the-job leadership development opportunities, off-the-job leadership
development opportunities, content of a leadership development program, and evaluating
leadership development.
Table 2
Focus Group Themes and Subthemes – Findings on Executive Level Leadership Development
Opportunities
Main Theme Subthemes
On-the-Job Leadership
Competency Development
Supportive Stretch Secondments, job shadowing, special assignments,
Assignments change management, attending senior meetings,
Supported Learning Mentoring & coaching, 360-degree reviews
Supportive Education Conferences, courses, graduate degree, university
diploma/certificate programs, external coach.
Off-the-Job Leadership
Competency Development
Education Formalized university masters degree, relevant
leadership/management programs & courses
Governance Experience Volunteer experience on boards, belong to a professional
institute or executive associations
External Secondments Outside of VIHA
Self-care Ability to deal with work–life balance
Leadership Development 3 Methods: Academic, Experiential, & Self-Reflection

Program Content
Strategic Awareness Whole environment context, global picture
Emotional Intelligence Building relationships, communication, team

collaboration, inquiry, adaptive leadership
Evaluating Leadership Formal mentoring, informal mentoring, 360-degree

Development review, performance evaluations, review boards,
external coach, leadership competency framework
Many common themes emerged throughout the interviews; these themes were
subsequently reflected and reiterated in the focus group dialogue. Especially worthy of note was
the emphasis on the importance of new leaders acquiring a solid grasp on strategic awareness
and planning, combined with the ability to master a level of high EI, in order to be able to work
within VIHA‘s collaborative executive team. Both data gathering methods uncovered the
importance for new leaders to have the opportunity for supportive workplace and academic
learning. In addition, learning through ongoing personalized assessment methods such as
mentoring, coaching, and 360-degree reviews was consistently expressed as effective and
informative in leadership development. Lastly, being a collaborative team player was threaded as
a common opinion throughout the inquiry study process. The findings from both the interviews
and focus group together provide a foundation towards conclusions and are shared in the next
section of this chapter.
Study Conclusions
This project was an opportunity to access the wisdom and wealth of knowledge of many
experienced executive-level health care leaders at VIHA. Each of these participants appeared to
genuinely engage in the inquiry study process, providing rich ideas and information towards
many findings and subsequent conclusions. This OLP aligns with the emergence of VIHA‘s new
LCP; therefore, the lens of the new LCP program is woven throughout the conclusions and
recommendations.
This section provides four main conclusions: (a) the new LCP program could benefit
from an executive-level leadership competency framework that highlights the importance of
strategic awareness and EI; (b) VIHA would be able to enhance the learning and development of
their targeted new senior leaders by offering supportive learning experiences through practical
workplace experiences in concert with development courses and academic learning
opportunities; (c) supportive personalized assessment tools such as mentoring, coaching, and
360-degree reviews are necessary for ongoing evaluation of leadership development progress;
and (d) a culture that encourages individual and team learning would enhance the current
executive team, the targeted new LCP leaders, and the organization as a whole. These
conclusions are based on a thorough academic literature search threaded with the findings from
data generated from this collaborative group of executives at VIHA.
Conclusion 1: VIHA executive-level leadership competencies
Strategic awareness and emotional intelligence
The results from the findings indicated that many leadership competencies are needed at
the executive level. In particular, strategic awareness and EI are the two paramount overarching
and interdependent competencies that must be highlighted as two essential competency areas
needed for the development of emerging VIHA executive leaders. Strategic awareness or
strategic planning is an essential executive directive function that encompasses improvement
planning and visioning, both here and now and for the future. Effective strategic leaders are
―envisioning a better future that includes improved processes, new technology, and new
behaviors based on the degree of effectiveness of existing processes‖ (Porter-O‘Grady &
Malloch, 2007, p. 552). Morrison (2000) discussed strategic planning as a combination of ―the
power of new information technology, the needs and wants of sophisticated consumers, and a
broader definition of what creates health to imagine a better future‖ (p. 207). All in all, capability
in strategic planning is necessary because ―leadership without direction is useless‖ (Wilhelm,
1996, p. 222). Furthermore, execution of strategic planning is as only as good as the
interpersonal skills of the executives and the efforts of their team collaboration, as heard clearly
in the interviews and focus group.
EI can be seen as a ―construct that unifies a slate of interpersonal skills‖ (Dye & Garman,
2006, p. 18) and involves ―understanding and working with other people‘s emotions while
understanding and managing your own emotional responses‖ (p. 18). Capability in forming
positive relationships and engaging many stakeholders impact the effectiveness of strategic
planning and moving visions forward. Kouzes and Posner (2007) summarized the relationship
between EI and strategic planning as ―success in leading will be wholly dependent upon the
capacity to build and sustain those human relationships that enable people to get extra-ordinary
things done on a regular basis‖ (p. 25). Lastly, Morrison (2000) asserted the importance of
emotionally intelligent teams:
Leaders play a key role in strategy innovation, but they do not have to do it all
themselves. Rather, they need to create the environment for innovation in strategy . . . to
build an ecosystem in which strategy innovation can flourish than to single-handedly
create the product. (p. 211)
VIHA executive-level leadership competency framework
It is evident from data collected from the participants that executive leaders at VIHA
need a common set of defined competencies and capabilities from which to identify, monitor,
and assess leadership growth and development of their new LCP leaders. One can conclude that
it is best if the executive staff at VIHA share similar language from within a health care
framework to yield a common foundation for competency description and provide a means for
ongoing evaluation. ―By meeting as a group to develop shared competencies, you can help staff
develop their own language . . . [which] can over time turn into process improvement meetings
in which performance-related dialog is present‖ (Dye & Garman, 2006, p. 220). Furthermore, a
comprehensive leadership framework designed for the health care environment will help ―create
a definition of exceptional health leadership that would guide program development, selection
processes, and recruitment of leaders‖ (Dickson, 2010, p. 1). This framework should identify
both the management and leadership as a complimentary set of capabilities required (Dickson,
2010, p. 2) and incorporate the findings on leadership competencies from this inquiry study.
Conclusion 2: Supportive learning opportunities
VIHA can strategize to support the leaders in the LCP program by providing a mixed-
model support for both practical workplace learning experiences and academic learning
opportunities. McAlearney (2008) described that both leadership education and training
programs help leaders meet their ongoing development needs (p. 320). Study findings indicated
that LCP participants would best learn and develop through experiential real-life work
opportunities in concert with a training program that offers a core and common curriculum. A
theoretical and academic component is also important for emerging leaders, and an executive
must obtain a relevant graduate-level education. Study findings also indicated that mentoring and
coaching, internal leadership development opportunities, and a variety of internal and external
learning and development courses and activities are all ideal for developing and assessing
leadership competencies.
Garman, Tyler, and Darnall (2004) asserted that formal education is a good foundation
for leadership skill development; however, most learning is acquired on the job through actually
experiencing a task or situation (p. 308). Therefore, much of the skill development needed occurs
right at the work setting (Garman et al., 2004, p. 308). ―Effective leadership training requires a
strong focus on the context and content of the leader‘s work and organization‖ (Shashkin &
Shashkin, 2003, p. 142). VIHA executives clearly shared that one cannot learn what it takes to be
an executive without exposure and experience firsthand at the work setting, especially in regards
to learning the thinking and actions behind decision-making in strategic planning. Leadership
training for VIHA executives must incorporate a good mix of practical and theoretical training;
however, it is imperative that new developing leaders receive ample opportunity for supported
on-the-job experiences to move them to new levels in leadership capabilities.

Conclusion 3: Supportive personalized development through assessment tools
Mentoring and coaching
Study participants indicated that those targeted to work in the senior arena need to be
guided in their development by having an individualized plan tailored to their learning needs.
Interview participants stated that each person moving through the LCP must do a thorough
assessment of where they have strengths, where they have challenge areas, and identify the gaps
and hone in on these for further development. LCP leaders need a supportive communication
avenue where they can continually communicate their learning and growth as they progress in
their journey towards an executive role. Mentoring and coaching was frequently suggested in as
ideal for ongoing individualized growth support.
Mentoring and coaching are two popular interactive approaches of supporting leadership
development and can be offered both formally and informally (Conference Board of Canada,
2007, p. 15). Dye and Garman (2006) viewed mentoring as especially important for identifying
career development for protégés and defined mentoring as ―the actions leaders take to support
the long-term growth of their direct reports‖ (p. 96). Many VIHA executives shared that they
currently informally mentor their direct reports, and that a more formal mentoring program
would be also be effective in developing leaders. Mentoring is traditionally viewed as a dyadic
relationship between a senior employee, as an advisor, and a junior employee, as the mentee
(Higgins & Kram, 2001, p. 264). A mentor can be seen as: a teacher who focuses on developing
the student‘s skills, a sponsor who shares his or her wealth of network contacts, a counselor
providing insight, and a social guide (Walker et al., 2002, p. 3). The mentor can be valuable to
increasing the learning capacity of a team or an organization, as they ―may provide a standard of
excellence that the protégé will aspire to surpass‖ (Walker et al., 2002, p. 3).
Some VIHA executives shared the value in having an executive coach for helping with
leadership development and communication. Coaching can be defined as ―the process by which
individuals impart advice or expertise in tutoring or collaborative situations to develop the
professional or organizational performance of other workers‖ (Conference Board of Canada,
2007, p. 15). Mentoring concentrates on teaching and transferring knowledge and skill
(Conference Board of Canada, 2007, p. 15), whereas the coach, like the coach of a sports team, is
―about the development of knowledge and skills‖ (p. 15). Walker et al. (2002) asserted,
―Coaching is a managerial technique to develop an explicit set of employee expectations‖ (p. 3).
The organization rather than the protégé is usually the benefactor of coaching (Walker et al.,
2002, p. 3). Both mentoring and coaching are highly supportive and personalized; therefore, both
approaches are interactive and provide individualized learning and assessment of each emerging
leader‘s unique needs.
Feedback programs: 360-degree feedback
Many VIHA executives spoke highly of the use of a 360-degree review program for their
protégées. VIHA has a current 360-degree feedback tool that is used for managers and senior
leadership staff (K. Pettit, personal communication, August 31, 2011). Many participants also
spoke of the importance of emerging leaders having opportunity for self-assessment. A 360-
degree feedback program consists of a survey instrument regarding relevant leadership
competencies, which provides feedback used for development or performance appraisal of an
individual candidate, a team, or of an organization (Dye & Garman, 2006, pp. 223–224).
Anonymous feedback is solicited from a variety of sources such as work peers, supervisors,
subordinates, clients (Dye & Garman, 2006, p. 223) as well the candidate being assessed
contributes his or her self-assessment to the instrument (Yukl, 2010, p. 212). A 360-degree
program reveals information on a leader‘s behaviours and skills and identifies strengths and
developmental needs (Yukl, 2010, p. 211). Seeking honest feedback, such as through a 360-
degree review program, is necessary for a leader to learn and grow and is a powerful tool for
eliciting self-improvement (Kouzes & Posner, 2007, pp. 85–86).
Conclusion 4: VIHA as a learning organization culture
Self-learning
It is evident that those who strive to lead at an executive level need to adopt a mindset of
being responsible for many aspects of their own leadership development. All executives new and
old need to be able to stay current in the ever-changing health care industry; executives also need
to be partly self-accountable for navigating this. Staying current is especially true in today‘s
climate, seeing that ―the leader of the future will face different and in many ways more
challenging demands than the leader of the past‖ (Goldsmith, 1996, p. 235).
New leaders in the LCP program should be committed toward filling their vessel of
leadership goods with unlimited abounds. Senge (2006) discussed that leaders need to be
disciplined in learning skills and competencies and could develop these through commitment to
their own dedication to lifelong practicing, otherwise known as personal mastery (pp. 7, 10). In
addition, ―personal leadership capacity grows from a long-term commitment to self-
understanding; to character development; to growing one‘s connection to the spirit of others‖
(Dickson, 2003, p. 5). An ongoing quest for self-improvement and learning is a key ingredient
for effective leadership; it must be an evolving, limitless activity and responsibility of every
emerging and dedicated leader of VIHA.

Team learning
As mirrored by the VIHA executive team responses in this study, Senge (2006) asserted
the importance of team collaboration and team learning, in which ―we can be more insightful,
more intelligent than we can possibly be individually‖ (p. 221). Senge asserted that it is critical
to master team learning towards building a learning organization (p. 221). Leatt and Porter
(2003) agreed and stated, ―Leadership development is not done solely to improve the leadership
skills of one individual but is an essential component of the development of the organization as a
whole‖ (p. 15). Findings demonstrate that VIHA executives value the nurturing and cultivating
of a learning culture. What is needed is a strategic and more formalized approach towards team
learning and organizational growth. As Senge (2006) so aptly told his readers, ―An
organization‘s commitment to and capacity for learning can be no greater than that of its
members‖ (p. 7). Emerging executive leaders need a supportive learning culture with formal
resources in place to self-learn, to assist in one another‘s in learning, and in learning as a team—
all towards the dedication of a learning mindset for the good of the organization as a whole.
Summary
The above conclusions reflect VIHA‘s current executive team‘s strong knowledge base
and dedication towards supporting leadership development. The insightful and informative
responses from the participants aligned with a plethora of strong literature towards these
conclusions and ensuing recommendations on best practice for executive-level leadership
development at VIHA and in the health care sector in general.
Scope and Limitations of the Inquiry
The focus of this study was to discover through the wisdom of VIHA‘s executive team,
knowledge on essential executive-level leadership competencies, and supportive strategies for

developing senior leaders at VIHA. The scope of information that I had the honour to collect as
data, and subsequently analyze, was rich and vast. However, circumstances particular to the
nature of this inquiry study have created some limitations (Glesne, 2011, p. 212) and are
discussed below.
Six participants from a total of eight executive vice-president level positions of VIHA
were able to participate in private one-to-one interviews. One limitation to the interview process
was that the participant pool invited was restricted solely to the vice-president and executive
vice-president level of the executive team. Interviews are an opportunity for drilling down for
deep information and knowledge. By not interviewing a wider range of the executive team,
valuable, rich data may have been missed. Another limitation was the fact that all interviews
were scheduled on two separate days of the same week. This tight timeline may have hampered
the ability of the outstanding two executive members from being available for the interview
process.
The time allotted as part of the senior team meeting for the focus group was kept to a
strict 60 minutes. This time constraint may have restricted some focus group members from
sharing or exploring topic ideas to their fullest potential breadth and depth.
Further limitations were that this study did not include the participation of other
important leaders, such as directors and managers or any of the LCP new targeted leaders.
Leaders at all levels have different perspectives and, therefore, have much to share and teach
each other. By not including these other valuable VIHA leaders, important viewpoints may not
have been fully captured. The directors and managers that report to each of the vice-president
portfolios would have enriched the data for this project, by sharing knowledge from their
perspectives and experiences in the organization. Furthermore, the selected individuals in the
LCP program could have contributed a different lens on what they think it is that they would
need for supportive leadership competency development.
Summary
The timing of this inquiry study aligned concurrently with the launching of the LCP
program. The participants portrayed a genuine sense of interest and dedication toward the action
inquiry process. These executives openly welcomed me and trusted me to conduct this inquiry
study in the privacy of their own offices and boardroom. VIHA executives have demonstrated
true leadership in this study: a willingness to impart their knowledge, an openness to share and
learn in front of their team members, and most of all, to assist in my learning in a graduate
leadership development program. The next chapter will provide corresponding recommendations
based from the inquiry study findings and conclusions.

CHAPTER FIVE: INQUIRY IMPLICATIONS
This chapter presents recommendations for VIHA on executive-level leadership
competency development, organizational implications of each recommendation, and
considerations for future research on this topic. The main inquiry question of this research
inquiry study was: How can VIHA support the development of leadership competencies for
employees targeted to move into executive-level positions? Three subquestions supported the
primary question:
in healthcare?
Study Recommendations
Recommendations within this report are founded on the data generated from the action
research inquiry study, a robust academic literature search, and from my own notes and
observations. Concurrently with this OLP, VIHA is launching their LCP as a supportive strategy
for developing in-house executive leadership talent. The lens of this developing LCP is reflected
in the recommendations. Five key recommendations are as follows:
1. Adopt the LEADS in a caring environment leadership competency framework.
2. Offer formalized on- and off-the-job leadership development programs.
3. Offer a formalized mentorship program.
4. Implement a supportive 360-degree review feedback program.
5. Create a learning environment and team cohort model.

There are many avenues and options to consider when choosing how to develop leaders,
especially at the senior level of an organization. Leatt and Porter (2003) claimed that leadership
development must be competency-based and assessment-oriented and should include the
following stages: graduate leadership education, management training through field experiences
or fellowships, 360-degree feedback and coaching, formal mentoring, and intense leadership
development experience (p. 27). Aspects of these leadership development components are
discussed within the recommendations.
Recommendation #1: Adopt the LEADS in a caring environment leadership
competency framework
Discovering the essential competencies needed at the executive level was an important
underpinning of this project. ―Specification and evaluation of competencies is seen as a critical
step toward improving professional education and ensuring alignment between individual
development and the needs of organizations and professions‖ (Calhoun et al., 2004, p. 421).
In 2006, The BC Leaders for Life program designed a pan-Canadian leadership
competency health care framework endorsed by the CCHL known as LEADS, an acronym that
stands for leads self, engage others, achieve results, develop coalitions, and systems thinking
(Dickson, 2010, pp. 1–3). The VIHA executive team will require a leadership competency
framework that is tailored to their unique organizational needs, while being pertinent to the
Canadian health care system. In particular, the LEADS in a Caring Environment Leadership
Capabilities Framework is recommended for VIHA to adopt, as seen in Figure 1. This
framework is recommended for four reasons: first, it defines a benchmark of core competencies
needed overall for today‘s Canadian health care leaders (Calhoun et al., 2004, p. 421); second, it
highlights VIHA‘s two overarching and essential executive competencies of strategic awareness
(worded as strategic processes) and EI (worded as personal processes); third, it brings together
the importance of leadership and management capabilities together as complementary skill sets
(Dickson, 2010, p. 2); and fourth, it encompasses working towards a common organizational
vision and incorporates caring in the title to emphasize ―delivering the best service with
compassion, respect, and empathy‖ (Dickson, 2010, p. 4). Furthermore, competency models can
address the development of EI, as they ―can help articulate the behavioral implications of a
strategic vision‖ (Garman & Johnson, 2006, p. 14).
This framework will provide the VIHA executive team an established tool from which to
provide assessments, feedback, and guidance to developing leaders. According to Dye and
Garman (2006), having a common understanding of competencies will ―help staff develop their
own language and reach a comfort level with it‖ (p. 220). Competency tools can also ―be used to
clarify an individual‘s roles, performance expectations, and plans for development‖ (Garman &
Johnson, 2006, p. 14).
It is recommended that VIHA use this competency framework to formulate personalized
leadership development plans for each prospective executive leader. Kotter (1999) stressed that
when it comes to developing executive leaders, ―the key ingredient appears to be an intelligent
assessment of what feasible development opportunities fit each candidate‘s needs‖ (p. 65). Each
leader brings different experience sets, skills, capabilities, and personal attributes to the team. A
leadership framework will then provide an avenue for important dialogue on individual
educational and leadership development (Robbins et al., 2001, p. 189) and also facilitates
feedback necessary to identify strengths and gaps (American College of Healthcare Executives,
2008, p. 1; Robbins et al., 2001, p. 194).

Figure 1. LEADS in a caring environment leadership capabilities framework.

Note. From The LEADS in a Caring Environment Leadership Capability Framework (p. 6), by
G. Dickson, 2010, Ottawa, ON, Canada: Canadian College of Health Leaders. Copyright 2010
by G. Dickson. Reprinted with permission.
Recommendation #2: Offer formalized on- and off-the-job leadership development
programs
It is recommended that VIHA offer developing executive leaders a comprehensive
leadership development program, by engaging them in both on- and off-the-job learning
opportunities. Leadership development through real work experiences and through off-the-job
learning activities ―can be complementary and mutually reinforcing‖ (Edmonstone & Western,
2002, p. 38).
First, it is important that leadership development programs are strategically offered
through formalized real workplace experiences (Anderson et al., 2009, p. 2). It is estimated that
―70% of what a worker knows about successfully performing a job comes from direct experience
gained from doing the job itself‖ (Echols, 2007, p. 37). Many executives at VIHA expressed that
leadership development would best be optimized through supported on-the-job experiences such
as job shadowing, new work assignments and projects, attending senior meetings, and being
seconded to new work environments.
Leadership is practiced in the details and must be learned close to where the tire hits the
road. In an organization that sees the talent pipeline as central to its adaptive potential,
people deep in the organization need clear on-the-job guidance to learn where they can
make their greatest contribution going forward and what must happen to maximize their
potential. (Heifetz et al., 2009, p. 104)
It is further recommended that supportive stretch assignments at VIHA be organized and
offered to learning leaders on a rotational basis amongst the varying executive portfolios (see
Appendix A for organizational chart). It is suggested that a select committee from the VIHA
executive team meet on a regular basis to orchestrate this rotational job experience plan. These
members will need to consider: length of each rotation, placements based on individual learner‘s
experience and needs, and the time commitment to evaluate and support the process. Lastly,
Edmonstone and Western (2002) warned that with work-based learning, one must be careful not
to be ―task focused, rather than development orientated‖ (p. 38).
Gaining real work experiences from many or all portfolio areas will allow participants to
incorporate new ―perspectives of patients, families, and colleagues in their immediate team,
wider organization and health economy‖ (Anderson et al., 2009, p. 2). Gaining knowledge in
strategic awareness has been expressed by the VIHA executive team as a vital leadership
capability essential at the senior level. Rotational on-the-job experience through different
departments will give developing leaders the comprehensive breadth and scope of strategic
perspectives needed. Inherent in this arrangement will also be the ongoing evolvement of one‘s
EI, as developing leaders will be required to learn to lead in varying team and work situations
and cultures.
According to Echols (2007), it is recommended that organizations strategize to provide
30% of leadership training through formal learning activities and courses (p. 37). The next part
of this recommendation is for VIHA to offer and support this 30% through educational training
and development that focuses on leadership studies primarily aimed at the health care sector. A
short-term educational strategy could include sending candidates to participate in various
ongoing educational opportunities such as web casts, conferences, and seminars hosted by
affiliates such as CCHL and Health Care Leaders Association of BC. A longer-term educational
strategy that requires more commitment for both parties would be to offer formalized academics
from an accredited university that specializes in teaching a leadership certificate or graduate
program in the health care sector. VIHA needs to consider the following: scope of course
content, choice of academic institutions to employ, granting the time needed for learners to thrive
in their studies, and educational funding to be offered.
Recommendation #3: Offer a formalized mentorship program
VIHA executives shared in the inquiry process their keen interest in providing supportive
feedback to developing leaders through mentoring. It was also heard that many mentorship
arrangements at VIHA were on an informal and friendly basis. Thus, the first part of this
recommendation is for VIHA‘s executive team committee to formalize an in-house mentoring
program to support the newly emerging executive leaders. Porter-O‘Grady and Malloch (2007)
described mentorship as, ―Feedback and counsel from trusted, competent colleagues specific to
improving the quality of one‘s work life, learning to prioritize effectively, and advancing one‘s
career is essential in the journey to leadership excellence‖ (p. 541). A mentoring program can be
implemented fairly easily and quickly and can reap many benefits to the individuals and the
performance of the teams and organization itself (Dye & Garman, 2006, p. 96). In addition, the
BC Health Authority Provincial Leadership Collaborative is an initiative that aims to assist
health authorities in BC develop mentoring and coaching programs for leadership development
at early, mid-career and senior level (K. Pettit, personal communication, August 31, 2011).
VIHA is currently investing in accessing this supportive initiative (K. Pettit, personal
communication, August 31, 2011).
Mentoring can be conducted face-to-face, by telephone, email, and even via a well-
designed web-based program. It is most ideal if a face-to-face mentorship program were
established; this will allow support on a personal level and will foster an environment of trust,
commitment, and accountability from both parties. It is recommended that the mentorship
arrangement be on a rotational basis in alignment with the rotational stretch assignment plan
recommended above. Rotating mentors from different departments can give each emerging
executive leaders the opportunity to gain the supportive perspective of a wide variety of leaders.
When designing a formalized mentorship program, one must consider: the time investment
needed for both parties, the careful planning required to support skill and career development for
protégées, and awareness of the needs of developing individuals whilst remembering the needs
of the organization itself (Dye & Garman, 2006, p. 96).
New leaders can also work through a self-development plan as part of the mentorship
experience. Dye and Garman (2006) described this plan similar to a business plan in which the
learner identifies short- and long-term goals, objectives, and resources needed (p. 203). A
personal development plan is ―focused more on personal development issues, with the prime aim
being for the participant to reflect on the findings with the help of an assessor‖ (KM Research
and Consultancy, 2010, p. 12). This personal development plan can be part of the 360-degree
review program discussed in the next section.

Recommendation #4: Implement a supportive 360-degree review feedback program
It is recommended that the VIHA adopt a mentor-supported 360-degree review web-
based program for emerging executive leaders, in which emerging executive leaders obtain
confidential feedback from subordinates, peers, and their managers at regular intervals. Research
showed that ―these tools can be beneficial for personal, team, and organizational development
(KM Research and Consultancy, 2010, p. 4). The use of 360-degree review tool is often seen by
some organizations as being primarily a performance review. However, according to the KM
Research and Consultancy (2010), it is not best practice to use this tool as a means of ―appraisal,
promotion, or rewards‖ (p. 13). Although sometimes difficult to separate, the 360-degree review
should instead place emphasis on a leader‘s ―personal development issues‖ (KM Research and
Consultancy, 2010, p. 11) and ―skills and abilities‖ (p. 13). It appears that this assessment tool
greatly assists leaders in honing in on leaders‘ EI. According to an in-depth study conducted by
the KM Research and Consultancy (2010), many executive health care leaders reported that the
360-degree feedback helped them realize the effects their behaviours, discover strength and
challenge areas previously unaware of, and feel empowered afterwards to work on areas
identified (pp. 5–6).
It is important to use a feedback instrument that is tailored to the uniqueness of the health
care sector since many 360-degree tools designed for other sectors do not easily apply (Garman
et al., 2004, p. 308). VIHA already has established a 360-degree tool called Insight 360 that is
used as a performance evaluation tool. However, it is suggested that they also consider adopting
the Leaders for Life 360 program designed especially for assessing leadership development at
the senior executive level in health care (G. Dickson, personal communication, August 5, 2011).
This tool would dovetail with the LEADS competency framework outlined in Recommendation
#1. Appendix L briefly explains the 360-degree executive-level program offered by Leaders for
Life.
Lastly, the success of a 360-degree review feedback program is greatly dependent on the
―quality of assessors and the encouragement of self-reflection and follow up‖ (KM Research and
Consultancy, 2010, p. 12). The 360-degree review process ―definitely needs a follow up plan.
Without follow-up it can be a waste of time‖ (G. Dickson, personal communication, August 5,
2011). It is, therefore, recommended that the VIHA executive mentor who is currently assigned
to the protégée should provide much-needed support and guidance for protégés to process and
handle the feedback.
Recommendation #5: Create a learning environment and team cohort model
This last recommendation is based on the premise that developing executive leaders need
to be immersed in a corporate culture that is steeped in an environment open to shared learning.
Edmonstone and Western (2002) discussed that leadership development is a team activity and
that ―there are limitations on what any one person can achieve because organizational culture is a
social, not an individual phenomenon‖ (pp. 35–36).
It is recommended that VIHA adopts a learning cohort model for shared learning
amongst all targeted executive leaders by organizing and offering: (a) access to on-line resources
that includes a robust library of articles, books, and journals on relevant leadership and
management topics; (b) resources and support to join relevant nonprofit professional associations
that encourage health care leadership development such as CCHL, Health Care Leaders
Association of BC, Leaders for Life, and Emerging Health Leaders Association; (c) a university
certificate or graduate leadership program that combines some face-to-face learning combined
with on-line cohort learning in which learners elect many courses based on individual learning
needs and enroll in core courses as required content; and (d) a formalized support cohort at
VIHA allowing emerging executive leaders to discuss, support, and learn from each other
through each sharing their professional development journeys. Even if learners are at different
stages in their experiential and academic process, both an on-line cohort academic forum and a
VIHA learning support group can be arranged so that the learning and support amongst the
leaders will be relevant and useful for learners in all developmental phases. ―Learning teams
need ‗practice fields‘, ways to practice together so that they can develop their collective learning
skills‖ (Senge, 2006, p. 240). Lastly, it is suggested that each emerging executive leader be given
approximately 2 years of concentrated leadership educational time. Three main considerations of
supporting an academic program are: the amount of funding resources needed for each learner,
the relevancy of course content to the real work place, and the recognized time required for each
learner to be successful in engaging in his or her studies.
Organizational Implications
In order for a leadership development program to be effective, ―leadership development
itself needs to be well led‖ (Edmonstone & Western, 2002, p. 46). It is imperative that those in
the VIHA executive team who are dedicated to rolling out the LCP program, ensure that they
create a supportive environment and dedicate the necessary time and energy needed to focus on
the success of developing their future executive leaders. As mentors, senior leaders will need to
bring to the table their own set of leadership expertise and capabilities, the ability to give
ongoing personal guidance to others, and the wherewithal to strategize their commitment to this
program in an ever-changing and highly demanding work environment. In addition, mentoring is
a complex skill that takes education and practice to master (Dye & Garman, 2006, pp. 104–105).
Thus, some VIHA executives who elect to become mentors may need coaching and training to
learn effective mentoring tactics and techniques.
The leadership competency framework in Figure 1 can be adopted immediately and can
serve as a common guide to determine and evaluate essential competencies of executive leaders.
It must be recognized that ―ongoing educational and professional development experiences will
need to be grounded in the utilization of competencies that reflect best practices as well as
impact organizational effectiveness‖ (Calhoun et al., 2004, p. 438).
One must consider that leadership competencies identified as needed today will not
necessarily mean that these will be the same set of competencies needed tomorrow. Hewitt
(2006) asserted that the health care system must address the issue of ―changing competency
requirements‖ (p. 9). VIHA‘s executives must carry with them a continuous awareness and quest
for adaptive leadership development in response to the needs of the health care system as it
continues to transform. Therefore, it is important that the LCP program commence at a fairly
urgent pace. According to Kotter (2007), ―getting a transformation program started requires the
aggressive cooperation of many individuals‖ (p. 97). It would benefit VIHA to immediately start
the overall processes, ensuring a dedicated timeline of approximately 2 years of concentrated
training for each developing leader. The recommendations given in this report today, may not
apply even 3-5 years from now. In the future, executive team members must remain flexible,
adaptive, and open to change in order to stay attuned to this issue.
It is evident that leadership development can happen through many methods such as work
experience, education, mentoring, feedback programs, and supportive learning groups.
Leadership development tends to be viewed as an informal activity and one must be aware that
continued supported guidance is needed to recognize and assess the learning (Edmonstone &
Western, 2002, p. 38). This reinforces the need for maintaining a formal leadership development
strategy with ample supports in place for the learning leaders. Furthermore, with continuous
efforts towards developing a collective learning mindset, VIHA has ―the potential to develop
their own stock of human capital through learning‖ (Echols, 2007, p. 37).
Part of developing leaders is the ability to cultivate a trusting environment in which
leaders can accept honest feedback from one another. According to Kouzes and Posner (2007),
leaders should demonstrate to others the willingness to take the risk of receiving feedback
(p. 87). ―If leaders want to know what kind of leaders they are, they need only look into the
mirror of their staff; reflected back will be the quality of their leadership‖ (Porter-O‘Grady &
Malloch, 2007, p. 199). Kouzes and Posner (2007) also asserted the importance of creating a
work climate for learning that includes a ―spirit of inquiry and openness, patience, and building
in a tolerance for error and a framework for forgiveness‖ (p. 201). In order for leaders to learn
together, people need to acknowledge both what they know and do not know, and be able to take
risks and learn from their mistakes without feeling judged (Heifetz et al., 2009, p. 106; Kouzes &
Posner, 2007).
It is also important that the executive team and the developing leaders at VIHA deeply
believe in the LCP program. Leatt and Porter (2003) purported ―readiness to learn along with
appropriate climate is key to effective leadership development‖ (p. 21). The LCP program will
demand learning not only for the targeted learners, but also from the executive team who will
engage in their own learning through giving and receiving feedback, challenging the learners,
and strategizing to give continuous support.
Just as we need more people to provide leadership in the complex organizations that
dominate our world today, we also need more people to develop the cultures that will
create that leadership. Institutionalizing a leadership-centered culture is the ultimate act
of leadership. (Kotter, 1999, p. 65)
According to Calhoun et al. (2004), ―Improving healthcare management education and
leadership development across all career levels (early, mid, and advanced) is pivotal to any long-
term, substantive improvements in clinical care and to the delivery of healthcare services‖
(p. 421). VIHA is committed towards employee development (VIHA, 2009, p. 38), and the LCP
plan currently aimed at the executive level is an important part of this. VIHA will need to
consider how they will transfer the knowledge gained from the LCP process at the executive
level, in order to expand such a program successfully into other professional areas and
geographical areas to address the notion of distributed excellence in leadership for quality care
that contributes to a sustainable health care system. Without concerted efforts towards employee
professional and leadership development, VIHA‘s level of quality and delivery of care to all
constituents may be put at risk. Leadership development at all levels is a necessary system-wide
and shared capability that ultimately impacts all stakeholders, especially the clients served.
Implications for Future Inquiry
The leadership development recommendations within this report were aimed mostly at
the local level within the confines of VIHA. It could be useful to consider involving and
incorporating coalitions and partnerships outside of VIHA‘s local community, for the purpose of
sharing and nurturing quality health care leadership development throughout the province,
nation, and even worldwide. For example, a web-based mentoring program for health care
executives throughout BC or Canada could be considered a possible tool for leadership
development. Secondments may not have to be adhered to strictly within the walls of VIHA.
External secondments or even trading of employees with other health authorities or related health
care organizations within BC or nationally could be considered as a viable future leadership
development work experience opportunity option. In addition, developing a national on-line

health care learning community as part of a Canadian leadership development campaign could
also be a consideration. As Dickson (2003) so aptly stated, ―Leaders need to build coalitions with
academics and other leaders to ensure that all the knowledge can be brought to bear‖ (p. 7). This
sharing of knowledge and building of partnerships could very well support and enhance the
scope leadership capabilities locally and beyond.
Hewitt (2006) asserted, ―The actions of health leaders and managers directly impact their
communities as well as the quality of health care services across the country‖ (p. 7). Thus,
through the next few decades, well-developed future executive leaders at VIHA have the
potential to greatly influence the quality and delivery of health care on many levels; locally,
provincially, and even nationally.
The LCP program together with any actions taken from the recommendations of this
project could change and influence the executive team‘s future leadership capabilities at VIHA.
After experiencing a concentrated 2-year executive competency development plan, the newly
developed executive leaders could consider providing, either independently or collectively, a
report of their own leadership learning journey for the benefit of many to learn from. New
knowledge and experiences including failures and successes experienced can subsequently be
shared with others in the industry. Sharing of this knowledge could have a positive ripple effect
on leadership in the health care system in BC and even across Canada. Furthermore, ―knowledge
arbitrage is the process of exchanging, transferring, and brokering knowledge from one context
and applying it in another to create new value‖ (Dickson, 2003, p. 4). Thus, other Canadian
health care teams could learn, adapt, and apply the findings from this project and from VIHA‘s
executive team‘s learning, to enhance their own workplace leadership environment, and perhaps
even enhancing the nation‘s leadership capabilities.

Summary
It is evident from the inquiry process of this study that the VIHA executive team is
dedicated to planning a future of well-developed and capable executive professionals. According
to Kotter (1999), it is important for organizations to skillfully identify and develop people into
visible leadership positions, especially at the senior executive level (p. 64). The LCP program
aims to develop those in critical positions, starting with targeting and developing talent to lead at
the executive level.
It is also recognized that health care systems are ―among the most complex and
challenging organizations to lead‖ (Calhoun et al., 2004, p. 438), and that ―leadership is the
quality we look for to guide us through change in complex environments, with uncertain futures‖
(Dickson, 2008, p. 6). It is evident that health care organizations today must remain a step-ahead
in their game and strategize their moves in a complex playing field with rules that can often
change. Furthermore, adopting a common national leadership competency framework and
feedback program provides a solid and common foundation throughout the system. After all, ―if
the health of the nation is to be truly improved, it is imperative that there be clarity and
agreement on effective leadership development in healthcare management‖ (Calhoun et al.,
2004, p. 438).
This report aimed to discuss, discover, and place recommendations on how best to
identify executive-level leadership competencies and approaches on developing and assessing
these competencies. VIHA is committed to the ongoing learning and development of their
internal executive talent. Through a commitment to leadership development, ―organizations
enhance their ability to handle adaptive challenges by ensuring a healthy pipeline of talent‖
(Heifetz et al., 2009, p. 104). The conclusions and recommendations from within this inquiry
study report intend to inform VIHA on ways to consider and enhance their executive talented
leadership pool for now, and several years to come.

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National Center for Healthcare Leadership. (2011). NCHL health leadership competency model.
Retrieved from http://www.nchl.org/static.asp?path=2852,3238
Ogden, G. (2010). Talent management drives success. Healthcare Financial Management

Magazine, 19(11), 8–11.
Palys, T., & Atchison, C. (2008). Research decisions: Quantitative and qualitative perspectives
(4th ed.). Toronto, ON, Canada: Nelson.
Parker, P. (2008). Emotional intelligence and leadership skills among NHS managers: An
empirical investigation. The International Journal of Clinical Leadership, 16, 137–142.
Porter-O‘Grady, T., & Malloch, K. (2007). Managing for success in health care. St. Louis, MO:
Mosby.
Robbins, C. J., Bradley, E. H., & Spicer, M. (2001). Developing leadership in healthcare
administration: A competency assessment tool. Journal of Healthcare Management,
46(3), 188–199.
Royal Roads University. (2007). Research ethics policy. Retrieved from

http://www.royalroads.ca/research/ethical-reviews/ethics-policy.htm
Ryan, F., Coughlan, M., & Cronin, P. (2009). Interviewing in qualitative research: The one-to-
one interview. International Journal of Therapy and Rehabilitation, 16(6), 309–314.
Sashkin, M., & Sashkin, M. G. (2003). Leadership that matters: The critical factors for making a
difference in people’s lives and organizations’ success. San Francisco, CA: Berrett-
Koehler.
Senge, P. (2006). The fifth discipline: The art & practice of the learning organization. New
York, NY: Doubleday.
Stringer, E. T. (2007). Action research (3rd ed.). Thousand Oaks, CA: Sage.
Vancouver Island Health Authority. (2009, July). Vancouver Island Health Authority (VIHA)
five-year strategic plan 2008 – 2013. Retrieved from
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20E408AA02AB/0/strategic_plan_2009.pdf
Wale, H. (2010). People plan 2010/11: Leadership continuity planning. Vancouver, BC, Canada:
Vancouver Island Health Authority.
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Custom.
APPENDIX A: VANCOUVER ISLAND HEALTH AUTHORITY EXECUTIVE TEAM
ORGANIZATION CHART
Note. From Executive Team Org Chart (p. 1), by the Vancouver Island Health Authority, 2011,
Victoria, BC, Canada: Author. Copyright 2011 by the Vancouver Island Health Authority.
Adapted with permission.
APPENDIX B: LEADERSHIP COMPETENCY FRAMEWORK OVERVIEW
Table 1. A comparison of Leadership Competency Models and Frameworks from Canada,

United States, and United Kingdom
LEADS Frameworka
Pan-Canadian Leadership Framework endorsed by Canadian Health Leadership Network
Domains Competencies
Leads Self Self-Aware
Manage Themselves
Develop Themselves
Demonstrate Character
Engage Others Foster Development of Others

Contribute to Creation of Healthy Organization
Communicate Effectively
Build Teams
Achieve Results Set Direction
Strategically Align Decisions with Vision, Values, Evidence
Take Action to Implement Decisions
Assess and Evaluate
Develop Coalitions Build Partnerships and Networks to Create Results
Demonstrate a Commitment to Customers and Service
Mobilize Knowledge
Navigate Socio-Political Environments
Systems Demonstrate Systems/Critical Thinking
Transformation Encourage and Support Innovation
Orient Self Strategically to Future
Champion and Orchestrate Change
NCHL Health Leadership Competency Modelb
United States Healthcare Framework from the National Center for Healthcare Leadership
Transformation Achievement Orientation
Analytical Thinking
Community Orientation
Financial Skills
Information Seeking
Innovative Thinking
People Strategic Orientation
Human Resources Management
Interpersonal Understanding
Professionalism
Relationship Building
Self-Confidence
Self-Development
Talent Development
Team Leadership
Accountability
Execution Change Leadership
Collaboration
Communication Skills
Impact and Influence
Information Technology Management
Initiative
Organizational Awareness
Performance Measurement
Process Management/Organizational Design
Project Management
Leadership Qualities Framework (LQF)c
United Kingdom Healthcare Framework by National Health Services
Personal Qualities Self-Belief
Self-Awareness
Self-Management
Drive to Improvement
Personal Integrity
Setting Direction Seizing the future
Intellectual flexibility
Broad scanning
Political astuteness
Drive for Results
Delivering the Services
Leading change through people
Holding to account
Empowering others
Effective and strategic influencing
Collaborative working
a
From LEADS Framework by Leadersforlife, 2010. Retrieved from
http://www.leadersforlife.ca/leads-framework
b
From NCHL Health Leadership Competency Model™, 2012. Retrieved from
http://www.nchl.org/static.asp?path=2852,3238
c
From Leadership Qualities Framework by NHS, 2011. Retrieved from
http://www.nhsleadershipqualities.nhs.uk/
APPENDIX C: INQUIRY TEAM MEMBER LETTER OF AGREEMENT
In partial fulfillment of the requirement for a Master of Arts in Leadership Degree at Royal
Roads University, Laura Cross will be conducting an inquiry research study at Vancouver Island
Health Authority (VIHA) to investigate leadership competency development targeted at the
senior executive level. The Student‘s credentials with Royal Roads University can be established
by calling Dr. Wendy Rowe, Program Head, MA Leadership (Health Specialization) at [phone
number].
Inquiry Team Member Role Description:

Thank you for considering to being an inquiry team member of this project. As a volunteer
Inquiry Team Member assisting the Student with this project, your role could include one or
more of the following: sending out emails to invite participants to an interview and focus group,
receiving emails of interest in participation from potential participants, booking the dates, times,
and location of all sessions, collecting any paperwork such as signed consent forms, formalize
the logistics for the data-gathering method, including contacting the participants about the time
and location of the interview or focus group, assisting the Student as an organizer and moderator
before and during the focus group, and taking notes during the focus group. In the course of this
activity, you may be privy to confidential inquiry data.
Confidentiality of Inquiry Data:

In compliance with the Royal Roads University Research Ethics Policy, under which this inquiry
project is being conducted, all personal identifiers and any other confidential information
generated or accessed by the inquiry team advisor will only be used in the performance of the
functions of this project, and must not be disclosed to anyone other than persons authorized to
receive it, both during the inquiry period and beyond it. Recorded information in all formats is
covered by this agreement. Personal identifiers include participant names, contact information,
personally identifying turns of phrase or comments, and any other personally identifying
information.
Statement of Informed Consent:

I have read and understand this agreement.
________________________ _________________________ _____________
Name (Please Print) Signature Date

APPENDIX D: LETTER OF INVITATION FOR INTERVIEW
Leadership Competency Development for Executive-Level Positions at

Vancouver Island Health Authority
May 9, 2011
Dear [Name],
I would like to invite you to be part of an inquiry research study that I am conducting. This
project is part of the requirement for a Master‘s Degree in Arts in Leadership in Healthcare at
Royal Roads University. My name is Laura Cross and my credentials with Royal Roads
University can be established by calling Dr. Wendy Rowe, Program Head, MA Leadership
(Health Specialty) at [phone number]
The objective of my inquiry study is to articulate supportive strategies for leadership competency
development at the senior executive level at Vancouver Island Health Authority (VIHA). Your
name was chosen as a prospective participant because of your experience on the senior executive
team at VIHA.
In addition to submitting my final report to Royal Roads University in partial fulfillment for a
MA Leadership Health, I will also be sharing my findings with VIHA.
The initial part of my study will consist of a private interview that will include open-ended
questions and is anticipated to last one hour. The foreseen questions will include: (1) What do
you think are the necessary core competencies needed at the executive leadership level at VIHA?
(2) What order of importance would you rank those competencies? (3) What do you do to
continue growing your leadership competencies? (4) What organization support is VIHA
currently practicing for developing leadership competencies that you think should be continued
or built on? and, (5) What do you think a successful program for leadership competency
development for employees aiming to work at the executive level should look like?
The second phase of the inquiry will consist of a focus group held approximately 2 weeks after
the interview session. Please expect an invitation for the focus group shortly. One invitation does
not preclude the other, thus if you are interested in participating in this study, you can volunteer
for either or both phases of the study.
Information will be recorded in audio taped format and, where appropriate summarized, in
anonymous format, in the body of the final report. At no time will any specific comments be
attributed to any individual unless your specific agreement has been obtained beforehand. All
documentation will be kept strictly confidential. All data generated from this research will be
retained in a secure locked cabinet under only my control for one year after this study is
completed, after which it will be destroyed via a secure and private shredding company. If an
individual should withdraw during the interview process, his or her data will be destroyed
securely and immediately. A copy of the final report will be published and archived in the RRU
Library.
Please feel free to contact me at any time should you have additional questions regarding the
project and its outcomes. After the Organizational Leadership Project is completed, it is my
intention to give a presentation to the executive team at VIHA on the findings and
recommendations. I do not work for VIHA, and thus I do not foresee any reason for conflict of
interest during this research process between participants and myself.
You are not compelled to participate in this inquiry research study. If you do choose to
participate, you are free to withdraw at any time without prejudice. Similarly, if you choose not
to participate in this study, this information will also be maintained in confidence.
If you would like to participate in my inquiry research study, please contact me at:
Name: Laura Cross
Email: [email address]
Telephone: [phone number]
Sincerely,
Laura Cross
APPENDIX E: INQUIRY RESEARCH STUDY CONSENT FORM FOR INTERVIEW

You are invited to participate in a study entitled Leadership Competency Development for
Executive Level Positions at Vancouver Island Health Authority (VIHA) that is being conducted
by Laura Cross. Laura Cross is a student in the Master of Art in Leadership Healthcare at Royal
Roads University (RRU), Victoria, BC. You may contact Laura Cross if you have questions by
calling [phone number]. Furthermore, credentials with Royal Roads University can be
established by telephoning Dr. Wendy Rowe, Program Head, MA Leadership (Health Specialty)
at [phone number].
Purpose & Objectives

This document constitutes an agreement to participate in my inquiry research study, the purpose
of which is to determine supportive strategies for Vancouver Island Health Authority (VIHA) to
articulate essential leadership competencies at the executive level, and on how to develop such
competencies for employees targeted to work at the executive level. The objectives of the study
is to assist in the developing and promoting of VIHA‘s leader continuity plan, which will in turn
enable the senior executive team to remain well supported and consistent through upcoming
expected human resource changes due to anticipated retirement trends. It is intended that this
study will also foster and stimulate knowledge transfer on leadership competency development
necessary for the senior executive level in health care.
Importance of Inquiry Research Study

This study is important because it will enhance VIHA‘s current leadership continuity goal of
identifying, targeting, and developing those employees with high potential for leadership and
growth at the senior executive level. According to VIHA‘s 2009 Strategic plan, retaining capable
staff is VIHA‘s top priority. VIHA‘s Organizational Development Department recognizes the
importance of retaining talented and capable leaders, largely due to the evident aging population
and workforce. Your participation in this study will help VIHA articulate what essential
leadership competencies are needed at the senior executive level and will help shape supportive
recommendations to VIHA on development of such competencies for employees targeted for
retention and development at your level. Thus, it is intended that this project will support your
departmental and organizational leadership continuity goals.
Participants Selection
The project sponsor Dr. Lynn Stevenson has selected you because of your valuable role on the
senior executive team at VIHA. Eight participants are being invited from the pool of senior
healthcare executives currently working at VIHA in Victoria BC in the capacity of an executive
and/or vice-president portfolio. It may be difficult to maintain complete anonymity due to the
small composition of your team. Thus, others in your department may know that you are being
asked to participate in the study.
What is Involved
The inquiry research study will consist of open-ended questions in a private interview format and
is expected to last no more than one hour. Interviews will be held in a private setting at your
office site, at a mutually identified convenient date and time. Once informed consent is attained,
I will take field notes and digitally record all sessions to thoroughly capture all discussions. I
plan to transcribe all sessions myself. Each participant will be consulted with shortly after the
interview with a written transcribed account of the interview for his or her review and approval
to ensure accuracy.
The foreseen questions will refer to (1) What do you consider as the necessary core
competencies needed at the executive leadership level at VIHA? (2) What order of importance
would you rank those competencies? (3) What do you do to continue growing your own
leadership competencies? (4) What organization support is VIHA currently practicing for
developing leadership competencies that you think should be continued or built on? and, (5)
What do you believe a successful program for leadership competency development for
employees aiming to work at the executive level should look like?
Inconvenience
Participation in this study may cause some inconvenience to you, including taking time away
from your valuable and busy workday schedule. Your participation in this study is valuable to
me and will be instrumental in the success of this research. Therefore, I intend to do my best to
accommodate your schedule needs and minimize inconvenience and disruption to you and your
department.
Risks
There are no known or anticipated risks to you by participating in this study. Your anonymity
will be protected through the following steps that I plan to take:
1. All data will be coded thereby removing any identifiers of participants. Each participant
will be assigned a combined alphabetic and numeric code that only the researcher will be
privy to.
2. Data will be analyzed and themed using this coding system to protect anonymity.
3. Data will be reported in the final document using the coded symbols. Interviews will be a
combination of I-1, I-2 etc. Focus groups will be a combination of FG-1, FG-2 etc.
Benefits
Potential benefits of your participation in this inquiry research study includes:
A. Benefits to Researcher: This inquiry project will enable and further my learning in the role
of an action researcher, and will deepen my knowledge on leadership competency development
at the senior level at VIHA. Furthermore, the outcomes from the study will enable me to
graduate and receive a degree in MA Leadership Health from RRU.
B. Benefits to Participants: Participants will benefit by communicating and sharing with the
action researcher in a one-to-one setting their knowledge on leadership competency development
at the senior level. Participants may gain new insights through this process, and may experience
personal intrinsic reward by sharing their own perspectives and knowledge by playing an integral
role toward meaningful change on developing a competent pool of leaders aimed at the executive
level.
C. Benefits to Sponsor Organization (VIHA): The sponsor will be able to take action on
recommendations acquired from the study and initiate changes on leadership competency
development to support their departmental and organizational goals in quality leadership
retention at the executive level. In addition, knowledge transfer from this research may be shared
within VIHA at different systems levels, and perhaps even across to other health authorities.
D. Benefits to Society: Society and the local community can benefit from the outcomes of this
study from the potential leadership competency enhancements to the current and future executive
leadership of the health care system in Victoria. By helping VIHA develop a pool of highly
capable executive leaders, this project could therefore mitigate potential leadership gaps,
yielding in continuous care for all community members. Knowledge transfer to other health
authorities and jurisdictions could also benefit other communities and therefore society at large.
Voluntary Participation
Your participation in this study must be completely voluntary. If you do decide to participate,
you may withdraw at any time without any consequences, prejudice, or any explanation.
Similarly, if you choose not to participate in this inquiry research study, this information will
also be maintained in confidence. If you do withdraw from the study your data will not be used.
Any data generated from you will be immediately destroyed by secure shredding of paper files
and/or deletion of computer files.
Compensation
No compensation is offered for this research study.
Researcher’s Relationship with Participants/Conflict of Interest

As the researcher, I do not have a relationship with any of the potential participants. I am
external to VIHA, and currently am an employee of Vancouver Coastal Health Authority. I do
not know the participants who will be invited to take part of the study. Thus, conflict of interest
is not a foreseeable issue during this study process between participants and myself as action
researcher.
On-going Consent
You will be consenting to one interview. To make sure that you consent to participate in this
process, it will be confirmed with you at the beginning of the interview that you have (1) signed
the consent form, (2) verbally confirmed that you wish to participate, and (3) clearly understood
the ramifications of consenting to the study.
Anonymity
In terms of protecting your anonymity it will be ensured that your name, position, title, role or
any other indicating feature will not be shared or revealed in the final written report. However,
complete anonymity is not possible during the study, since the researcher will be engaging in the
interview process with you and will be apprised of your responses to the questions.
Confidentiality
Your confidentiality and the confidentiality of the data will be protected. Information will be
recorded by computer digital technology and backed up by an audiotape and where appropriate,
summarized, in anonymous format, in the body of the final report. At no time will any specific
comments be attributed to any individual unless specific agreement has been obtained
beforehand. All documentation both paper and electronic data, will be kept strictly locked, secure
and confidential and only accessible by the action researcher.
Dissemination of Results
It is anticipated that the results of this study will be disseminated in the following ways: In
addition to submitting a final report to Royal Roads University in partial fulfillment for a MA
Leadership Health, research findings will be shared in a final report with VIHA, by providing
them with one PDF electronic file copy and one printed copy. A copy of the final report will also
be published and archived in the RRU Library. After the inquiry research study is completed, a
presentation to the executive team at VIHA on the findings and recommendations will be
offered.
Commercial Use of Results

This study will not lead to a commercial product or service.
Disposal of Data
All data generated from this study will be retained in a secure locked cabinet and will be only
accessible by the action researcher for one year after this study is completed, after which it will
be destroyed via a secure and private shredding company for paper files, and/or permanent
deletion of electronic data files. Audio recordings of the session will be erased immediately after
the transcription has been completed and approved by participant.
Contacts
Individuals that may be contacted regarding this study are indicated at the beginning of this
consent form. In addition, you may verify the ethical approval of this study, or raise any
concerns about your rights as a research subject by contacting the Research Ethics Office at the
Vancouver Island Health Authority [phone number].
Your signature below indicates that you understand the above conditions of participation in this
study and that you have had the opportunity to have your questions answered by the action
researcher.
Name of Participant Signature Date
A copy of this consent form will be given to you, and the researcher will retain the original
signed copy.
APPENDIX F: SCRIPT FOR EMAIL INVITATION REQUEST FOR INTERVIEW
Subject Title of Email: Interview Request for Participation in an Inquiry Study on Leadership
Competency Development at the Senior Executive Level at VIHA
Dear [Name],
My name is Laura Cross and I am a Master of Arts Leadership Healthcare student at Royal
Roads University. I would like to introduce you to an inquiry research study regarding leadership
competency development at the senior level that I would like to conduct in your department at
VIHA. This study is being sponsored by Dr. Lynn Stevenson, Executive Vice President of
People Organizational Development Practice and Chief Nurse.
I would like to request a private one-to-one interview with you, since you can provide valuable
qualitative data for this study by sharing your extensive knowledge and experience from working
at a senior executive level in health care.
Attached you will find a letter of invitation and an informed consent form for your review. You
will see the questions for the interview listed in the letter of invitation. Please note that your
participation is voluntary, confidential, and if you consent to participate you are entitled to
withdraw at any time during the study, without judgment. In addition, an invitation for a focus
group for this study will follow shortly.
If you would like to participate in one private interview of no more than one hour in length as
part of this study, kindly reply to me by May 11, 2011 so that I may proceed to coordinate the
best times and dates of the session. Consent forms can be signed ahead of time or I will provide
copies for signing at the beginning of your session. I welcome any questions you may have and
can be reached at telephone [phone number] or email: [email address].
Thank you in advance for your kind consideration of this request.
Regards,
Laura Cross
APPENDIX G: LETTER OF INVITATION FOR FOCUS GROUP

May 16, 2011

Dear [Name],
I would like to invite you to be part of an inquiry research study that I am conducting. This
project is part of the requirement for a Master‘s Degree in Arts in Leadership in Healthcare at
Royal Roads University. My name is Laura Cross and my credentials with Royal Roads
University can be established by calling Dr. Wendy Rowe, Program Head, MA Leadership
(Health Specialty) at [phone number].
The objective of my study is to articulate supportive strategies for leadership competency
development at the senior executive level at Vancouver Island Health Authority (VIHA). Your
name was chosen as a prospective participant because of your role on the senior executive team
at VIHA. In addition to submitting my final report to Royal Roads University in partial
fulfillment for a MA Leadership Health, I will also be sharing my study findings with VIHA.
This phase of the study will consist of a focus group scheduled on May 25, 2011 at 1pm at the
executive offices of VIHA, and is anticipated to last to a maximum of 90 minutes. The foreseen
open-ended questions may include: (1) What type of on-the-job leadership competency
development activities would you envision as being most effective and sustainable for those
targeted to move into a senior executive-level position at VIHA?, (2) What type of off-the-job
learning development programs do you think would be most useful and sustainable for those
targeted to move into a senior executive-level position at VIHA?, (3) What type of professional
development offerings from VIHA do you think would be most appealing to enable retention of
the Generation X (ages 30-43) and the Generation Y (ages less than 30)?, (4) What type of
content and material should be taught to targeted learners in a formal training and development
program to prepare them for a senior role at VIHA?, (5) How do you see the best way that one
can monitor and evaluate the competency and knowledge progress of individuals as they journey
through learning and training programs both on and off the job?
Information will be recorded in audio taped format and, where appropriate summarized, in
anonymous format, in the body of the final report. At no time will any specific comments be
attributed to any individual unless your specific agreement has been obtained beforehand. All
documentation will be kept strictly confidential. All data generated from this research will be
retained in a secure locked cabinet under only my control for one year after this study is
completed, after which it will be destroyed via a secure and private shredding company. If an
individual should withdraw during the focus group process, his or her data will still be used in an
anonymous format for the final report. Due to the nature of group recordings it will not be
possible to extrapolate the data from withdrawn participants from the collective group recorded
session. A copy of the final report will be published and archived in the RRU Library.
Please feel free to contact me at any time should you have additional questions regarding the
project and its outcomes. After the Organizational Leadership Project is completed, it is my
intention to give a presentation to the executive team at VIHA on the findings and
recommendations. I do not work for VIHA and thus, do not foresee any reason for conflict of
interest during this research process between participants and myself.
You are not compelled to participate in this study. If you do choose to participate, you are free to
withdraw at any time without prejudice. Similarly, if you choose not to participate in this inquiry
study, this information will also be maintained in confidence. If you would like to participate in
my study, please contact me at:
Name: Laura Cross

Email: [email address]
Telephone: [phone number]
Sincerely,
Laura Cross
APPENDIX H: INQUIRY RESEARCH STUDY CONSENT FORM FOR FOCUS GROUP

You are invited to participate in a study entitled Leadership Competency Development for
Executive Level Positions at Vancouver Island Health Authority (VIHA) that is being conducted
by Laura Cross. Laura Cross is a student in the Master of Art in Leadership Healthcare at Royal
Roads University (RRU), Victoria, BC. You may contact Laura Cross if you have questions by
calling [phone number]. Furthermore, credentials with Royal Roads University can be established
by telephoning Dr. Wendy Rowe, Program Head, MA Leadership (Health Specialty) at [phone
number].
Purpose & Objectives

This document constitutes an agreement to participate in my inquiry project, the purpose of
which is to determine supportive strategies for Vancouver Island Health Authority (VIHA) to
articulate essential leadership competencies at the executive level, and on how to develop such
competencies for employees targeted to work at the executive level. The objectives of the
research is to assist in the developing and promoting of VIHA‘s leader continuity plan, which
will in turn enable the senior executive team to remain well supported and consistent through
upcoming expected human resource changes due to anticipated retirement trends. It is intended
that this research will also foster and stimulate knowledge transfer on leadership competency
development necessary for the senior executive level in health care.
Importance of Research
This research is important because it will enhance VIHA‘s current and proactive leadership
continuity goal of identifying, targeting, and developing those employees with high potential for
leadership and growth at the senior executive level. According to VIHA‘s 2009 Strategic plan,
retaining capable staff is VIHA‘s top priority. VIHA‘s Organizational Development Department
recognizes the importance of retaining talented and capable leaders, largely due to the evident
aging population and workforce. Your participation in this study will help VIHA articulate what
essential leadership competencies are needed at the senior executive level and will help shape
supportive recommendations to VIHA on development of such competencies for employees
targeted for retention and development at your level. Thus, it is intended that this project will
support your departmental and organizational leadership continuity goals.
Participants Selection
The project sponsor Dr. Lynn Stevenson has selected you because of your valuable role on the
senior executive team at VIHA. Eight participants are being invited from the pool of senior
healthcare executives currently working at VIHA in Victoria BC in the capacity of an executive
and/or vice-president portfolio. It may be difficult to maintain complete anonymity due to the
small composition of your team. Thus, others in your department may know that you are being
asked to participate in the study.
What is Involved
The research will consist of open-ended question in an focus group format and is expected to last
no more than one hour. Focus groups are group interviews, where the participants are asked to
openly share and express their knowledge and ideas on a topic. The focus group will be held at
your office site at a mutually identified convenient date and time. Once informed consent is
attained, I will take field notes and digitally record all sessions to thoroughly capture all
discussions. I plan to transcribe all sessions myself. Each participant will be consulted with
shortly after the interview with a written transcribed account of the interview for his or her
review and approval to ensure accuracy.
The foreseen questions may include: (1) How can leadership competencies can best be identified,
monitored and measured? (2) How can VIHA can support and enhance continued leadership
competency development for those currently working at the senior executive level? (3) How can
VIHA best support their ―shining star‖ employees to help them develop leadership competencies
for professional growth aimed toward the senior executive level?
Inconvenience
Participation in this study may cause some inconvenience to you, including taking time away from your valuable
and busy workday schedule. Your participation in this study is valuable to me and will be instrumental in the
success of this research. Therefore, I intend to do my best to accommodate your schedule needs and minimize
inconvenience and disruption to you and your department.
Risks
There are no known or anticipated risks to you by participating in this research. Your anonymity
will be protected through the following steps that I plan to take:
1. All data will be coded thereby removing any identifiers of participants. Each participant will
be assigned a combined alphabetic and numeric code that only the researcher will be privy to.
2. Data will be analyzed and themed using this coding system to protect anonymity.
3. Data will be reported in the final document using the coded symbols. Interviews will be a
combination of I-1, I-2 etc. Focus groups will be a combination of FG-1, FG-2 etc.
Benefits
Potential benefits of your participation in this research includes:
A. Benefits to Researcher: This research will enable and further my learning in the role of an
action researcher, and will deepen my knowledge on leadership competency development at the
senior level at VIHA. Furthermore, the outcomes from the research will enable me to graduate
and receive a degree in MA Leadership Health from RRU.
B. Benefits to Participants: Participants will benefit by communicating and sharing with the
action researcher and group interview setting their knowledge on leadership competency
development at the senior level. Participants may gain new insights through this process, and
may experience personal intrinsic reward by sharing their own perspectives and knowledge by
playing an integral role toward meaningful change on developing a competent pool of leaders
aimed at the executive level.
C. Benefits to Sponsor Organization (VIHA): The sponsor will be able to take action on
recommendations acquired from the research and initiate changes on leadership competency
development to support their departmental and organizational goals in quality leadership
retention at the executive level. In addition, knowledge transfer from this research may be shared
within VIHA at different systems levels, and perhaps even across to other health authorities.
D. Benefits to Society: Society and the local community can benefit from the outcomes of this
research from the potential leadership competency enhancements to the current and future
executive leadership of the health care system in Victoria. By helping VIHA develop a pool of
highly capable executive leaders, this project could therefore mitigate potential leadership gaps,
yielding in continuous care for all community members. Knowledge transfer to other health
authorities and jurisdictions could also benefit other communities and therefore society at large.
Voluntary Participation
Your participation in this research must be completely voluntary. If you do decide to participate,
you may withdraw at any time without any consequences, prejudice, or any explanation. Similarly,
if you choose not to participate in this inquiry project, this information will also be maintained in
confidence. If you do withdraw from the study your data will not be used. Any data generated from
you will be immediately destroyed by secure shredding of paper files and/or deletion of computer
files.
Compensation
No compensation is offered for this research study. Refreshments will be offered at the focus
group session for participants to enjoy.
Researcher’s Relationship with Participants/Conflict of Interest

The researcher does not may have a relationship with any of the potential participants. The
researcher is external to VIHA, and currently is an employee of Vancouver Coastal Health
Authority. The researcher does not know the participants who will be invited to take part of the
study. Because the researcher is acting in capacity as an external consultant working at a different
health authority in BC, conflict of interest is not a foreseeable issue during this research process
between participants and researcher.
On-going Consent
You will be consenting to one focus group. To make sure that you consent to participate in this
process, it will be confirmed with you at the beginning of the interview that you have (1) signed
the consent form, (2) that you verbally confirmed that you wish to participate, and (3) that you
clearly understood the ramifications of consenting to the study.
Anonymity
In terms of protecting your anonymity it will be ensured that your name, position, title, role or any
other indicating feature will not be revealed in the final research written report, unless your
individual agreement has been obtained beforehand. However, complete anonymity is not possible
during the research, since the researcher and other focus group members will be engaging in a
group interview process with you and will be apprised of your responses to the questions.
Confidentiality
Your confidentiality and the confidentiality of the data will be protected as much as possible in a
group setting. Participants will be asked to maintain confidentiality, but the researcher cannot
guarantee this. Information will be recorded by computer digital technology and backed up by an
audiotape and where appropriate, summarized, in anonymous format, in the body of the final
report. At no time will any specific comments be attributed to any individual unless specific
agreement has been obtained beforehand. A silent recorder will be present during the focus group
and will complete a letter of confidentiality. All documentation will be kept strictly locked, secure
and confidential and only accessible by the researcher.
Dissemination of Results
It is anticipated that the results of this study will be disseminated in the following ways: In
addition to submitting a final report to Royal Roads University in partial fulfillment for a MA
Leadership Health, research findings will be shared in a final report with VIHA, by providing
them with one PDF electronic file copy and one printed copy. A copy of the final report will also
be published and archived in the RRU Library. After the inquiry project is completed, a
presentation to the executive team at VIHA on the findings and recommendations will be
offered.
Commercial Use of Results

This research will not lead to a commercial product or service.
Disposal of Data
All data generated from this research will be retained in a secure locked cabinet and will be only
accessible by the researcher for one year after this study is completed, after which it will be
destroyed via a secure and private shredding company for paper files, and/or permanent deletion of
electronic data files. Audio recordings of the session will be erased immediately after the
transcription has been completed and approved by participants.
Contacts
Individuals that may be contacted regarding this study are indicated at the beginning of this
consent form. In addition, you may verify the ethical approval of this study, or raise any concerns
about your rights as a research subject by contacting the Research Ethics Office at the Vancouver
Island Health Authority [phone number].
Your signature below indicates that you understand the above conditions of participation in this
study and that you have had the opportunity to have your questions answered by the researchers.
Name of Participant Signature Date
A copy of this consent form will be given to you, and the researcher will retain the original
signed copy.
APPENDIX H: INTERVIEW QUESTIONS WITH EXTRA 3 QUESTIONS
1. What do you think are the essential core competencies currently needed to work at the
executive leadership level at VIHA?
2. What order of importance would you rank those competencies?
3. What do you currently do to continue enhancing your own leadership competencies?
4. What organization support is VIHA currently practicing for developing leadership
competencies that you believe should be continued or built on?
5. What do you think an ideal program for leadership competency development for employees
aiming to work at the executive level should look like?
EXTRA QUESTIONS:
A). If you selected someone to take your place today, what skills would you make certain that
that person possessed?
B). What competencies and skills are demonstrated by your colleagues at VIHA that you most
admire?
C). What do you think it will take to retain the younger hi-potential leaders of tomorrow at VIHA
for years to come?
APPENDIX J: FOCUS GROUP AGENDA
Focus Group Agenda

VIHA Executive Team Meeting, May 25, 2011, 1:00-2:00pm
Project Title: Leadership Competency Development for Executive-Level Positions at

Facilitator: Laura Cross, MA Leadership Health, RRU

Co-Facilitators: [Name], MA Leadership Health, RRU &
[Name], HR Consultant
Agenda Item Time
Review of Leadership Competency Ranking from 5 mins

Interviews
Main Focus Group Questions:
1. What type of on-the-job leadership competency

development activities would you envision as being most 10 mins
effective and sustainable for those leaders targeted to
move into a senior executive-level position at VIHA?
2. What type of off-the-job learning development

activities and programs do you think would be most 10 mins
useful and sustainable for those leaders targeted to move
into a senior executive-level position at VIHA?
3. What type of content and material should be taught

to targeted leaders in a formal training and development
program to prepare them for a senior role at VIHA? 10 mins
4. How do you see the best way that one can monitor
and evaluate the competency and knowledge progress of
individuals as they journey through learning and training 10 mins
programs both on and off the job?
Closing Comments from group: Themes, ideas, remarks 5 mins

APPENDIX K: FOCUS GROUP DIAGRAM PRESENTING CORE EXECUTIVE-
LEVEL LEADERSHIP COMPETENCIES AT VIHA

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LEADERSHIP COMPETENCY DEVELOPMENT FOR EXECUTIVE-LEVEL POSITIONS

AT VANCOUVER ISLAND HEALTH AUTHORITY

BBA, Simon Fraser University, 1985

An Organizational Leadership Project Report submitted in partial fulfillment of

We accept this Report as conforming

Lynn Stevenson, PhD, Project Sponsor

Marie Graf, MA, Faculty Supervisor

Wendy Rowe, PhD, Committee Chair

ROYAL ROADS UNIVERSITY

© Laura Cross, 2011

395 Wellington Street 395, rue Wellington

Our file Notre référence

The author retains copyright L'auteur conserve la propriété du droit d'auteur

In compliance with the Canadian Conformément à la loi canadienne sur la

395 Wellington Street 395, rue Wellington

Our file Notre référence

The author retains copyright L'auteur conserve la propriété du droit d'auteur

In compliance with the Canadian Conformément à la loi canadienne sur la

competency development, especially at the executive leadership level. This organizational

the topic of executive leadership competency development through participating in a series of

a leadership competency framework, offering experiential and educational development

opportunities, organizing a mentoring program, developing a 360-degree feedback review plan,

faculty, all of you contributed to enriching my learning journey.

ACKNOWLEDGEMENTS ........................................................................................................... iii

LIST OF FIGURES ...................................................................................................................... vii

CHAPTER ONE: FOCUS AND FRAMING ..................................................................................1

CHAPTER TWO: REVIEW OF LITERATURE ..........................................................................12

CHAPTER THREE: INQUIRY APPROACH AND METHODOLOGY ....................................27

CHAPTER FOUR: ACTION INQUIRY PROJECT RESULTS AND CONCLUSIONS ............44

CHAPTER FIVE: INQUIRY IMPLICATIONS ...........................................................................68

APPENDIX A: VANCOUVER ISLAND HEALTH AUTHORITY EXECUTIVE TEAM

APPENDIX B: LEADERSHIP COMPETENCY FRAMEWORK OVERVIEW ........................90

APPENDIX C: INQUIRY TEAM MEMBER LETTER OF AGREEMENT ...............................92

APPENDIX D: LETTER OF INVITATION FOR INTERVIEW ................................................93

APPENDIX E: INQUIRY RESEARCH STUDY CONSENT FORM FOR INTERVIEW .........95

APPENDIX F: SCRIPT FOR EMAIL INVITATION REQUEST FOR INTERVIEW ...............99

APPENDIX G: LETTER OF INVITATION FOR FOCUS GROUP .........................................100

APPENDIX H: INTERVIEW QUESTIONS WITH EXTRA 3 QUESTIONS ..........................107

APPENDIX J: FOCUS GROUP AGENDA ................................................................................108

APPENDIX K: FOCUS GROUP DIAGRAM PRESENTING CORE EXECUTIVE-LEVEL

APPENDIX L: LEADS 360-DEGREE FEEDBACK ASSESSMENT ......................................110

Figure 1. LEADS in a caring environment leadership capabilities framework .............................71

CHAPTER ONE: FOCUS AND FRAMING

management team to experience a breadth of leadership learning and development opportunities

been identified‖ (Wale, 2010, p. 3).

positions as they become vacant.

I became interested in leadership development and succession planning approximately 3

Stevenson, the Executive Vice-President of People Organizational Development, Practice and

subject of leadership competency in healthcare, I was positioned externally to VIHA when

leading this action research study.

into executive-level positions? Three subquestions supported the primary question:

2. How can VIHA strategize to support high-potential employees in gaining the

appropriate leadership competencies?

3. How can these competencies be monitored and measured?

Significance of the Inquiry

mounting pressure‖ (p. 1).

―companies which place a heavy emphasis on leadership development experience considerably

vacancies with capable internal employees (Wale, 2010, p. 2).

enhancement on development opportunities for senior-level employees to gain the necessary

well-rounded and robust leadership competency development program, which subsequently

2010) for VIHA‘s senior leadership team.

twenty years‖ (p. 15).

VIHA‘s workforce is also threatened by an anticipated retirement boom. A strategic

knowledge, and evidence-based practice; (d) partnerships and collaboration to share

using available resources to meet needs (p. 11).

a safe, healthy work environment (VIHA, 2009, p. 21).

vice-president portfolios. The vice-president and executive vice-president leadership level at